Hello, whilst most Endos recommend taking Levo first thing in the morning and waiting 30 mins before eating anything, I came across an idea that actually it’s better to take it after food in the morning.
I’ve also seen some stuff about splitting dosage so you have one in the morning and one with dinner.
Any experience of this?
I want to hear about experience and not people’s thoughts as thoughts are just based on what our doctors tell us.
It depends on how you are. I have 2 hypo friends who take their levo with food or forget to take it the odd day and it makes no difference to them - they are well.
If you are like me you need to try and optimise each dose. Levo is absorbed in the gut so I have always assumed that an empty gut makes for better absorption. I don't worry about not having dairy within 4 hours etc or about avoiding foods apart from soy.
I have always split my dose morning and night because I cannot tolerate a full dose of levo at one go.
No, my thoughts are not based on what doctors tell me. I wouldn't trust any of them as far as I could throw them! Which wouldn't be very far.
Are you suggesting that you take your levo just after breakfast? Without any gap? Whilst your stomach is still full of food? What would be the advantage of that? Is this what you actually do?
If you're recommending this proceedure, I would like to see labs from before you started doing it, and six weeks after, on the same dose, to prove that absorption isn't compromised - which I'm pretty sure it would be. Otherwise, listening to you would be no better than listening to our doctors.
Actually, my doctors didn't give the slightest hint how it should be taken. First of all, I took it as it said on the PIL, which says half an hour. Then, I read that an hour was better to give maximum possible absorption.
Where did you come across this idea, anyway? I've never heard anything like it. 
The disadvantage of taking T4 after food is that the efficiency of takeup into your body through the intestines can be adversely affected because of food ingredient interference. There's no advantage splitting T4 dose -with a halflife in your body of 8 days, one dose or two will make no difference.
A point from Wikipedia:
The absorption of levothyroxine in the gut is decreased when taking the hormone at the same time as calcium, iron and some foods and other drugs. Because of this, patients are usually instructed to take levothyroxine on an empty stomach 30-60 minutes before food intake to avoid erratic absorption of the hormone
I guess the same logic would apply to alternate day dosing? Say, 100 one day, 125 the next? Not sufficient to have a real impact on blood levels?
I cannot explain it, but I dislike alternate day dosing. I always feel wrong when I try to do it.
112.5 every day is much more acceptable.
Obviously, as an observation of myself, with all the issues of being aware, this cannot count as proof of anything. But I have tried several times and prefer exactly the same every day.
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
verywellhealth.com/best-tim...
Personally I found it noticeably better taking at bedtime and certainly much more convenient.
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium (including calcium rich food), magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
Ok so no experience so far of doing this. Interesting.
It’s an idea in Dr Blanchard’s book, he appears to be a consultant Endo.
OK, Here is my experience. When I used to take Levothyroxine and was well on it (before an Endo screwed things up for me) I took my Levo in one big gulp one hour before breakfast. That is so that there was no competition for absorption from food.
Now, that is just my experience. You will find others have been kind enough to tell you thier experience which leaves you in the same position as you were to begin with. You will now have to take all of those experiences and apply thought to which ones you are going to try. We all got to successful, stable situations by listening to others thoughts and experiences. You should do the same, do not neglect the theory for the practice nor vice-a-versa.
Dr Kenneth Blanchard?
Afraid he died.
legacy.com/obituaries/bosto...
Yes the idea is from his book but I’ve read the same idea in a few places. There’s logic to it and clearly he was an experienced doctor so I feel there must be some truth to the theory. Doesn’t look like much consensus on here for splitting the dose.
Dk123, 'Doesn’t look like much consensus on here for splitting the dose.'
By far the majority of people do seem to be fine taking T4 in one dose, either first thing in the morning or last thing at night. But a few people do find they need to split dose it. The 'theory' says it shouldn't make any difference, and I'm happy to accept that this is true in terms of the amount of hormone being stored etc., as indicated in the comment above by diogenes and our medics. However, this theory doesn't take into account the fact that some of us actually feel quite a strong and unpleasant effect from the peak in blood level that occurs within a relatively short time after ingesting. Split dosing helps to lessen this effect for those that experience it. So, if you have reason to think it might make a difference for you, just try it.
I take my Levothyroxine as a split dose. I take my first half at noon then the second half at 4.30pm. This works well for me. My levels are good so it’s getting in ok.
Hi DK, I take my first dose of thyroid meds first thing and usually around the same time that I have coffee and a light bfast snack. My 'personal' experience is that it doesn't 'feel' any the less effective but it might be slower to act with food/coffee - slower to peak in terms of how I feel...which could be roughly aligned with a lizard warming up on a rock.
I have also trialled split dose of levo and 'feel' the effect within two hours as I do with a morning dose. The same feeling of peaking that I get with t3 but the T3 is faster acting, in either condition. So...personally, after years of trialling myself, I find that taking without food might be faster acting but taking with food not less potent. Sorry, I have no science for my own experience.
High stress can really mess up my conversion. For example, if I'm hugely stressed, I rarely get the sensation of peaking after a dose. And I have always experiencef peaking on T4 within two hours despite the science of an even flow from a resoviour of T4. But, T4 will last me most of the day before a sensation of dropping, unlike direct T3 which troughs around every 4/5 hours, sometimes less, depending how active I am.
On T4 alone, my T3 is never high enough to make me feel really well...just function.
Very tricky. My bloods also show a lower ratio of T3/T4 on levo than a normal thyroid output. There is science for lower t/3/t4 ratio in replaced patients, and physical activity using up T3 faster...no brainer, and the effects of stress/ cortisol blocking conversion.
I've forgotten half of what I knew but hope my comment is readable.
I take mine with my blood pressure tablet and my diabetes tablet..sometime before breakfast or after...never have any problems
If you want to trial a different way of taking your Levo why not just try it? I would suggest having TSH, Free T4 and Free T3 tested with your current method of taking the Levo, then make the change immediately after the test then get tested again 6 - 8 weeks later. Then compare the results.
This is not guaranteed to be totally accurate, particularly if you have Hashimoto's Thyroiditis, which can cause levels of thyroid hormones to fluctuate without anything else being changed, but it is the best option you have.
If you do such a trial make sure that the conditions, preparation and timing of the tests before and after are kept as similar as possible.
I take mine at night and have done for years, I sleep better that way and I find it easier not to eat for an hour or 2 beforehand in the evening, than taking it first thing in the morning on an empty stomach and then having to wait 30mins-1h before eating and drinking and having to be careful with having things like fortified cereals, etc for breakfast.
I've never tried splitting the dose or having it after breakfast but I feel that would be way less practical with my work life and would leave me open to be more forgetful with taking it but if you like to try it then it's worth having a go and see if you feel better for it, you can always go back to the old routine if it doesn't work for you.
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