Taking Levo at night along with Mirtazapine - Thyroid UK

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Taking Levo at night along with Mirtazapine

elaine2447 profile image

Hi, I am at long last starting on 25mcg of levo (Wockhardt). I take half a Mirtazapine (7.5mg) at night as I am such a poor sleeper. I have severe osteoporosis and take various supplements including calcium so taking Levo in the morning is a bit difficult with breakfast (including fortified plant milk as I cannot tolerate dairy) so I don't want to down double the amount at lunchtime because of the four hour recommended gap. I am wondering if it is okay to say take the mirtazapine at 10.30 say and the Levo at around 11.30 when i go to bed. I take the last calcium capsule, K2 and magnesium with my dinner around 7.00 p.m.

The reason I am only starting on a small dose, well actually 12.5mcg for the first few days is because the GP had to ask the endo dept if this was okay due to my having Hashimotos and had a really bad hyper attack 6 years ago which lasted 13 solid weeks. It was a nightmare, day and night.

Thanks, any advice would be much appreciated.

50 Replies

Levo should be taken strictly on its own, no food or coffee for two hours before or one hour after. All supplements/other medication at least two hours away - four hours for calcium, iron, magnesium, vit D, oestrogen and PPIs.

So, it's really not a good idea to take levo and Mirtazapine so close together, if you want maximum absorption of levo - especially on such a stupid low dose! You risk not absorbing any of it at all.

I really don't see the connection between having had a Hashi's 'hyper' swing 6 years ago has to do with your dose today. What counts today is your latest blood test results. Taking levo is not, in any way, going to cause another 'hyper' swing. That's not how it works. Do you have copies of your latest labs?

Calcium in not a cure or a treatment for osteoporosis - in fact it can make things worse by making bones brittle. Magnesium, vit D, vit A, etc. are far more important for bones - as is an optimal level of T3, which I doubt you have. And, calcium is a very bad supplement to take because it's so poorly absorbed, and tends to build up in the soft tissues and arteries, causing problems. Have you had your calcium tested at least? Do you take vit D? That can increase absorption of calcium from food, which is a far better way of doing things if your calcium is low. But, it's a myth that you only get calcium from dairy, all sorts of other food stuffs contain calcium, including some veggies. So, might be an idea to rethink the calcium and make sure you absolutely need to take it. :)

elaine2447 profile image
elaine2447 in reply to greygoose

Thank you for taking the time to reply. My main concern was the mirtazapine and thyroxine causing a reaction with me rather than lack of absorption.

The reason for my taking calcium is because I have been fairly hypocaelcemic the last couple of years since i had a parathyroidectomy and had three of the four glands removed. It is a fairly good supplement Life Extension Bone strength with KoAct and around 300mg of calcium (not carbonate!!) plus boron, prune powder, vitamin D and magnesium but I take additonal vitamin D, magnesium capsule at night as well together with vitamin k2 Mk4 and Mk7 for the sake of not clogging up my arteries and kidneys. I have two types of neuropathy brought on we think by the covid double vax.

I don’t know why the GP said she must get permission from the endocrine department, unless it was because she was a locum, but i just accepted that as I didn’t not want a hyper. I have been let down very badly by that department in the past and my own GP now retired with my hyperparathyroidism.

I had to pay a nurse to come to my house to do a medichecks tests once in august and again in December and both times the TSH was over 8 but GP’s don’t like medichecks.

I then saw a consultant in February and he arranged for surgery to do more blood tests as I have neuropathy, both sensory and I understand autonomous, the latter meaning that it affects my abdomen and digestion and so i cannot eat very much and do not get sufficient calcium from food.

My February readings were

TSH 7.16 mU/L 0 0-35 – 5.50

T4 13.7 10.5 – 21.0

T3 5.2 pmol/L 3.5 – 6.5

It was the locum who picked up the TSH and I had another done three weeks later

TSH 5.91 mU/L 0.35 - 5.50 mU/L

Free T4 13.9 pmol/L 10.5 - 21.0 pmol/L

My own GP in December said that thyroxine would probably not make me feel any better due to the Hashimotos.

He was reluctant to give our thyroxine as it can cause heart problems. I already have a PMV so didn’t want any more problems and so I left it.

The fact that I am now a stone overweight, tired and having itching eyelids is probably what prompted the locum to suggest a trial 25 mcg.

greygoose profile image
greygoose in reply to elaine2447

I don't think taking the two together would cause any sort of reaction, but absorption is a very important point. Especially, as I said, when you're taking such a tiny dose. Your doctor is right, it won't do you much good, but not because of the Hashi's! That has nothing to do with it - where the hell did he go to school?!?

If you have Hashi's, your immune system is slowly destroying your thyroid, so your need for thyroid hormone replacement is increasing all the time.

Levo has no negative effect on your heart - lord knows where he got that from! - not unless you take too much - not much chance of that with your doctor, I don't think! lol And, you would have to take a hell of a lot. You'd probably make yourself ill before it did anything to your heart. However, being hypo is very, very bad for hearts. They need an awful lot of T3 to function correctly.

Do you have any results for calcium? It should be tested regularly when taking calcium supplements, to make sure you don't over-dose.

elaine2447 profile image
elaine2447 in reply to greygoose

My adjusted calcium has gone up now to 2.4 (range 2.20 to 2.60) The problem is my stomach is so squished up from spinal fracture and now this autonomnous neuropathy, plus scoliosis doesnt help digestion, that I have no appetite and feel nauseous.

greygoose profile image
greygoose in reply to elaine2447

You more than likely have low stomach acid. Most hypos do. That will cause nausea and lack of appetite, and affect abosrption of everything.

elaine2447 profile image
elaine2447 in reply to greygoose

This started about two weeks ago getting slightly worse and awful by today. I make too much acid have done since childhood.

greygoose profile image
greygoose in reply to elaine2447

How do you know you have high stomach acid?

elaine2447 profile image
elaine2447 in reply to greygoose

I burn up inside. I had endoscopy a few years ago and they said I had osophogitis. I can taste it when I get anxious like the last few days. I used to take zantac but its been banned now.

greygoose profile image
greygoose in reply to elaine2447

Did you know that the symptoms of high stomach acid, and low stomach acid are the same. You cannot tell which you have from symptoms alone.

elaine2447 profile image
elaine2447 in reply to greygoose

I'm a wreck particularly today. I'm usually very mindful of diet and I don't eat meat and cut out gluten. Tonight I've had to force down a couple of bits of toast and some soup which is not great of course. I have to sit at meantimes with heatpad around my stomach as well as my back. I tried doing a bit of gardening this morning as I hate sitting about, have done DIY since my husband died suddenly leaving me with 3 year old in 1985 but used my non dominate arm today because of my back and muscle problems. However I had to have a rest as I began to feel ill and then my arm was aching so I thought don't say I'm going to have a heart attack so I had to quickly write out a list of feeding for 3 cats. So, got agitated and popped a bromazepam. I'm a neurological and psychological mess as I'm thinking all sorts of hideous things like stomach cancer. I didn't know hypo can cause nausea so thank you for that.

greygoose profile image
greygoose in reply to elaine2447

Being hypo for years - and you could very well have been hypo since childhood without knowing it- being hypo will make you a neurological and psychological mess. Thyroid hormones are needed by every single cell in your body. And, if there's not enough to go round all sorts of symptoms can arise. You cannot live without thyroid hormone.

Did you know that going vegetarian can be a hypo symptom? Hypos very often don't fancy meat because - subconsciously - they find it hard to digest. But, being veggie is not good for hypos. I cut out meat before my diagnosis, and it made me very ill - both physically and mentally. I lost my job, my home, everything.

Do you keep a check on your B12 if you don't eat meat?

elaine2447 profile image
elaine2447 in reply to greygoose

I couldn't eat red meat as that is bad and hard to digest or pork but eat chicken breasts and different kinds of fish or I did but feel so yuck and bloated now feel full up. Today instead of a cheese and salad sandwich fancied a banana sandwich but only got through half. Something is going on. Problem is backache so bad and neck both with arthritis, that makes me feel sick. Trying to lay off the cocodomol as I'm on a cannabis trial but couldn't stomach the cbd oil and so take a small amount of thc but it's not helping with pain and maybe making me feel worse but not causing this tight band around my stomach. Our surgery is not the best and my philosophy usually is suffer it out until it goes away. But symptoms are so vague and weird would be hard for even a decent gp I think.

greygoose profile image
greygoose in reply to elaine2447

Well, it all sounds like hypothyroidism to me. I'm willing to bet that if you got your thyroid status optimised, a lot of your problems would go away. Doctors do not realise the dammage low thyroid hormone levels can do to a body.

elaine2447 profile image
elaine2447 in reply to greygoose

Thanks very much for your advice. I don't know if drinking fortified milk on my breakfast counts as giving the four hour gap as opposed to cow's milk, in which case, do I put water on my gluten free nutribrex?? I wish I could blame how I am onto the thyroid but alas, it hasn't caused the neuropathy. I had my whole of what is left of my life left to live from March 2020 after my long awaited private parathyroidectomy but it wasn't to be and thanks to vaccines. Even the Nutribrex has some vitamins in it and what do people do about taking B12 and probiotics for example, even cocodomol as I am always in pain.

just to clarify in case you have misunderstood the '4 hour' thing ......you can take levo first thing in a.m , on empty stomach with water , then wait an hour ...... then have your breakfast.... ( which can be anything you want)..... you don't need to wait 4 hours after levo to eat breakfast .

or perhaps i'm the one who misunderstood what you wrote :) .. anyway .. just checking you didn't think you have to wait 4 hours to have your breakfast.

**Edit .. oh i see, sorry , you mean '4 hours' because it's 'fortified' plant milk ? ie calcium (+ vits?) added to it ..... i would assume it's only got enough calcium added to bring it back to something like the level that cows milk would have anyway ?.. What sort of plant milk is it ?

Hi thanks for replying it is the koko coconut unsweetened milk. I used to buy the milk without casein but they stopped supplying in in the uk. I never really know for sure if its the lactose or casein. I am not great with dairy for years. That is why I am confused because a friend said that if i use fortified milk that has added calcium and vitamins, I shouldnt use. So I bought 8 litres of hazelnut milk from amazon, it looked pale mauve and wasn't very nice, tipped one away and gave one to my daughter and still got the rest to get rid of maybe at a foodbank lol.


Water, Coconut Milk (7%), Calcium Phosphate, Emulsifier (Sucrose Ester of Fatty Acids), Sea Salt, Stabiliser (Gellan Gum), Colour (Carotene), Vitamin D2, Vitamin B12

say's it's contains (per 100ml):

Calcium phosphate 120mg 15% RI (reference intake of average adult)

Vit B12 0.75ug 15% RI

Vit D 0.38ug 15% RI

I don't know if that is likely to be an issue or not ? greygoose SeasideSusie ? Does it present a problem for absorption of (25mcg !) levo if elaine2447 is having this 'fortified ' coconut milk for breakfast after taking levo earlier ?

if it is problem ,,, i wonder what just getting a tin of 'straight' coconut milk would taste like on your breakfast instead ? (just coconut and water , not fortified )

Thanks for finding the actual measurements of the additives. I only use this fortified milk to help with my bones as I have severe osteoporosis and already have a T5 compression fracture. My diet is not so great lately as I've got no appetite and tend to feel nauseous a lot of the time. The spinal injury has altered the shape of my stomach and the neuropathy is affecting my stomach (autonomous neuropathy) I started off first with sensory neuropathy which affects my feet and walking. So I worry all the time about not getting enough weight bearing (walking) I bought a marodyne low intensity vibrating plate specifically designed for osteoporosis some years ago. It didn't help having a gp who said after every pth, calcium and vit d result for four years 'above the normal range, to be expected "🤬🤬 so osteoporosis worsened by a further 12 percent and the endo dept were worse, so I ended up paying £11k in March 2020, 3 days before lockdown for a private operation. Surgeon removed 3 of the 4 glands and said I was too old to regain any bone density but hoped it would slow the deterioration down.

yes , i realised why you are having it.... i was just meaning if the calcium in that form / amount turns out to be a big problem for taking too close to levo (i don't know if it is or not) then why not just have 'normal' coconut milk with your breakfast, and have your fortified milk at some later point in the day ?

Being pragmatic if you've been diagnosed as hypothyroid, you need to get on with it and start taking the Levo , so don't make life impossible for yourself by worrying about whether this milk counts as a 'calcium supplement' or if it's not really any more of a problem than normal milk would be and can be had an hour. after levo....... for now, just take the levo as soon as you wake up (with water) and leave as long as possible before eating your breakfast to give you the best chance of absorbing as much of Levo as you can before you put anything else in . (be consistent )

once you've taken it for 6 weeks and they have tested your bloods , it will probably need increasing anyway.. 25mcg is more or less 'nothing' anyway .. it's just a small dribble to make sure your body doesn't find the introduction of thyroid hormone a shock

According to this, one shouldn't drink milk until 4 hours after, so seems if I can't take the levo early enough, it's back to the hazelnut milk 🤢 or eating toast!!drugs.com/medical-answers/l...

yes ..... i think the advice on that american site is 'a bit over the top' . Millions of patients on levo all over the world are happily having milk for breakfast an hour (or even less) after taking their levo .. their levo still works.

I've been having porridge made with milk an hour after levo since 2003... (and i even break the 'rules' and have a splash of milk in tea WITH my levo first thing ... i always have done ) .... my levo still get's absorbed and works .... if it didn't i'd know from how i felt and from my blood test results .. perhaps i would absorb slightly more from each tablet if i left longer before i had any milk ... but in effect that would just mean my dose might only need to be about 75mcg instead of the 112.5mcg that i do take , in order to get the same amount absorbed into my blood stream .

The only down side is the 'waste of Levo' if i don't absorb it all and am taking a bigger dose to compensate , but since it only costs about £12 a year to treat patients with levo ,who cares ?

You need to eat a breakfast you enjoy ( you've already got enough restrictions on what/when you can eat and enjoy it )...... and you need to take levo ..... so don't overthink it to the point your diet is so restricted there's no enjoyment left in eating anything at all.

Basically ,, whatever you decide to around levo/ breakfast .. just do it consistently .. so you are always getting the same absorption, not varied every day , and then your blood test will show if its a big enough dose , or needs increasing.

Yes , it's true there is research showing that large amounts of calcium /Iron / caffeine taken at the same time as levo will reduce the amount that is absorbed.. but even that doesn't totally stop people absorbing 'any' .... they still absorb some , just less.

Funnily enough I was just talking to my cousin on the phone, older than me and been on levo for years and still only 25mcg, she had never heard of the milk problem. Thanks a lot for all your input

SlowDragon profile image
SlowDragonAdministrator in reply to elaine2447

Think your cousin better do a Medichecks test

25mcg is only half the stater dose levothyroxine

Make sure she knows to always test thyroid levels early morning, before 9am and last dose levothyroxine 24 hours before test

Likely low vitamin levels if been left ludicrously under medicated for years

She's my late mums 2nd cousin, I call her my cousin. She is older than me and not well and getting over pneumonia and wouldn't have a clue about self testing. Apparently she has been on that small dose for years and has regular GP tests. I don't know if it is coincidence with me, I hope so, but I noticed my heart is a bit racy since I started on the 25mcg. I do have a PMV which doesn't help and am always stressed and in constant pain from fractured spine.

When I was taking levo as part of my ‘block and replace’ treatment I used to keep the tablets by the bed and take one as soon as I woke up - early 5 or 6 o’clock then lie in bed for at least an hour then get up and have breakfast. I never waited for four hours. It must have been ok to do that because my blood results were always what was expected. If I slept in then I would take my pill and take my breakfast with me in the car to eat an hour or so after my levo.

It is very depressing that so many doctors still seem to know so little about the thyroid isn’t it!

Hi, thanks for input. So far taken them at 5.30 and even 4.30 as I didn't want to go back to sleep and take one too late. You're right about GP's and thyroid. At least this locum first picked up high TSH, the one who organised different brand said they don't tell patients to leave off morning of test as then they don't get correct reading!!!!!!!!

Or maybe they do! (Get the correct reading that is)

True, a friend on Facebook who has been on thyroxine for years, says her surgery is the same, not to leave the tablet off that morning.

it's the phrase "correct reading" , that causes the problems ...All fT4 reading's are "correct" .. as in , they accurately measure what is there at the time .

The part that is misunderstood by many GP's and even some Endo's ( because they only really teach them about TSH testing) .. is that you need to interpret the fT4 result differently depending on what time the last dose of levo was taken.

IF you wanted to know the maximum level of fT4 there is in the blood at any point in the day (the post ingestion peak) .. then you would test about 2-6 hours after the last dose was taken ..and that would be "correct" FOR THAT PURPOSE, and that purpose only.

But if you wanted to know the average level of fT4 the dose of levo was giving the person (after this brief 'post ingestion peak' had subsided)...then you would test with a much longer gap from last dose .. at least 12 hours to be on the safe side.

Between 12 hrs and 24 hrs the fT4 level doesn't change all that much .. but the best way to get consistency (especially when trying to keep instructions simple for thousands of new patients, who mostly take levo in the morning ,and who should ideally be having a 9am blood test for TSH purposes ) .. is to say '24 hrs'

ONLY if you go much over the 24 hrs from last dose levo .... THEN you could say it was "incorrect" and not properly representative of the daily dose taken.

Vet's know about the importance of taking time of last dose into account when interpreting fT4 tests ... but GP's are taught TSH is all they really need to know about (... and it is true that 'time of last dose' does not matter for TSH tests) .

But until all GP's learn more than the NICE guidelines tell them , and research for themselves how 'time of last dose' affects fT4 result .. and how 'time of day' affects TSH results ... they will be getting very inconsistent test results from the patient because on one test the patient takes levo at 7am and goes for blood test at 4 pm .. (giving a relatively low fT4 and 'lowest' TSH)

Then the same patient goes for their repeat test , but next time they book a 9 am blood test and since they took their levo at 7am , the fT4 result looks relatively high , and the TSH also looks 'higher' .

If you tell patients to take levo on the day of test, but then tell them it doesn't matter what time the test is ... you will get all sorts of inconsistencies .

It's not about "which method is 'correct' or not" ... it's about understanding how it works , and interpreting the results correctly based on that understanding .

Many GP's are going around telling people "this is the correct way" because they simply don't understand the subject as well as your Vet does .

greygoose profile image
greygoose in reply to elaine2447

Well, I said before, calcium is not a cure or a treatment for osteoporosis. In fact, it can make the worse because the bones become brittle. We've all been brain-washed by the dairy industry into thinging we need excessive amount of calcium. We don't. You are taking 3000 mg a day when the daily requirement is 2500 mg. You are over-dosing on calcium. You're calcium level is now good. You don't need all that calcium.

You are hypo, and you need to take that seriously. Taking such a fiddling little dose of levo - which you probably aren't absorbing at all - is not going to help you.

You also need to take low stomach acid seriously. As I said, the symptoms of both high and low stomach acid are the same, so you cannot know the level of your stomach acid just from symptoms. You need to find out.

Obviously all food has some vitamins in it, but not the amount you would get from a supplement. As long as you leave an hour before eating and drinking anything other than water, it should be alright.

Also, your coconut milk contains D2, which is the wrong form of vit D. What you need is D3. And, just taking one B vitamin is not very helpful because they all work to gether, so need to be kept balanced.

Leave two hours before taking B12, cocodomol, etc. as I explained above.

elaine2447 profile image
elaine2447 in reply to greygoose

Oh dear, you misread my calcium intake, it's 300mg not 3000mg so if you say the daily requirement is 2500 a day, then I really am sadly lacking. I hate milk and some bone people call it the ugly white liquid lurking in the fridge. The capsule I take with the 300mg contains lots of other stuff including vitamin D but I take an extra Vitamin D anyway and B12. I just wish there was an easy fix without having to rely on food as I just dont feel like eating although i do eat fruit and nuts but can't face anything big any more. I think i will have to try taking the levo at 5 in the morning and by the time i have my breakfast, the so called fortified milk will be around 4 hours. If I am lucky enough to sleep beyond that, will have to have toast or something although as tattybogle said, loads of people drink milk with the breakfast and I have not long been off the phone with my cousin who had never even heard of the four hour thing with calcium. If my bones were not in such a bad state I wouldnt worry so much. I live on my own with three cats and so I worry about them should I break something again. If it werent for the mirtazapine it would be easy just taking it at night. I have to have a blood test in six weeks after starting the levo so will be interesting if it has any effect. Anyway, thank you for all your suggestions. Much appreciated.

greygoose profile image
greygoose in reply to elaine2447

Yes, sorry, got my zeros in a tangle!

Please stop talking about milk. I very, very rarely have milk myself, but it really isn't the only source of calcium, and no-one is suggesting you have it. A lot of people live very happily without milk. But, you cannot possibly know how much calcium you are getting without weighing everything you eat and researching the calcium content etc. What I'm saying is: stop being so hung up on calcium. Your blood test is saying that your blood contains enough.

You don't feel like eating probably because you are hypo - loss of appetite is a hypo symptom - and because you probably have low stomach acid. We all have the same problems with low nutrients, the majority of us have to supplement. And, by the way, nuts contain a lot of calcium.

And, I very much doubt you need to leave four hours between your levo and your breakfast. An hour should do. Especially if you always have the same things, because your dose should be adjusted to accomadate any loss of absorption. But, at the moment, your dose is far, far too small, and that is probably making you feel worse. Very small doses are a bad idea. Pity doctors don't understand that!

elaine2447 profile image
elaine2447 in reply to greygoose

I only mentioned the four hours because of using plant based milk otherwise I wouldn't fancy water on my nutribrex. My breakfast is very boring like me, every day the same, two nutribrex, two chopped up brazils for the selenium and half a dozen soaked almonds with a chopped organic apple on top.

Apparently a blood test reading of calcium I am told is not an indication of what is going on with one's bones.

Someone posted up this today on the osteoporosis group and I happened to pick this bit up although the whole study is quite depressing with the amount of drugs that do harm to the bones including thyroxine but I would imagine that is someone who has been on these drugs for many years " Research conducted in Spain assessed risk factors for osteoporosis and fractures in 4960 postmenopausal women aged 50 to 65 years. Its finding: the 2 top risk factors identified for osteoporosis were low intake of calcium and benzodiazepine use"


greygoose profile image
greygoose in reply to elaine2447

I'm sure you're not very boring! :) But, you still don't need to leave four hours. No idea what nutribrex is, though. I have pretty much the same thing everyday, too. If it's what you like, why not?

Of course, a blood test cannot tell you what's going on in your bones, it only tells you what's in your blood. But, calcium is just not the most important nutrient for bones. Yes, if you had low intake of calcium if would have an effect, but once you've actually got osteoporosis, taking extra calcium is not going to get rid of it. That's my point.

Are you sure thyroxine harms bones? Considering it's a bioidentical hormone, that sounds rather strange. After all, you can't live without it.

elaine2447 profile image
elaine2447 in reply to greygoose

Yes, afraid so about the thyroxine, along with steroids (including inhalers) gabapentin, pregabalin, ppi's are notorious for it. This is nutribrex sainsburys.co.uk/gol-ui/pro...

greygoose profile image
greygoose in reply to elaine2447

PPIs are evil things! It's taken me 9 years to get over the 9 months I took them! So, that doesn't surprise me at all. But, I'm not convinced about thyroxine.

elaine2447 profile image
elaine2447 in reply to greygoose

"What is the link between thyroid disease and osteoporosis?Thyroid hormone affects the rate of bone replacement. Too much thyroid hormone (i.e. thyroxine) in your body speeds the rate at which bone is lost. If this happens too fast the osteoblasts may not be able to replace the bone loss quickly enough. If the thyroxine level in your body stays too high for a long period or the thyroid-stimulating hormone (TSH) level in your body stays too low for a long period then there is a higher risk of developing osteoporosis. There is also some evidence that people with low TSH levels may lose bone at a faster rate than those with normal TSH levels even when the blood thyroxine measurement is within the normal range, but this is still being studied"


This is related to hyperthyroidism.. (people with overly high levels of thyroid hormones and consequently low TSH ).. but you are hypothyroid . your TSH is HIGH.

if you were ever to be to be overmedicated on levo , then it might be relevant to you , but at the moment your High TSH and low Thyroid hormone Levels present different risks of their own. Your GP will monitor your thyroid hormone levels and will not prescribe so much Thyroid Hormone that you become overmedicated.

Adequate levels of thyroid hormone are not a problem for bones .. in fact they are necessary to look after your bones .

You don't need to worry about thyroid hormones harming you unless you are taking too much of them.

See this study of patients on levo long term :


"Results: Cardiovascular disease, dysrhythmias, and fractures were increased in patients with a high TSH: adjusted hazards ratio, 1.95 (1.73–2.21), 1.80 (1.33–2.44), and 1.83 (1.41–2.37), respectively; and patients with a suppressed TSH: 1.37 (1.17–1.60), 1.6 (1.10–2.33), and 2.02 (1.55–2.62), respectively, when compared to patients with a TSH in the laboratory reference range. Patients with a low TSH did not have an increased risk of any of these outcomes [hazards ratio: 1.1 (0.99–1.123), 1.13 (0.88–1.47), and 1.13 (0.92–1.39), respectively].

Conclusions: Patients with a high or suppressed TSH had an increased risk of cardiovascular disease, dysrhythmias, and fractures, but patients with a low but unsuppressed TSH did not. It may be safe for patients treated with T4 to have a low but not suppressed serum TSH"

Also this one :


Also : see my reply to this post (3rd reply down) healthunlocked.com/thyroidu...

For a list of other useful post on the subject of low TSH /risks/ bones/ heart

I'm sorry if I gave you the wrong opinion. I'm not worried about myself being hypo and the affects of thyroxine as my bones are so bad and beyond anything now particularly at my age. I was thinking of my poor friend whose been on ppis and thyroxine for years to the detriment of her bones. It was just a link that someone posted up on the osteoporosis group that mentioned thyroxine amongst other meds.

ah ,ok ..... as long as you understand that thyroxine ( whether it is from your own thyroid ,or from replacement levo-thyroxine) does not harm your bones in any way .. TOO MUCH of it does ... and too little of it does.

You have too little of it ,, which is also bad for your bones , too little makes them more brittle and so more likely to break.

'Too much' is bad .. and 'Too little' is bad .. but the thing itself is essential for the proper function of more or less all of your cells , and if you don't make enough of your own thyroxine anymore ,you need to take replacement thyroxine ,so you have the right amount again..... or else all sorts of other problems will just get worse.

greygoose profile image
greygoose in reply to elaine2447

Totally agree with Tatty. This has nothing to do with you. You have a long, long way to go before your dose is too high, and you'd probably feel ill before you got to that point.

But, these studies are flawed, because they don't take T3 into account. Low TSH in and of itself, has no effect on bones, that's not its job. But, sometimes, when the TSH is very low, it's due to high FT3, which is not a good thing and will affect bones, along with a lot of other things. So, none of this is anything for you to worry about. :)

SlowDragon profile image

If you regularly get up for the loo in the night ….take levothyroxine then

Many members do this

Get a weekly pill dispenser……keep it in the bathroom….take your levothyroxine in middle of night

Insomnia is extremely common hypothyroid symptom

You should see significant improvements once you get on a decent dose (typically at least 100mcg per day)

Dose is increased slowly upwards in 12.5mcg or 25mcg steps over many months

Roughly how old are you

Standard starter dose of levothyroxine is 50mcg unless over 60 years old

Have you had vitamin D, folate, ferritin and B12 levels tested recently?

Thank you you for your reply.

I couldn't rely on taking it in the middle of the night as then i would never get any sleep worried if i would wake up. I only get around 4 to 5 hours sleep if i go to bed at midnight as by 4ish my neck and head are raging from lying in the one position on my back. A chiro caused some damage 22 months ago cracking my neck.

I have been gluten free for 6 years and it has made no difference to how i feel or to my antibodies which are very high.

I am not coeliac and all the other blood tests I have had done came back as normal and aged 74

Sadly i know that thyroxine can cause bone density loss, as does long term SSRi's and SSNR's (mirtazapine) and gabapentin etc.

SlowDragon profile image
SlowDragonAdministrator in reply to elaine2447

So what are your most recent vitamin D, folate, ferritin and B12 results

Can you take levothyroxine when you wake

Eg 4-5am

I am desperate for sleep and so didnt have a good night last night but eventually dropped off and came to about 7ish. I am not a reliable sleeper.

Vitamin D 98.00, Active B12 160, Ferritin 54.70, folate 22.4 with Medichecks

SlowDragon profile image

Very helpful profile

Have you had coeliac blood test done

Are you on strictly gluten free diet

Anxiety is common hypothyroid symptom.

Also common with gluten intolerance

Can I throw into the mix that when I started taking the calcium and vitamin D prescribed my the osteoporosis nurse the calcium prescribed was calcium carbonate which totally messed up my gut. My GO prescribed a different calcium / vitamin D tablet which was just as bad it was then that I discovered that calcium carbonate is cheap and nasty and can really upset the gut.

In the end it was decided that I get enough dietary calcium so I could stop the calcium tablets. I now top up with one capsule of seaweed based calcium a day (just to be on the safe side) and I also buy my own D3 capsules. Basically I was having too much calcium carbonate (and compared to the amount I would normally take) not enough D3.

If you look through this leaflet Elaine you will see that there are a lot of calcium rich foods that you can eat. I tend to top up through the day with the foods that I like - I hardly ever drink milk and I don’t like yoghurt either but I do eat some cheese. There is a similar leaflet for vitamin D3.


Also it’s an overactive (hyper) thyroid that leads to osteoporosis - an overactive thyroid has a very low TSH - mine was <0.03.

Your TSH is that of someone with an underactive (hypo) thyroid. That will make you feel pretty awful too but in a different way to being hyper.

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