When to take meds: Hi, my ffirst post so... - Thyroid UK

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When to take meds

Poll8 profile image
27 Replies

Hi, my ffirst post so, apologies if you've answered this query before.Had toatal thyroidectomy 4 weeks ago after thyroid cancer diagnosis 18 months ago.

Been taking 125mg levothyroxine since the op. I take it when I first get up in the morning followed by emeprazole and high blood pressure tabs about 30 mins later and predisolone (steroid for polymyalgia) about 1 hr after that with breakfast..usually yoghurt/banana or porridge or if I'm in a rush, just a couple of biscuits.

I have my 1st cup of tea directly after taking my levothyroxine and usually another cup about 30 mins later.

I have read so many variations about not eating or drinking..they vary..30 mins/1hr/3-4hrs..same with meds...totally confused. Was given no instruction by consultant, who's been a bit blase all the way through this and can't even get to speak to my GP let alone an appt!

I feel absolutely fine..no side effects, no pain, no problems. Not had a blood test yet..no follow up appt. or blood tests arranged..waiting for appt. letter.

My sister has taken it for about 20 years.. same way I do..first thing..followed by cuppa and breakfast about 45 mins. later.

Interested to know how other people take theirs please.

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Poll8
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helvella profile image
helvellaAdministratorThyroid UK

This recent paper gives quite a good review of many of the things that can impair absorption of levothyroxine:

Levothyroxine: Conventional and Novel Drug Delivery Formulations

doi.org/10.1210/endrev/bnac030

Of course, if you always do exactly the same, then it is argued that your dose will be adjusted to take account of these factors.

But few of us are ever that precise. One day we leave it a bit longer for some reason. Or one of the medicines is changed. And we end up effectively having a higher dose!

The whole family of ***-azole medicines affect absorption significantly.

You always have the option of taking levothyroxine at bed-time. That's what I do!

Poll8 profile image
Poll8 in reply to helvella

Thanks for your reply. Will certainly read that article tomorrow (bedtime) Thought about taking at night but take take calcium just before bed (advised by rheumy for PMR) might see if I can change that. Emeprazole is to protect my stomach before steroids which I need to take as early as poss.

Everything is so connected to each other!

greygoose profile image
greygoose in reply to Poll8

Sorry, but how is calcium supposed to help PMR? Calcium supplements really aren't a very good thing to take, They are not easily absorbed and can build up in the arteries. Did you at least have your calcium levels tested before starting it? And do you have regular checks to make sure you're not taking too much?

Poll8 profile image
Poll8 in reply to greygoose

My rheumy says it is bone protection..along with alendronic acid, which i stopped taking because my teeth started falling out! Yes, I do have the levels checked..seems OK

greygoose profile image
greygoose in reply to Poll8

Well, I would disagree with your rheumy! He's been brainwashed like the rest of them. Too much calcium makes bones brittle, which is highly undesirable. Calcium is not a treatment nor a cure for osteoporosis. And more is not better. Alendronic acid is used as a treatment but I'm not sure how effective it is.

How is your vit D? Vit D and magnesium are far more important for bones than calcium.

greygoose profile image
greygoose

On here, we usually recommend leaving a gap of 1 hour after levo before eating or drinking anything other than water, and at least two hours before taking other medications or supplements. However, taking them all together is not going to cause you any pain or anything like that, it's just going to affect your absorption of levo. But, if you do it on a regular basis - and you have a reasonable GP! - the lack of absorption will be compensated by increases in dose. So, the difference is that if you took it our way, you would probably need less levo, that's all.

That is maybe not a problem if you're on levo and getting it prescribed by a doctor. But, if you're self-treating, and/or adding T3, that can be an important consideration.

Poll8 profile image
Poll8 in reply to greygoose

Hi, thanks for reply. Was hoping to get as low as poss. with levo so thinking absorption matters but need to think about other things I need to take into account too. It is prescribed by my consultant..dont really want to take chances by self medicating after thyroid cancer.Can I take it very early am. and then go back to bed? I usually wake up about 3-4am when my adrenalin kicks in..awake for about half hour then go back to sleep.

greygoose profile image
greygoose in reply to Poll8

Hoping to get what as low as possible?

You most certainly can take it in the early hours. A lot of people do that. Or, take it before you go to bed. Doesn't matter what time of day you take it, as long as it's a time that suits you. :)

Poll8 profile image
Poll8 in reply to greygoose

I was told, when I left hospital that the dose will be adjusted once I have had a blood test and review. This is the highest dose, I guess cos I've never taken it before and it needs to be worked out according to test results and how I tolerate it. I also had biopsies, so maybe those results affect it..this is all new to me

greygoose profile image
greygoose in reply to Poll8

There is no limit to doses. You need what you need. Levo is not a drug, it is a hormone. And your dose doesn't just depend on your numbers but most importantly how you feel. But, you do need a doctor who understands the numbers, and does the right tests. Most of them don't. You need:

TSH

FT4

FT3

And the most important number is the FT3, which they very rarely even test. Never let a doctor change your dose just on the basis of the TSH, which most of them do. Always insist on full testing. And, if you don't understand the results, post them on here, with the ranges, and we will help you understand. Be very, very careful, because doctors love to under-medicate!

Poll8 profile image
Poll8 in reply to greygoose

Thankyou for the advice..I wasn't aware of any of that so will make sure I get the right tests. Might have to work on getting my consultant to actually listen to me for a change..but getting better at that after 2 years treatments.

greygoose profile image
greygoose in reply to Poll8

I'm afraid there's quite a lot to learn if you want to get the maximum benefit from your treatment.

I sometimes think that doctors don't listen because they're afraid you might ask questions they can't answer and/or make suggestions/requests that they don't understand. Their training in thyroid is very, very limited and I think most of them know that they're out of their depth. Which, of course, is very embarrassing if you want to maintain your god-like status! lol But that's just my theory. I could be wrong. :)

Poll8 profile image
Poll8 in reply to greygoose

Haha..think you are so right. My consultant always tries to dismiss me with as little info as possible..I see his shoulders droop when I ask a question! I had to push for the op. so prepared to push for answers so that I get the treatment right for me

Poll8 profile image
Poll8 in reply to greygoose

I have dinner about 7.30 and usually a hot drink about 9 ish..thought I had to leave 4 hours after food before taking levo. Might try about lunchtime..take my pred about 9am so could take 4 hrs later...just have to experiment. Awful thought that my life is now dominated by pill timings..but I know I am not alone..and I am still alive..so no real complaints

greygoose profile image
greygoose in reply to Poll8

Two hours after food is usually enough. And two hours after pred should be enough.

Sparklingsunshine profile image
Sparklingsunshine in reply to Poll8

I always take mine in the wee small hours when I get up for the loo. Just keep some water next to your bed to swig it down with.

Poll8 profile image
Poll8 in reply to Sparklingsunshine

Hiya, so, its OK to go back to bed after taking it? I thought you couldnt lie down because it would have a detrimental effect on your throat. There are soooo many myths out there!

Sparklingsunshine profile image
Sparklingsunshine in reply to Poll8

I've never had any issues, I just make sure I drink enough water to wash them down. Which as they're pretty small isnt much.

Poll8 profile image
Poll8 in reply to Sparklingsunshine

That timing would actually suit me so much better..might give it a try..thanks

Sparklingsunshine profile image
Sparklingsunshine in reply to Poll8

It suits me as I take HRT and have to supplement B12, folate and vitamin D, more importantly it means I can start my day with coffee, which is non negotiable 😄. I think there is some research to suggest Levo is better absorbed at night.

Mazzer profile image
Mazzer

I noticed that you are talking omeprazole. This can inhibit absorption of your thyroid meds.

Poll8 profile image
Poll8 in reply to Mazzer

Hi, my consultant knows I take emeprazole as a stomach protection for my steroids for pmr. I also have diverticulitis and it wards against stomach ulcers. Guess it's just another question I need answers to 😄So much information I wasnt given. Obviously you all live with thyroid problems and are invested in solutions..thanks to all for your invaluable advice..will keep reading this forum and in the meantime will try to push for a consultant appointment.

greygoose profile image
greygoose in reply to Poll8

I also have diverticulitis and it wards against stomach ulcers.

I don't really think that's true. Stomach ulcers are caused by a virus which thrives in low stomach acid. If you're hypo, you already have low stomach acid, and taking omeprazole will make it even lower. So that would probably encourage stomach ulcers, not guarde against them.

Poll8 profile image
Poll8 in reply to greygoose

Hi..emeprazole was prescribed by consultant who diagnosed diverticulitis 3 years ago. The radiotherapy on my groin area kicked off a flare a couple of months ago and I spent 2 nights in hospital..they checked for an ulcer..nothing to see.. and told me to carry on taking emeprazole.. I really WOULD like to come off it eventually, like the steroids...slow slow taper ..but need to get all this other stuff sorted first. Will get there 👍

greygoose profile image
greygoose in reply to Poll8

Just as long as you know what you're taking and what it can do - and, more importantly, what it can't do! PPIs are one of the things doctors love to prescribe without really knowing much about them - bit like statins and anti-depressants. We have to be informed consumers to make sure what we're given is the right thing for us. It very often isn't.

Poll8 profile image
Poll8 in reply to greygoose

Abso!utely true! I know how bad the steroids and emeprazole are for me which is why i have refused to increase either dose..against docs. advice and luckily I'm still doing OK

greygoose profile image
greygoose in reply to Poll8

Remember to get your nutrient levels checked regularly, because the emeprazole will stop you absorbing them.

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