Morning levothyroxine and tea

[Tintin21]

Can I drink non caffeine herbal tea (chamomile) first thing in the morning with my levothyroxine?

[SlowDragon Administrator]

Ideally not.....but if you do you should do same thing every day

How much levothyroxine are you currently taking

Do you always get same brand levothyroxine

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...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

Many people find Levothyroxine brands are not interchangeable.

Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Are you currently taking Teva?

Teva, Aristo and Glenmark are the only lactose free tablets

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds

....but beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/medications-f...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

[Tintin21 in reply to SlowDragon]

Thank you for all that information. I would take at bedtime but don't think my tummy would be empty enough. I'll try hot water and hold out for an hour before proper tea!

[Josephineinamachine in reply to Tintin21]

I can’t get out of bed unless I know I’m going to have a coffee immediately... so I set my alarm for 5am, take my tablet, go back to sleep, wake at 6 - 6.30 and have my coffee 😊 Tried to get up and wait for an hour and didn’t know what to do with myself!!

[Tintin21 in reply to Josephineinamachine]

Hi! I've decided to to do similar, wake earlier and go back to sleep as I'm the same in the that I can't get up without a strong cup of tea! But I have to be very quiet so as not to wake partner😳

[Josephineinamachine in reply to Tintin21]

Lol! Your partner will probably get used to sleeping through it 😊

[helvella Administrator Thyroid UK]

You may care to read a fairly recent thread:

Herb tea with levothyroxine?

healthunlocked.com/thyroidu...

[Tintin21 in reply to helvella]

Thank you helvella, I'm going to try hot water instead of tea. I'm going to miss the tea but hopefully it will help.

[SlowDragon Administrator in reply to Tintin21]

How long have you been taking levothyroxine

How much levothyroxine are you currently taking?

You can take at bedtime as long as it’s 2-3 hours after main meal.

No snacks or anything other than water for at least an hour before taking it

[Tintin21 in reply to SlowDragon]

Hi there, I've actually been on levothyroxine for 17 years, with the dose changing all the time. I'm now on 125mcg. I have always taken it on waking an hour before eating but with a cup of tea. I didn't realise that caffeine had such an effect on the medication. I will try the waking extra early, taking my dose, then hopefully falling back to sleep again for a while. My tea first thing is one of those small pleasures in life!! Helps with brain fog!

[SlowDragon Administrator in reply to Tintin21]

Personally I find it much more convenient and effective taken at bedtime

Dose should not be changed up and down like b****y yo-yo

Sounds like GP is dosing by TSH (hopeless)

Do you always get same brand of levothyroxine at each prescription

Different brands are not interchangeable

What vitamin supplements are you currently taking

Do you have Hashimoto’s? Autoimmune thyroid disease diagnosed by high thyroid antibodies?

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

EXTREMELY important to test vitamin D, folate, ferritin and B12 at least annually

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 (and thyroid antibodies if not been tested)

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?

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

[Tintin21 in reply to SlowDragon]

Crumbs, a lot to digest. I will consult my GP re blood tests. I was diagnosed with Rheumatoid arthritis three years ago and take Methotrexate and hydroxichloriquine. Supplements: Vit B complex, Vit D, omega 3 fish oils.

[SlowDragon Administrator in reply to Tintin21]

Important to stop vitamin B complex a week before ALL BLOOD TESTS as contains biotin and biotin can falsely affect test results

Vitamin D supplements need to be four hours away from levothyroxine (unless taking vitamin D mouth spray)

[SlowDragon Administrator in reply to Tintin21]

So that’s autoimmune...presumably your hypothyroidism is autoimmune thyroid disease also called Hashimoto’s

Strictly gluten free diet often helps rheumatoid arthritis

healthline.com/health/rheum...

And is extremely common that strictly gluten free diet helps or is essential with autoimmune thyroid disease (Hashimoto’s)

Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function with Hashimoto’s 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.

[silverfox7]

What is best for my thyroid always comes first for me and so I very rarely have any issues. It must help me though not having any antibodies to deal with!