Iron & levothyroxine

[Dahli]

I was told some years ago that iron tabs & thyroxine should be taken at least 2 hours apart, after checking paperwork with the tablets & having found nothing, I asked a pharmacist. Shesaid "never heard that" so I just stood my ground & smiled she laughed & said "you want me to check don't you", & I said yes please. When she returned she affirmed that indeed you do need to leave at least 2 hrs gap or the iron results in thyroxine not being as effective. I started taking my iron at lunchtime.

[SlowDragon Administrator]

Actually iron should be four hours minimum from levothyroxine and at least 2 hours away from any other medication or supplements

Same is true of magnesium, calcium, HRT, any PPI like omeprazole, or vitamin D tablets - all need to be four hours away from levothyroxine

(Vitamin D mouth spray is ok an hour away)

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...

[Dahli in reply to SlowDragon]

Thank you, I take mine from 4-6am when I get a bladder call before going back to bed😉 . Can omeprazol & magnesium be taken together?

[SlowDragon Administrator in reply to Dahli]

Omeprazole is for high stomach acid

Majority of hypothyroid patients have low stomach acid

How long have you been on omeprazole?

Needs to be taken as far away from levothyroxine as possible

Thousands of posts on here about low stomach acid

healthunlocked.com/search/p...

Web links re low stomach acid and reflux and hypothyroidism

nutritionjersey.com/high-or...

articles.mercola.com/sites/...

thyroidpharmacist.com/artic...

stopthethyroidmadness.com/s...

healthygut.com/articles/3-t...

naturalendocrinesolutions.c...

Ppi tend to lower B12 and magnesium

So good you are taking magnesium supplements

pulsetoday.co.uk/clinical/m...

gov.uk/drug-safety-update/p...

[Dahli in reply to SlowDragon]

Hi, I'm on 100mcg. Can you recommend the best place to read up all about all this? I find it very difficult maintaining my vit d levels & even taking high dose caps everyday in winter it still drops very low. I've said several times I'm not absorbing things but GP not interested. Thank you

[SlowDragon Administrator in reply to Dahli]

“ I find it very difficult maintaining my vit d levels & even taking high dose caps everyday in winter it still drops very low. “

How much vitamin D do you typically take?

GP will often only prescribe to bring levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

Calculator for working out dose you may need to bring level to 40ng/ml = 100nmol

grassrootshealth.net/projec...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Taking too much vitamin D is not a good idea

chriskresser.com/vitamin-d-...

With your Vit D, are you also taking important cofactors - magnesium and Vit K2-MK7?

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[SlowDragon Administrator]

Presumably you have Hashimoto’s?

How much levothyroxine are you currently taking

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Is this how you do your tests?

[Dahli in reply to SlowDragon]

Hi this is really interesting, i have thyroid antibodies but Hashimoto has never been mentioned.I have PCOS, Hypothyroidism, Ehlers Danlos Syndrome, POTS, probable Mast Cell Activation Syndrome, Lichen Sclerosis. My maternal grandma, mother, aunt cousins have all had hypothyroidism. I will have a look at Hashimoto not that i really want to add to my life's achievement

😉 Gill

[SlowDragon Administrator in reply to Dahli]

About 90% of all primary hypothyroidism in Uk is due to autoimmune thyroid disease ( aka Hashimoto’s.)

So if you have high TPO or TG thyroid antibodies this confirms autoimmune thyroid disease also called Hashimoto’s

Autoimmune thyroid disease frequently runs in families

Medics here in U.K. never refer to autoimmune thyroid disease as Hashimoto’s

Medics rarely consider the autoimmune aspect of the autoimmune thyroid disease important, because there’s no medical treatment for the autoimmune aspect, just levothyroxine to treat the resulting hypothyroidism

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...

PCoS and autoimmune thyroid disease often go together

hashimotoshealing.com/hashi...

verywellhealth.com/hypothyr...

thepcosnutritionist.com/blo...

Gluten intolerance/sensitivity can be linked to lichen sclerosis

ncbi.nlm.nih.gov/pmc/articl...

Gluten intolerance is EXTREMELY common with Hashimoto’s.

You don’t need any obvious gut issues at all.

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

healthcheckshop.co.uk/store...?

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

[SlowDragon Administrator in reply to Dahli]

EDS and Hashimoto’s are possibly linked. We get quite a few Hashimoto’s members who also have EDS

healthunlocked.com/search/p...

[Dahli in reply to SlowDragon]

Yes I discovered this some years ago, but when I mentioned it to my GP she said not necessary but I've always kept to it as it was the consultant endocrinologist who diagnosed me who gave me the advice. Thank you so much. I wish I had found you years ago.

[SlowDragon Administrator in reply to Dahli]

I only made progress and full recovery after joining this forum....seeing just how common low vitamin levels and food intolerances are

Just replacing missing thyroid hormones with levothyroxine is not adequate treatment for many, many patients

[helvella Administrator Thyroid UK]

It is not good that the pharmacist took any time at all to find out!

The Patient Information Leaflets for levothyroxine say things like:

The following may affect the way that levothyroxine works:

• medicines containing iron that are taken by mouth

While they don't give a time gap!

But the Summary of Product Characteristics documents (the "professional" version of the PIL) say:

Absorption of levothyroxine (thyroxine) possibly reduced by antacids, proton pump inhibitors, calcium salts, cimetidine, oral iron, sucralfate, colestipol, polystyrene sulphonate resin and cholestyramine (administration should be separated by 4-5 hours).

medicines.org.uk/emc/produc...

These documents are available to anyone and should be at the fingertips of a pharmacist.

Well done for standing your ground and getting it checked.