Levo at night

[ChickieBaker]

If I take my Levothyroxine at night do I really have to have it with a large glass of water. I'm already having to get up in the middle of the night for the bathroom, I don't really want to have to get up twice !! Thanks.

[seveneleven]

Nope, no need. Just swig it back with a small mouthful, same as any other tablet. If it goes down, that's what matters!

[jimh111]

The suggestion is because the tablet can dissolve and get stuck but I don't think it happens. With a tablet I just get some saliva on it and then swallow with a little bit of water. You can always use a little more water if it doesn't go down.

[helvella Administrator in reply to jimh111]

It does happen with tablets that are super-disintegrators - the most reported being the reformulated Pfizer Levoxyl around 20 years ago! The previous version was dire and clearly did not disintegrate properly. When forced to do something they perhaps went over the top. The new tablet would start puffing up as soon as it was dampened.

I think the important excipient was croscarmellose.

The other issue is that a single tablet, with almost no water, can result in that tablet affecting a tiny area of the stomach. Whether that is the active ingredient, or one or other excipients, won't always be clear.

Like so many things, actual research has been limited and I suspect there is many times more locked away in pharmaceutical company records than everywhere else put together.

[Knittergirl3 in reply to helvella]

I know this is an old post but I’d love to find more info about Levoxyl melting in my mouth. A year ago I switched to Levoxyl white 50’s and the first thing I noticed is that they disintegrate so quickly when I take them. Does this impact the amount of medication that I’m actually getting? I ask because my Levoxyl experience has been much different than previous Synthroid and generic levothyroxine, in that with Levoxyl I have more of a TSH.

If there are any links or information about Levoxyl I’d love to explore this more.

Thanks

[helvella Administrator in reply to Knittergirl3]

It is not the only formulation that disintegrates quickly - but might be the only USA product (I don't know).

The company information continues to say:

Instruct patients to take LEVOXYL as a single dose, preferably on an empty stomach, one-half to one hour before breakfast with a full glass of water to avoid choking or gagging.

pfizermedicalinformation.co...

I don't think there is any reason to suspect getting a lower dose due to disintegration so long as you follow the advice. If there were, the FDA would by now have acted, I'm sure.

[Knittergirl3 in reply to helvella]

Thanks. Levoxyl has been a puzzle since I started it. Taking it mornings resulted in a little more tsh than levothyroxine and taking it at bedtime a lot more tsh. I’m sure the bedtime dosing has to be impacting that. I don’t want to change back to mornings though because I got a nice ft3 boost when I switched to bedtime.

[Gingernut44]

If you are already getting up in the night for the loo, why don’t you take your Levo then? Lots of people already do this.

[Sparklingsunshine in reply to Gingernut44]

I'm a hot drink lover, I dont drink fizzy drinks or squash so I started taking thyroid meds at night when I get up for the loo. I like to start my day with coffee so didnt want to wait for an hour. I just get them ready next to the bed and keep a bottle of water handy.

[Gingernut44 in reply to Sparklingsunshine]

You should have addressed this to ChickieBaker

[Blissful]

I believe it is vital to drink a decent amount of water - T4 is designed to be destined/absorbed via our jejunum:

healthline.com/human-body-m...

I don't know what time "middle of the night" is for you (to me it would be about 2pm) - I usually need to wee around that time and that's when I take T4 with a glass of water - I don't need another wee until around 7pm when I wake/get up).

sleepfoundation.org/nutriti...

[kiefer in reply to Blissful]

Just keep in mind that the more water you drink, the more you raise the pH in your stomach. Levothyroxine is primarily absorbed in the small intestine, but 1it has to be dissolved first, which requires a low pH.

"The solubility of LT4 tablets at 30 minutes is approximately 100% at pH 1.2 and 2.4. Its solubility decreases substantially to less than 60% at pH 4.0, regardless of the brand. The nadir is reached at pH 5.0, where the percentage of dissolution at 60 minutes decreases to less than 40%."

academic.oup.com/edrv/artic...

"A glass of water immediately increases gastric pH in healthy subjects"

pubmed.ncbi.nlm.nih.gov/184...

"Levothyroxine Therapy in Gastric Malabsorptive Disorders"

ncbi.nlm.nih.gov/pmc/articl...

"Levothyroxine treatment and gastric juice pH in humans: the proof of concept"

ncbi.nlm.nih.gov/pmc/articl...

Perhaps one way to combat this is to take a vitamin C 500mg tabet (ascorbic acid, not the buffered kind known as sodium ascorbate) which is effective in lowering the pH and improving T4 efficacy:

"Effect of vitamin C on the absorption of levothyroxine in patients with hypothyroidism and gastritis"

pubmed.ncbi.nlm.nih.gov/246...

[Blissful in reply to kiefer]

Perhaps one way to combat this is to take a vitamin C 500mg tabet (ascorbic acid, not the buffered kind known as sodium ascorbate) which is effective in lowering the pH and improving T4 efficacy

Good thinking Batman!

[Gingernut44 in reply to kiefer]

Are you saying that everyone should take their Levo with a glass of orange juice ?

[kiefer in reply to Gingernut44]

A 'glass' of orange juice (8oz) has about 24 grams of sugar in it, vitamin C doesn't. I would stick with water.

[Ellie-Louise]

Before getting into bed, I have a gulp with each tablet (2) and then another 2 gulps for luck.

[Me2U]

Must admit I do not have a full cupfull of water,sometimes just a few sips but after reading Blissful's comment sounds as if it is indeed important to do so.

[Ronnielady]

I started working from home once the pandemic hit so I'd take mine with my first cup of tea and breakfast. 3.5yrs later my thyroid blood test was 55 shouldn't be more than 5. Doc asked me how I took my meds. I got a very stern answer back. You take levo 1st thing in morning before you eat and drink caffeine. You don't eat or drink caffeine for 30 mins after. My response was I've been doing my way for 3.5yrs. He asked if I read the leaflet. Of course not. Anyway when I got home....there it was in the leaflet. My jump in TSH is likely down to now discovering I tested positive for Hashimoto's and after going onto 100mg it came down too 13. Previous blood tests were within range or slightly over.

[SlowDragon Administrator in reply to Ronnielady]

On levothyroxine TSH should always be below 2. Most people when adequately treated will have TSH around 1 or less

At least an hour between Levo and tea or coffee

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)

may be more convenient and perhaps more effective if Levo is taken at bedtime or in night

verywellhealth.com/best-tim...

markvanderpump.co.uk/blog/p...

markvanderpump.co.uk/blog/p...

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

[JacquieCB in reply to SlowDragon]

levo gives me an energy boost so I take it in the early am.

[SlowDragon Administrator in reply to JacquieCB]

Levothyroxine is a storage hormone, it takes a few days for each dose to be ready for use

[ChickieBaker in reply to SlowDragon]

How will I know when I'm on the right dosage ? Whilst I do have lots of symptoms some of them could be down to other issues so I probably can't totally rely on all my symptoms getting better ! My Dr is going to test my TSH in 8 weeks and at some stage I'll do another medichecks test as I also need to keep an eye on my CRP and ferritin which were out of range.

[SlowDragon Administrator in reply to ChickieBaker]

Retest 6-8 weeks after starting to take levothyroxine correctly

Meanwhile get vitamin levels tested via GP if possible

Are you on gluten free diet, if not get GP to run coeliac test BEFORE you try gluten free diet

[ChickieBaker in reply to SlowDragon]

The doctor has asked for a blood test in 8 weeks for the TSH. When you say taking the Levo correctly what do you mean ? I’ve been gluten free for nearly 3 years since I was first diagnosed with Hashies.

[SlowDragon Administrator in reply to ChickieBaker]

Apologies…..

Didn’t realise the post that talks about not taking levothyroxine correctly wasn’t you ..it was Ronnielady

Ignore that then

[SlowDragon Administrator in reply to ChickieBaker]

So you are highly likely under medicated and in need of dose increase in levothyroxine

See what results show

GP highly likely only testing TSH….plus Ft4 if you’re lucky

You need FULL thyroid and vitamin testing

Vitamin D, folate, B12 and ferritin

ALWAYS book early morning test ….ideally just before 9am ….only drink water between waking and test and last dose levothyroxine 24 hours before test

What vitamin supplements are you taking

Have you tried dairy free too

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

NHS England Liothyronine guidelines July 2019

sps.nhs.uk/wp-content/uploa...

Page 9

Test for Deficiency of any of the following: Vitamin B12, Folate, Vitamin D, Iron

See page 13

1. Where symptoms of hypothyroidism persist despite optimal dosage with levothyroxine.

(TSH 0.4-1.5mU/L)

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

If GP still won’t increase after test in 8 weeks request referral to endocrinologist of your choice…..or see privately

List of thyroid specialists and endocrinologists

healthunlocked.com/thyroidu...

[Dona31]

Never take it at night,I used to and doctor went through me cause with my bloods results it looked like I wasn't taking my tablets, take it first thing in the morning with water only and wait 30 minutes before any other meds or food and drinks

[helvella Administrator in reply to Dona31]

Whereas I do perfectly fine taking it at bed-time - and have always done so.

[Gingernut44 in reply to Dona31]

I don’t understand why unless you were taking it to close to your last meal or other medication/supplements. I like my coffee as soon as I get up so taking my T4/T3 at bedtime works perfectly well for me.

[Duchy82]

I take my levo at night and and have done for over a decade. I only have a couple of gulps of water with mine, no more than half a small glass and have never had any problems taking them that way, so I'd say you'd probably be fine reducing the amount of water you take with the tablets.

[LizzieAFib]

I take my 2 tablets of Levo at bedtime with approx 3 sips of water. Therefore I’m taking it hours after eating no hours before eating, plus, better time lapse between taking Levo and having blood test.

[Phil865]

I have made it a habit to take it around 3:00 am when I get up to pee. But not as much water as they say.

[Blobby1234]

I don't know how old you are but once you hit 50 you're up for a wee in the night whatever other complant you have! Sorry to be the bearer of bad news.

[Sunflower535 in reply to Blobby1234]

Not always the case - I am nearly 60 and am only up very occasionally - but I do stop eating and drinking by 6pm - maybe that makes a difference

[D99333309 in reply to Blobby1234]

Rubbish, I'm 62, NEVER need to get up in the night, and my hubby 61 very rarely has to.

[helvella Administrator in reply to Blobby1234]

Virtually never!

And 50 is very much in the rear-view mirror.

[Blobby1234]

Must just be and my husband then!😅

[Eddie83]

Who said you need a large glass of water?? I take mine with just enough water to get it down.

[millie8309]

I take mine first thing in the morning but don't have anything to eat or drink caffeine for at least 1/2 after you have taken it. I've been doing this for 20 years. Hope this helps.