supplements and medicines

[Cassie75]

What can you take with levothyroxine, i have just found out that taking omeprazole prescribed by my GP is a no no

[SlowDragon Administrator]

Why have you been prescribed omeprazole?

If you absolutely had to take it, it should be at least 4 hours away from levothyroxine

Any PPI Likely to result in even lower vitamin levels

what vitamin supplements are you currently taking

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)

Have you had dose increase in levothyroxine since last post

When were full thyroid and vitamins last tested

suggest you reread your previous post from year ago

healthunlocked.com/thyroidu...

[fiftyone in reply to SlowDragon]

what happens if you don't follow the above timings exactly? I take levo in the morning with a cup of tea about an hour before I eat.

[SlowDragon Administrator in reply to fiftyone]

fiftyone

You’re likely to only absorb about half the dose

If you ALWAYS take it the same way every day and can get GP to prescribe higher dose ……then you might be ok

But levothyroxine is extremely fussy and to get full absorption it should be on empty stomach and then nothing apart from water for at least an hour

No other medications or supplements within 2 hours

No calcium, magnesium, iron, PPI, HRT or vitamin D within 4 hours

[FearFracture in reply to SlowDragon]

When they say wait 4 hours after taking levothyroxine to take supplements, specifically calcium, does that mean you should also wait 4 hours to eat foods that contain calcium?

[SlowDragon Administrator in reply to FearFracture]

NHS says yes

nhs.uk/medicines/levothyrox...

calcium-rich foods, such as milk, cheese, yoghurt and broccoli, can reduce the amount of levothyroxine your body takes in. Leave at least 4 hours between taking levothyroxine and eating calcium-rich foods.

But again if you ALWAYS have same breakfast including milk/yogurt then it will affect absorption…..but same every day

[FearFracture in reply to SlowDragon]

Thank you. I have 8 oz of milk approximately 1 hour after taking my levothyroxine. In addition to hypothyroidism (hashimoto’s) I also have osteoporosis (July 2019 DEXA lumbar t-score was -3.9, December 2022 DEXA lumbar t-score was -3.6). The last thing I take before going to bed is a calcium supplement—research shows this reduces bone turnover markers during the fasting state. I will continue to drink the 8 oz of milk in the morning because I really don’t want my body to be deprived of calcium and release PTH to get it from my bones 🦴 Also, I like exercising in the mornings and I will not exercise unless I’ve given my body adequate calcium.

[Cassie75]

Hello

Thank you for your reply, my GP only test TSH once a year, my last test was December when it was 3 , I had foolishly taken my tablets when I woke up at 6am forgetting a 9:30 appointment. I was prescribed omeprazole for indigestion which I intend to stop and then have a private blood test in a couple of weeks. I also take glucosamine, omega oil and vitamin B complex.

[SeasideSusie Remembering in reply to Cassie75]

Cassie75

my GP only test TSH once a year, my last test was December when it was 3 , I had foolishly taken my tablets when I woke up at 6am forgetting a 9:30 appointment.

Taking Levo before a test doesn't affect the TSH result, it only affects the FT4 result. Levo peaks in the blood 2-4 hours after ingestion. Levo is T4 so by taking it close to your test you would be measuring FT4 at it's peak level rather than at it's normal circulating level, hence the advice to leave 24 hours between Levo and thyroid testing, but if all that is tested is TSH then it wont matter.

When you do your private test it should include TSH, FT4 and FT3 so it's important to leave the 24 hour gap between last dose of Levo and blood draw, also leave off B Complex for 3-7 days before the test as it contains biotin which can cause false results with any blood test.

A TSH of 3 is usually too high for a treated hypo patient, most feel best when it's around 1 or below. It's not about numbers, it's about how we feel but doctors see a result in range and don't bother about how the patient is feeling.

[Cassie75 in reply to SeasideSusie]

Thank you

[elaine2447]

Apart from being a no no with levo, taken long term causes osteoporosis.

[Miffie]

Taking omeprazole with Levo isn’t necessarily a complete no no. It’s important to get the timings sorted. I take both and have done for several years. I have Barrett’s oesophagus, hiatus hernia and gastritis. With out PPI life was miserable. I take thyroid hormones in the middle of the night or very early hours of the morning when up for the loo and then PPI an hour or so after other medications on rising and again in the same routine early evening. I do have to watch vitamins but haven’t felt omeprazole taken usually at least 5 hours away from everything else OK.

Hopefully you won’t need it for too long. Good luck .

[Cassie75 in reply to Miffie]

Thank you

[FearFracture]

I have hypothyroidism (hashimoto’s) and osteoporosis. My new gastrointestinal told me omeprazole was bad for bone density and switched me to famotidine.

[Locky1971]

I was prescribed that by my GP. But people with underactive thyroid are more likely to have low stomach acid. So taking PPI s can make it worse.Personally I started taking Marshmallow root capsules at bedtime. Working great for me. No acid reflux and if I have a bad night I use gaviscon.