Medication timing and coffee

[Mothebear]

I feel rather naff in asking this question. I know no meds (t3, t4) for 2 hours after a meal, and then no food for 1 hour after taking. Does this include black coffee if I eat breakfast at 9am (having taken t3 at 7 am), can I have a coffee say 11.30 am and still take my second t3 at say 12pm or does a black coffee constitute food? ( a dairy free, gf diet is bad enough!). Thanks for any information.

[jimh111]

The research shows that coffee and tea impair levothyroxine absorption if taken within one hour. If you want links to the studies click on my profile and see my posts

[Mothebear in reply to jimh111]

Thank you - it's t3 only as I take levothyroxine at 2 am, well clear of foods etc. Just wondered whether t3 might be different.... it was a long shot!

[jimh111 in reply to Mothebear]

There are no studies on T3 (liothyronine or NDT) as far as I know. Liothyronine is much more easily absorbed than levothyroxine although I would try to take it one hour away from coffee or tea just in case.

[PixieElv in reply to jimh111]

hi jimh111

Do you know about food and NDT? Is it the same levo?

Thank you

[jimh111 in reply to PixieElv]

Don’t know, there aren’t any studies. I would assume the same to be on the safe side.

[terebol in reply to PixieElv]

I am on NDT & have been for years. I go by the rule of meds 30-60mns prior to coffee/tea, food or 2hrs post. I used to supplement w/liothyronine (T3) and took that right after eating or drinking w/no neg. affects. Never found any research that showed absorption impact of T3 meds from food/drink. I put cream in my coffee so that is why I wait. Never have figured out why mfgrs. say wait 30-60mns after NDT or levo before eating/drinking. to be on the safe side, I wait 45mns.

[PixieElv in reply to terebol]

Thank you. I do that too, just to be safe, but it can be a pain, especially if your dosing 2 or 3 times a day.

[terebol in reply to PixieElv]

I feel fortunate as I have been able to single dose my NDT in the a.m. and it carries me throughout the day. I am a forager in the kitchen, and if I had to multidose on NDT or T4 only, it would be a disruptive change in my life.

[PixieElv in reply to terebol]

that’s me all over 😂 I am struggling with the multiple doses.

May I ask how much you take and when please?

[terebol in reply to PixieElv]

Certainly - I take 90mg NP thyroid. I take it when the dogs wake me between 6:15-6:45am, and that is all of the thyroid meds I take for the day. I had been on Nature-throid until pulled from US market & I ran out 3/2021. Struggled trying to use synthetic T4/T3. Finally made the switch over to NP last June. Took a couple of tweaks over 5mos to arrive @my happy place.

[PixieElv in reply to terebol]

I am so glad it works for you.

I take more than twice, so that probably won’t work for me 🙂

[terebol in reply to PixieElv]

as long as you can find what makes your thyroid happy. I don't know what makes it work for me & not many other people. I will consider myself fortunate!

[Mothebear]

Even one hour is much easier than two! Thank you!

[Regenallotment Ambassador]

I have a black decaff coffee 1 to 2 hours after Levo, not tried T3 yet. One thing I spotted from the more experienced is that if you have a consistent habit the absorption is levelled out as your dose settles with the routine. What you can’t for is chop and change if that makes sense. 🦋💚🦋

[Mothebear in reply to Regenallotment]

Thanks Regenallotment

Yes, that makes perfect sense and I am very consistent in my schedule. It’s just that I need two doses of T3 and about 4 - 5 hours apart to cover the better part of a day, so I genuinely find it hard to manage the hours from 8.30 breakfast to 5 hours later (1.30pm) then not eating until 2.30pm, if I can’t have anything after 11am. With Jimh111’s suggestion that one hour before is ok, this means I can have a mid morning black coffee and still take my t3 at 1.30. Hence I’m happy and no fear of gaining weight on this schedule!

Happy New year to you and all.

[terebol in reply to Mothebear]

I used to supplement w/liothyronine when titrating my NDT. I would take the T3 mid-day w/o concern for what I just ate/drank or what I was about to eat/drink. that never affected my FT3 levels. I never found any research or anecdotal info that said food/drink interferes w/absorption of liothyronine (T3). I remember reading that if T3 meds upset your stomach, take it with food No longer am I on T3 supplementation, but if I had to revert to adding it in, I would follow my old protocol

[HandS]

I had the same problems until I read on this group that’s ok to take t4 and t3 together in one go in the middle of the night - so away from food etc. I decided to give try it as I have very irregular daily schedules . Anyway - it’s been life transforming for me. I put a drink of water and the 4 pills at side of my bed and just take them at whatever time I wake in the night - usually about 3 or 4 am - and go back to sleep.

I now never worry about eating/coffee/meds or carrying t3 with me. But more than that - I feel better than I have for years.

Also, since doing this, my T4 increased slightly and T3 has increased nearer to the top of range when tested ; my Endo spoke to me about maybe reducing T4 - but I explained my regime change to him and told him how well I felt. He agreed to leave it and just requested a dexa scan for me - which I’m having next week.

We all have to do what works for us individually - and this has been life changing for me : I’d never have known about if not for this group

Good luck

[Mothebear in reply to HandS]

hi Hands

Thank you. I’m exactly the same… T3 has transformed my life, but I thought because of its speed of acting you take it when you need it…as in day not night, so I fear my ignorance may be showing,

Also my Endo wanted to lower my T4 last round and I said (thanks to medichecks blood results - nhs ones gave me lower TSH, though I’m better with that and T3 does suppress TSH I understand, but Endos still incorrectly use this measure) I need to leave everything where it is for now….I’ve got my life (more specifically my brain!) back. Also sent for Dexa - had done just before Xmas. Have to question the value of even my bones preserved if I have no brain. So yes, totally concur this site is invaluable!

[HandS in reply to Mothebear]

I had a dexa 5 years ago so time for another !

It’s complex, isn’t it. Like you, I’m very rigid about complying with a meds regime - but a few times I got to the end of a week with a dose of t3 left over - not because I’m forgetful but because I was dealing with a ‘crisis’ - not mine, but a dependant’s - that’s just part of normal life for me - and so no matter how organised , etc, I am, the regime can slip under such pressures.

I also very recently read about new research into the different ways in which we take meds (all meds - not just thyroid) greatly affects their efficacy. This is a ‘new’ area of research apparently ! But it really resonated with me : (it was in the general press) as I’ve had to deal with many occasions where complex prescribing and lack of advice on managing multiple meds (not for me) has caused problems.

Anyway -good luck going forward - I hope you continue to feel well

[Hidden in reply to HandS]

thanks for this. I read you need to take meds at same time each day. I was taking T3 and T4 when I woke in the night but as sometimes it varied a lot was worried and altered it to when I wake up later between 5 and 7 but get worried if not roughly the same each day. I was told to take Liothyronine in two separate doses, 10 mcg but finding it difficult spacing with food.

[HandS in reply to Hidden]

I take 125mcg T4 and 20mg T3 at whatever time I wake up - I don’t worry if it varies an a hour or two - what seems to be important is that there is a reasonable gap of a couple of hours either side of eating and drinking which allows for good absorption of the meds. I have not experienced any downside to this time variation .

Like you, I was told to take twice a day but whatever evidence that advice is based on, didn’t work so well for me .

We’re all different - I just find that this really works for me and I only learned of the idea from this Group . I think we each have to work out what suits us best - taking into consideration our lifestyle, other meds, etc. ?

Good luck with your meds x

[Mothebear in reply to HandS]

many thanks. X

[SeasideSusie Remembering in reply to Hidden]

Hidden

I read you need to take meds at same time each day.

It doesn't have to be at exactly the same time each day. It would be OK to "narrow" it down to "in the morning", "before bed", etc. I take mine in the early hours of the morning as I always have to use the bathroom but the time varies, it can be 3am, 4am, 5am and sometimes even 6am, so I just take it then. I am retired so don't have to be out of the house, having had breakfast, by a certain time so I still get the time gap between thyroid meds and food/drink, etc.

I was told to take Liothyronine in two separate doses, 10 mcg but finding it difficult spacing with food.

No you don't have to take two separate doses, you do what works for you. I took my T3 all at once with my Levo, then I split my T3 dose into 2 but found no benefit, now I've gone back to one dose with my Levo and that suits me. Many members are fine with one dose daily, some need to divide into 2 or 3 doses, just find what's right for you.

[Hidden in reply to SeasideSusie]

thanks. Will try this as will make life a lot easier especially as I have other medications I need to take as well,blood thinners and pain medications and was becoming a nightmare trying to space them all out properly

[DaisyJones1 in reply to SeasideSusie]

I hope you don’t mind me jumping in here, do you know whether this is also possible with NDT - rather than two separate doses to take one dose during the early morning? Thank you

[SeasideSusie Remembering in reply to DaisyJones1]

DJ1

Anything is possible. Just experiment and see what suits you best, we're all different and just need to find what is right for us 😊

[SBM7102]

My first coffee of the day is decaf and is usually within an hour of taking meds. Doesn’t appear to affect my well being.

[heathermr]

I take my T3 by dissolving it under my tongue. It has no taste and gets rapidly into my blood stream and start to work within about 5 to 10 minutes. The tongue and mouth have far more blood vessels than the stomach so the absorption is much more rapid than the stomach, and you can eat or drink after about 10 minutes. I take my T3 split into several doses through out the day so this is much easier and I find it much more effective than swallowing the tablet.

Heather

[Mothebear in reply to heathermr]

Thank you Heather. I think you may have answered another question I had which is, is it the food and T3/T4 mixing in stomach that affects uptake, or is it food and T3/T4 fighting it out in the blood stream?

If it is the latter than I figure taking it under the tongue is ok, but still don’t add food molecules in the stomach to enter the blood stream at the same time, cos this interferes with the T3/T4 uptake. You are implying the latter is not the case.

[heathermr in reply to Mothebear]

I only take T3, my TSH and T4 are undectable due to pituitary failure. Once the T3 slides into the blood stream it drops the sodium molecule as ions are carried independently in the blood stream. The T3 is then ready to work. Food in the stomach is broken down to its components which then pass into the blood stream but there is no direct competition with T3. My husband is a biochemist having worked with the human body all of his life so I don't need so called scientific papers.Heather

[tattybogle in reply to heathermr]

some people do say they 'take it sublingually' ..... but i'm sure i remember reading that T4 molecules are simply too 'big' (chemically) to pass though mucous membranes ... so even if you dissolve it in saliva your mouth .. it still has to make it's way down the throat to the stomach (and then to the relevant bit of the gut that does most of the absorption) before it can be absorbed into the blood.

Can't remember reading anything specific about T3 , but fairly sure i've read that about T4 from somewhere 'proper' .. can't remember where unfortunately.... perhaps someone else will have a scientific reference .

[Mothebear in reply to tattybogle]

thanks tattybogle

I think you will find it is T3 that people dissolve in the mouth, it has no taste and disperses very quickly. T4 is a different matter.

[heathermr in reply to tattybogle]

I don't know where the idea about t3 being too big to pass through mucus membranes like blood vessels came from but it really is completely wrong. After all the blood vessels in the stomach are no different to those in the mouth. The T3 dissolves in the saliva and slides through to the blood vessels in the mouth and tongue and directly into the blood where it drops off the sodium molecule which is carried independently in the blood as are all ions. The T3 is now ready to work. This is all basic biochemistry, ask any biochemist who has worked with the human body, like my husband.Heather

[tattybogle in reply to heathermr]

maybe i should have said 'oral mucosa' , rather than 'mucous membranes'. i was trying to say 'anywhere in the mouth tongue/ gums etc ' .

"The T3 dissolves in the saliva" ..... but does it ? ..... everything i've ever read states Levo does not dissolve in water. "Levothyroxine, the levo-isomer of thyroxine, is insoluble in water and in other usual organic solvents (11)" ncbi.nlm.nih.gov/pmc/articl... (Levothyroxine Therapy in Gastric Malabsorptive Disorders~ 2020)

So is T3 different in this aspect ?,

Most of 'the tablet' will certainly dissolve in saliva .(even a levo tablet does, if you forget to swallow it) , ie. the various fillers. carriers, excipients etc dissolve ,.. but the amount of 'actual' T4 (or T3) is presumably miniscule.. so how do we know that dissolved?

If the actual T4 (or T3) can dissolve so easily and quickly in saliva and be absorbed that way , then i can't understand how most of the Levo we take gets all the way past the stomach and is actually absorbed via the small intestine.

"Absorption and Bioavailability

Levothyroxine is mainly absorbed in the small intestine, more specifically through the duodenum, jejunum and ileum.10,11 Very little is absorbed in the stomach. Consequently, patients with shorter small intestines (bowel resection) have reduced absorption and require higher levothyroxine doses..."

We often read that gastric acid play's an important role in the process of absorption of Levo from the gut , and when it is reduced, the absorption is reduced , so this too always makes me wonder how it can be absorbed well via the mouth .

"The normal acid environment in the stomach is necessary for L-T4 absorption....The absorption of levothyroxine appears to be influenced by gastric pH.17,18 Centanni et al. demonstrated that in euthyroid patients suffering from nontoxic multinodular goiter, impaired gastric acid secretion or the use of omeprazole was associated with increased dosing requirements in order to adequately suppress TSH" ncbi.nlm.nih.gov/pmc/articl...

[TiggerMe Ambassador in reply to tattybogle]

I think    jimh111 has enlightened me in the past about sublingual use, wasn't a fan, better to just swallow.

Though I'm pretty sure Dr Peatfield was a sublingual man?

[jimh111 in reply to TiggerMe]

Don’t remember commenting on sublingual T3 but I might have, I get forgetful! I wouldn’t take T3 sublingually as it would be preferable to have a slower absorption to spread the dose a little. I know years ago people on forums used to suggest taking liothyronine with food to slow down absorption, it seemed to work, or at least nobody reported problems.

I take my T3 and T4 with orange juice three minutes before my porridge with a second dose of T3 at bedtime.

[TiggerMe Ambassador in reply to jimh111]

Ah yes, it was you, as I remember the OJ and porridge 🤗

[paddington]

I know what's recommended and what people on here say. However, I experience absolutely no difference if I eat, don't eat , drink or don't drink when taking my tablets. I have been taking them for over 30 years. I honestly believe you just have to find what's best for you personally, and stick to it. We are all different in the way we react to dosages, and this site promotes that view. So why does it state such a strict protocol, for taking tablets? At the end of the day we need to do what suits us best.

[tattybogle in reply to paddington]

mainly because it's a good idea to be consistent with whatever you take close to meds to ensure your effective dose isn't changing all the time. Absorption is proven to affected by a few food substances / other medications etc that have been tested already .. and therefore it's reasonable to assume it is affected by plenty of others. It would appear from the studies so far that people are individual in the degree of this affect. some more some less. But when giving advice especially to new patients , or to people experiencing problems , or people adjusting dose, it makes sense to rule out this variable as far as possible. And the easiest way to do this is to have a clear guide that is easily stated, hundreds of time a week . without having to go into complex explanations/ discussions every time .

Once poeple have understood the basics and are more experienced ,they will figure out for themselves how strictly then wish to follow this guideline. But if you didn't have it as a base line for advice , then it would be much harder to get to the bottom of some peoples problems .

So id' say it's 'strict' because it's the best way to manage such a busy information site and to rule out the simple 'variables' before you start looking into the reasons for whtaever the issue is .

I've always taken my Levo with Tea . consistently .and an hour before or 3 hrs after food. My dose has therefore been adjusted over time to take into account any effect my cup of tea has on reducing how much of it i actually absorb . Arguably, if i always had water instead. my dose may now be slightly lower than it is . But to me that is not an issue , i see no reason to be concerned about whether i have to take eg. 112.5mcg to absorb the dose i need, or 100mcg.

i don't experience any difference 'on the day' if i take food close to them or not, and i doubt anybody would ....a 'one off' is largely irrelevant the difference will be tiny but if i changed my habits consistently , then over time it might affect the fine tuning of my dose.

[Mothebear in reply to tattybogle]

hi tattybogle

Thank you.

I’m amazed you can take your Levo with tea if it’s white tea. Dr Child’s - see his YouTube video show what levo does in the milk in tea! As many are saying it’s what works for you.

All I know is I had such severe brain fog before getting T3, I reached a point that I wasn’t sure which side of the road to drive on and I had to slow my speech to wait to find the words I needed.

It was terrifying - that and about 20 other symptoms have all resolved or diminished significantly (including numb feet, trigger finger, frequent urination, severe cramps and all the obvious ones of coldness, fatigue, hair loss, dry skin etc etc etc) so without sounding dramatic, my life depends on my T3/T4 medication working, hence I’m willing to be a total stickler for taking it ‘correctly’.

[tattybogle in reply to Mothebear]

it's just the absorption (from the gut~ to the blood ) that is affected by milk/ tea , and any loss in that department is compensated for by an increase in the dose we take (as long as we are consistent in our habits).

Milk/ tea doesn't affect how Levo 'works' once its got through your gut wall to your blood ,

Levo doesn't have perfect absorption from the gut anyway , even in perfect circumstances it's only about 80% depending on the individual.

ie . if you take 100mcg you only get about 80 mcg in your blood , even if taken with empty stomach / water ,

So someone whose body actually needs 100mcg will end up on a dose of 125mcg.

So ....... if you mess with that absorption rate a bit more by taking your levo with milk in your tea, then perhaps you might end up only getting eg. 65% absorption rather than the 80% you'd get under ideal circumstances ,,, in which case the person whose body needed 100mcg will end up on a dose of about 150mcg .

But that's not a problem , since levo costs nothing, so who care's if you have to take 125 or 150 ,to get the same 100mcg into your blood ?

Once it's in your blood it makes no difference whatsoever if you had milk in your tea,

Obviously the considerations are different with T3/ NDT as it's not free , and it's difficult to get your hands on , so you wouldn't want to compromise your absorption of that, you'd try to make sure it was absorbed as fully as possible to keep the expense as low as possible and make your stocks last .

i don't go on u-tube ,, but curious.... what happens to levo in milk ?

if my dose is too low , i can't drive or cross the road safely either , or speak ,i totally get what you mean about having to slow down to find the words, and i am sensitive to even 12.5mcg adjustments in my dose ,,, but as long as my dose is ok i'm alright.,, well, as 'alright' as any of us get on here.... but on a good day i can go up scaffolding. even though i swallowed my Levo that morning with milk in my tea.

[FAB-jellybean]

Hi Mothebear, I always leave 2 hours after taking levothyroxine before i have coffee as it seems to be more sensitive and half an hour for liothyronine. Haven't had any issues with that.