Hi All,
It's been a day since i have been diagnosed and i have been given levothyroxine 50mg..
Are there any limitations whilst taking levothyroxine in terms of diet? like can i have coffee still? Will have small amount of carbs deter the working of levothyroxine? Sorry if these questions sound daft. But would really appreciate any guidance on this.. Still processing it's a life long journey ..
Thank you
Mrs S
Hello and Welcome, yes, don't worry you can still have your coffee, but you can't swill your Levo down with it . You don't want caffeine in your stomach at the same time as it's trying to dissolve the Levothyroxine. Caffeine will reduce the amount of Levo thyroxine that is absorbed , so it would be like taking a lower dose.
It's recommended to have levo on empty stomach with water and leave at least an hour before the coffee. Calcium and Iron also get in the way of proper absorption.
Ah, Thank you! this makes sense.. On my 1st pill today and have this storming headache..
noteboo
Headaches are listed as a side effect of Levo.
What brand have you been given?
Take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for an hour either side, as absorption will be affected. Take any other medication and supplements 2 hours away from Levo, some need 4 hours.
Are you scheduled to retest in a few weeks? After starting on Levo normal protocol is to retest after 6 weeks, increase dose by 25mcg, retest 6-8 weeks later, continue with testing/increasing until your levels are where they need to be for your symptoms to abate and for you to feel well.
The aim of a treated Hypo patient on Levo, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges.
Always advised here, when having thyroid tests:
* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH
* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.
* Last dose of Levo 24 hours before the test, take that day's dose after the blood draw. This is because if you take your Levo before the blood draw the test will measure the dose just taken and show a false high. If you leave longer than 24 hours the result will. Show a false low.
* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).
These are patient to patient tips which we don't discuss with phlebotomists or doctors.
Thank you! i was reading your reply today.. I have bloodworks every 8 weeks.. I am taking the Levo with water and wait for an hour to have breakfast.. I'm currently on no supplements. Since April this year I've noticed my knee making crackling sound and for past 3 weeks i havd this awful back pain and my left knee has a rubbery feeling just at the top of the knee and does look swollen.. The GP doctor told me its all related to underactive thyriod. I do have a physio appt for my back next week.
Any thoughts on the knee pain .. Thank you!
Good heavens, if you have found a GP that knows this you should hang on to him/her. (Many think nothing is related to thyroid ! )
I believe my current troubles with re-appearance of 'Housemaids Knee' may be thyroid related too.
Sorry , i don't have a cure for knee pain tho'
noteboo
Any thoughts on the knee pain .
Sorry, no. It could be anything.
Muscle aches and pains can be low Vit D but whether that fits only you would know 
It's possible (if you took it first thing today) that headache is an effect of the thyroxine speeding up your system, and since you must have been Hypo for a while to have been prescribed Levothyroxine, you have become used to everything going slow.This is why a low dose is prescribed to start with, so it's not too much of a shock to the system.
Or it's possible it's coincidence. (it's also possible that you don't like the fillers that are in that particular brand , but i wouldn't worry about that just yet)
See how it goes for a couple of weeks, the thyroid hormones in Levo are slow things to take effect..
It will be a few weeks before you can be sure how you feel on this dose , you should be having another blood test 6/8 weeks after starting, and most likely the dose will need to be raised again. Most people end up on somewhere between 75mcg and 150mcg.
The tablet you are taking contains T4, and this is an inactive 'storage' form of the active hormone T3. Your body converts it to T3 as needed.....( well, that's the theory anyway. long story!)
T4 lasts over a week in your blood , and you keep it topped up daily with the Levo. But the thing the NHS measure is called TSH (Thyroid Stimulating Hormone) which is not actually a hormone, but comes from your pituitary gland. Its a signal to the thyroid gland to make more hormone. This has a 'delayed reaction' to the hormones that the hypothalamus+pituitary sense in the blood , which is why the blood is not re-tested for at least 6/8 weeks after a dose change.
Coffee and bran reduce levothyroxine absorption so avoid these before taking your tablet. You may find it simpler to take your levothyroxine at bedtime.
Thank you all! This is very helpful replies and detailed.. Any suggestions on dietary ?
Just eat good clean food.
The things to avoid are artificial sweeteners, processed seed oils and - more importantly - all forms of unfermented soy: soy flour, soy protein, soy oil, etc. So, that means, really, avoiding all processed foods because they tend to contain all of the above.
Do you know if you have Hashi's? Were your antibodies tested? Because if you do, you might feel better on a 100% gluten-free diet.
Thank you! yes was checked for TPO it was 42 ..the GP doctor was hesitant to confirm but said it will be down the road in months or years.
I am intolerant to dairy and follow vegan diet (ocassional chicken here and there .. My body cant breakdown red meat)
Be careful of your iron and B12 levels, then. They can drop very easily.
Have you tried a gluten-free diet?
Absolutely essential to regularly test vitamin D, folate, ferritin and B12
On meat free diet you will need to supplement B12 and test iron and ferritin very regularly...likely to need to supplement
academic.oup.com/nutritionr...
The present review of the literature regarding B12 status among vegetarians shows that the rates of B12 depletion and deficiency are high. It is, therefore, recommended that health professionals alert vegetarians about the risk of developing subnormal B12 status. Vegetarians should also take preventive measures to ensure adequate intake of this vitamin, including the regular intake of B12 supplements to prevent deficiency. Considering the low absorption rate of B12 from supplements, a dose of at least 250 μg should be ingested for the best results.3
Eating iron rich foods, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
List of iron rich foods
Links about iron and ferritin
irondisorders.org/Websites/...
drhedberg.com/ferritin-hypo...
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
healthunlocked.com/thyroidu...
Thyroid disease is as much about optimising vitamins as thyroid hormones
Thank you! those links are very helpful! I have requested for my bloodworks results to know where i stand.. I have noticed some symptoms but was told underactive thyriod was the cause for it and all these symptoms will eventually feel better.
Get B12 and ferritin levels tested ASAP
Folate and vitamin D too
Likely to need to supplement
Ah ok.. is need to look up Hashimoto to understand the differences with underactive thyriod
The point really is that hypothyroidism is the consequence of Hashimoto's. However, between here and there, it is possible that the path will not be straight. It is common to have periods during which thyroid hormone levels rise.
This can occur to such an extent that people have been diagnosed hyperthyroid.
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.
Link about thyroid blood tests
thyroiduk.org/getting-a-dia...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
List of hypothyroid symptoms
50mcg levothyroxine is only the standard starter dose
Bloods should be retested 6-8 weeks after EACH dose increase
guidelines on dose levothyroxine by weight
Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose
NICE guidelines on full replacement dose
nice.org.uk/guidance/ng145/...
1.3.6
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
gp-update.co.uk/Latest-Upda...
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.
BMJ also clear on dose required
Newly diagnosed with underactive thyroid. Need help with blood results!
Diagnosed underactive March 2017
Newly diagnosed and feeling overwhelmed 
Diagnosed with underactive thyroid
