I work in shifts of 8hrs, ranging from 07:00 starts to 22:45 starts. Doc has advised me to take Levothyroxine on an empty stomach and an hr before eating, which is a tad annoying bc eating was the first thing I used to do when waking up, but so be it. I cannot take it at night as am on other meds and also a late eater.
So, when I'm working a night, I will wake up at around 15/16:00, and if I'm working a morning it'll be 05:30. I'm worried about the time difference in taking the LT. Will I experience a lot of fluctuations in my levels? Is it going to affect me a lot? Any advice and/or tips are appreciated.
I also have had a few symptoms which aren't in line with what I've read (in fact, the opposite, in some cases). I sweat excessively, I have slight heat intolerance, hot flushes, and also some digestive issues like discomfort, bloating, a ton of gas, and indigestion. Does anyone know if these could be possible symptoms of hypo?
I only started on LT 3 days ago, so waiting to see still if these things get better.
Thanks for your help in advance!
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The time difference shouldn't make any difference to your levels because T4 is basically a storage hormone, that doesn't do much until it is converted into T3. And that can take several weeks. Meantime, it just sits there, waiting to be converted.
The only problem you're going to have due to you working shifts, is the timing of your future blood tests.
Ideally, the blood draw should be early morning - before 9 am - after fasting over-night, leaving a 24 hour gap between your last dose of levo and the blood draw. I imagine that is going to take some complicated organisation.
The reason for this is that TSH is highest early morning, and drops throughout the day, being at its lowest around lunchtime. And, as doctors only tend to look at the TSH, if you want an increase in dose, you need your TSH as high as possible. Eating and drinking cafeine can also lower TSH.
As for the 24 hour gap between the last dose of levo and the blood draw, that is because T4 levels peak in the blood a couple of hours after taking the pill. So, taking your levo before the blood draw would give you a false FT4 - if your doctor even tests that! To know what your normal circulating levo of T4 is, it's best to leave the 24 hour gap.
It's also very important to always have your blood draw at the same time of day, and under the same circumstances. Otherwise, you cannot compar them to see how well you are progressing.
I have slight heat intolerance, hot flushes, and also some digestive issues like discomfort, bloating, a ton of gas, and indigestion. Does anyone know if these could be possible symptoms of hypo?
Yes. Most definitely. The cause of the digestive issues is probably low stomach acid, which most hypos suffer from. When stomach acid is low, the food is not digested properly, and just sits in the bottom of the stomach, fermenting. This cause the gas and bloating and all sorts of other problems. Have a look at this article, and try the home test at the end:
Thank you greygoose . I was worried I wasn't gonna get a reply to this. Thanks a lot for the additional info regarding the testing specifics, it is something I will have to plan ahead!
The word "fine" relating to test results is never fine. You need to get a copy of the test result sheet with the reference ranges and post it here for proper advice to get you optimal. You are legally entitled to that. I ring my surgery and ask the receptionist to email my results to me. Give it a go. If they won't email you need to pop in and pick them up. Do it after every blood test from now onward.
6 months is 3 months too long. Ring up and just move your blood test date. They won't know.
Hey, I said it was fine bc I have a copy myself and researched the normal limits (I have now posted them), it also has normal ranges stated on the work. I will definitely book my tests earlier than advised, thank you.
You just might find the article below (and the full paper which you can access) interesting and/or useful.
The normal range: it is not normal and it is not a range
1. Martin Brunel Whyte
2. Philip Kelly
Abstract
The NHS ‘Choose Wisely’ campaign places greater emphasis on the clinician-patient dialogue. Patients are often in receipt of their laboratory data and want to know whether they are normal. But what is meant by normal? Comparator data, to a measured value, are colloquially known as the ‘normal range’. It is often assumed that a result outside this limit signals disease and a result within health. However, this range is correctly termed the ‘reference interval’. The clinical risk from a measured value is continuous, not binary. The reference interval provides a point of reference against which to interpret an individual’s results—rather than defining normality itself. This article discusses the theory of normality—and describes that it is relative and situational. The concept of normality being not an absolute state influenced the development of the reference interval. We conclude with suggestions to optimise the use and interpretation of the reference interval, thereby facilitating greater patient understanding.
Aim of levothyroxine is increase the dose slowly upwards in 25mcg steps retesting levels 6-8 weeks after each dose change or brand change in levothyroxine
TSH should always be under two when adequately treated
50mcg is only the standard starter dose
Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Having looked at your test results, your FT4 is just 52.90% through the reference range. And your TSH is high. Most patients need their FT4 to be towards the top of the range to give themselves a fighting chance to have good levels of FT3 (which wasn't tested for you). You have plenty of room for a 25mcg dose increase in Levothyroxine and retest 8 weeks later.
Unless I missed it, I can't see a vitamin D test. It's probably low if you are in the Northern hemisphere. I would get that tested and supplemented. We need our levels to be around 100-120 to be optimal.
The obvious problem in these results is your dire level of ferritin. Ferritin is the iron storage hormone and is very important in the conversion process of FT4 to FT3. You will probably be suffering some hair loss with levels down there as well as other things. I struggle with ferritin. It's a constant battle. We (as thyroid patients) need to have ferritin between 80-100 on the test scale. Certainly under 70 will lead to problems. Eat iron rich foods if you can, liver, pate, black pudding, cook in a cast iron pan or put an iron lucky fish (available on Amazon) into your pan when boiling things. But you also need to supplement with something to increase those levels. Ask SeasideSusie for supplement advice. She's a wiz at what's best to take.
Thanks a lot for the advice! I'm vegan so those items are off the list for more but will definitely source alternatives and have a good look into iron supplements, I'm slightly annoyed bc the doctor told me it's normal for it to be this low bc I'm a woman. I will also get Vit D tested and probably go and see an endo instead of a regular GP
GPs are pretty hopeless with vitamins and minerals. Provided your blood test result is somewhere in the range and not flagged for them, they are happy you are "fine!". We really have to learn this stuff for ourselves and then make it happen. I used Solgar Gentle Iron for ages, no side effects but it didn't bring my levels up much at all. Which is why I suggested you ask SeasideSusie for a supplement you could try. Be sure to tell her your dietary status though as like me, she eats iron rich animal products to do it.
Without an iron panel to check your serum iron and saturation levels then it's difficult to know what to do. If your serum iron level is already good then taking iron tablets will likely take it too high and too much iron is as bad as too little. You can have a decent serum iron level but poor ferritin level which has been my problem but I've been happy to eat liver and this has gradually raised my ferritin level without affecting my serum iron or saturation levels.
There are, apparently, some "ferritin" supplements but I don't know anything about them. helvella has an iron document but I can't link to it, here is his profile, scroll down until you see
helvella - Iron Document
Information collected and linked regarding iron and iron supplementation.
I knew mine was truncated, I was just indicating where the OP could find your document.
When I click on your links in your profile I get the option to open pdf with my browser Firefox or Adobe. If I open with Adobe I don't get a link I can pass on. If I open in Firefox it links to a file on my computer. So I've never been able to pass on a workable link to your documents.
Now I've got that workable link to your iron document I've saved it so I can pass on in future 😊
If you see a link, such as in my profile or anywhere else on HU, click on it. That will open a new tab (or window - depending on settings) in your browser.
Oh good grief, why didn't I think of that 🥴 honestly, I don't know what goes on in my brain some days, I thought if you had the pointy finger (technical term!) you could only click on it 🤣
Hi, when I was doing shift work earlies lates and nights I just always took my levo at 10 pm. It took me a while to get to that but on nights I stayed awake and on the other shifts I slept all night. Jo xx
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Poll- what hypo symptoms have you had? 
Diagnosed with Graves & Hashimoto's but symptoms are Hypo - Doctor useless!!
How/when do you take levothyroxine 
Hyperthyroid + shift work
How long does it take levothyroxine to start working?
