on reading the insert leaflet they advise against having caffeine for an hour after taking your tablet. I’m wondering what other people do about that as I could swap my morning cuppa for a caffeine free one or take at bedtime instead. My dose has gone from starting on 50mg in May 2023 to 75 in September and now up to 100 today. Am I not absorbing the meds because of my morning cuppas I can’t help but question myself!!
caffeine and Levo: on reading the insert leaflet... - Thyroid UK
caffeine and Levo
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BrocksfieldJo
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Buddy195Administrator
I like to have my thyroid meds in a pot by my bed and take it as soon as I wake up with water. I do this early enough that I can have a lie in before I have breakfast (with an espresso!) Others take their Levo before bed…..it may be worth trying this if you can’t wait an hour in the morning before having a coffee.
Having key thyroid vitamins optimal will hugely support your thyroid health. Have you checked ferritin, folate, B12 and vit D recently?
No I’ve not had my vits tested ever but I do eat a very good home cooked diet. I had thought VIt D might be worth taking though.
We 100% recommend testing key thyroid vitamins. It is important that these are optimal as opposed to what GPs might say is ‘normal’ or ‘within range’. It’s also useful to share thyroid tests for TSH, FT3 and FT4 (with ranges as these can vary between laboratories)
If your GP is unable to complete all the above (eg if TSH is within range, some surgeries may not be able to access FT4 and FT3 tests), you could look to do this privately, as many forum members do, for a better picture of your thyroid health:
No I’ve not had my vits tested ever but I do eat a very good home cooked diet.
You could be eating the best possible diet ever and still be deficient in some - or all - nutrients if you're hypo. Because being hypo probably means that your stomach acid is low, making digestion and absorption of nutrients difficult. Best to get them tested to be sure: vit D, vit B12, folate, ferritin.
Don't start supplementing without testing first, the results will give you a base line and tell you if and how much you need to supplement.
Post results and ranges on here for help interpreting. Don't just rely on your doctor's opinion, because doctors know nothing whatsoever about nutrients. 
thank you! Such a minefield. My Dad had thyroid cancer which invaded his larynx. He was 80 and he’d had a ‘lump’ for years which he ignored largely but I have wondered sometimes if we are connected health wise…….My husband is on 50mg and his GP never asks for bloods 🤷🏻♀️ My daughter is on 75 and her GP does keep an eye. Care is so varied.
My husband is on 50mg and his GP never asks for bloods
Your husband should book testing at least annually
For full Thyroid evaluation he needs TSH, FT4 and FT3 tested
Also both TPO and TG thyroid antibodies tested at least once
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
very, very unlikely 50mcg is high enough dose
ALWAYS test thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Testing options and includes money off codes for private testing
Medichecks Thyroid plus antibodies and vitamins
medichecks.com/products/adv...
Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins
bluehorizonbloodtests.co.uk...
Only do private testing early Monday or Tuesday morning.
Link about thyroid blood tests
thyroiduk.org/testing/thyro...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
Symptoms of hypothyroidism
thyroiduk.org/signs-and-sym...
Tips on how to do DIY finger prick test
support.medichecks.com/hc/e...
Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee
guidelines on dose levothyroxine by weight
Even if we frequently START on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose (approximately 1.6mcg Levo per kilo of your weight per day)
pathlabs.rlbuht.nhs.uk/tft_...
Guiding Treatment with Thyroxine:
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
Yes, care is varied, so it’s very important that we learn to be advocates of our own health. In the first instance, I would ask your GP for a copy of your thyroid blood test results and share levels with forum members in a new post.
Fi yes thyroxine taken with a glass of water i hour befo breakfast I take mine about 6 am
Some people take at night some can’t and some wake through the night. Depends what works for you I suppose.
I’m love my caffeine and am reluctant to give it up and I have found my one cup in the morning has increased to two and sometimes three as I’ve been struggling for energy. I’m trying to have hot water on waking and delay my coffee until 8/9am instead of hitting my system first thing with it at 6.30am. I know cortisol is high in the morning and adding coffee then isn’t supposed to be good. I’m feeling surprisingly better on the hot water but time will tell if I can sustain the new habit. Not sure if this will help you, I don’t want to give up coffee, I already gave up alcohol as it makes me feel awful and I don’t like tea. Good luck and if you go decaf the water decaf method is supposed to avoid nasty chemicals.
I take mine with water on waking and nothing but a fruit tea for an hour., that includes other meds. When timing is a bit short I wait at least half-an hour or the last thing before going out of the door.
I’m newly diagnosed a month ago. I thought you had to wait 30-60 minutes after taking dose so I’ve been having a relatively weak cup of tea with milk after thirty minutes . Wondering now should I be waiting longer though love my morning routine and cuppa. Seen some research that said people having coffee five minutes after dose made no difference , though there also does appear to be contradictory research
Calcium also prevents absorption. So really the only thing you can do, to ensure max. absorption, is water in the first 60 mins. No calcium for 4 hours. Thought I'd mention it in case the milk you use is cow milk or has calcium.
Thank you, I will wait an hour in future but may be grizzly!
You could take it before you go to bed?
Thank you! Is it as effective and do people still sleep well?
Could be more effective... it depends how sensitive you are to Levo so I'm afraid it's trial and error... I take it in the middle of the night when up for a pee
🍄 has added more info below 🤗
Thanks, might be worth trying maybe. I just don’t know if my body when asleep would be naturally creating that much hormone when it’s resting and resetting ? Whereas in the morning it’s all systems go ? (Hopefully! )
Having caffeine within an hour of taking your thyroxine can prevent you from converting the T4 into T3. I am a poor convertor so I have to ensure I take my Thyroxine away from caffeine and iron tablets. You could have your T4 and T3 levels checked to see how well you are converting.
Thank you, I didn’t understand that. I have had a test this week and awaiting results , four weeks on levo, so shall see if any changes . Is first time T3 checked so nothing to compare it with though. No calcium for four hours might be hard though
I have learned a lot from the people who contribute to this group. Because of them I have improved my Thyroid health. Check back in when you have your blood results.
Will do , thank you
helvellaAdministratorThyroid UK
I like coffee. A good strong cup to start and another late morning.
There is an option!
By the way, do you take milk? Because that might have as much impact as caffeine - there is little good research into such things.
helvella - Bed-time dosing of levothyroxine
Discussion about taking levothyroxine at bed-time.
helvella.blogspot.com/p/hel...
Is there any chance you could give a brief précis please as to whether there are any differences between time of dose. If I decided to take on a night would I need not to eat or drink for four hours beforehand ?
Pretty much the same as for morning doses!
Suggest a gap of two hours before taking the levothyroxine. But a four hour gap if you take iron or any of the other substances that very a very potent impact.
Thanks , I may try, but I suppose a glass of wine is forbidden in that two hour gap before dose?! Morning tea or evening tipple, what a choice ! My first thyroid tests were taken when I was also taking a vit b and a vit d supplement so not sure what that could have done, test was also after eating and drinking and near lunchtime. Would that have made results better or worse?!
Never seen any research on the effect of wine within two hours of taking levothyroxine!
Maybe I could be the Guinea pig , and would hopefully be a long study! I think wine has healthy riboflavinoids or something?!
Do the same empty stomach rules apply for Liothyronine (T3)? I take both, usually around 5-6:00 am then go back to sleep. I would like to try splitting the T3 but my meal times vary so much throughout the day that I find it really difficult.
This has been asked many times. Unfortunately, the answer is still much the same as ever. That is, there has been insufficient research.
Many who take T3 believe it is at least much less affected. Possibly not affected at all though that might depend on what you eat.
It is clear that levothyroxine is particularly susceptible to interference from many substances. That has not been claimed regarding T3.
Hi I was always a strong coffee girl first thing till I found out it was a no no. I swapped to black de caf Tea instead years ago. Then when I first saw an Endocrinologist he suggested taking it last thing at night instead. It seems to work ok for me.
Hi
I find this a pain. I put the alarm on for 7 am and take the tablet with water (both at bedside). I have a snooze and get up at 8 am. Trouble is sometimes, I fall back into a deep sleep. I have a cup of tea at 8 am - M&S extra strong. I always wondered what people meant by 30 to 60 minutes so opted for 60. (If I wake up in the night, I take it then so I don't have to wait an hour in the morning. Trouble with that is you might not remember in the morning that you have taken it during the night. )
I think tea is less harmful than coffee to levo. It took me years to figure out why having tea at night before bedtime kept me awake all night but strong coffee did not. It is because tea has a slow release of caffeine but coffee gives you an instant shot which does not last. Thus, if you want a caffeinated drink in the morning and you are taking levo, tea would be better than coffee.
As regards taking Levo at night, I think you have to wait around four hours so you can take it on an empty stomach, which is no good for me as I eat and drink late, and also take various other tablets - HRT and vitamins - at night.
Hope this helps.
I worried sometimes if I’d forgotten I’d taken my NDT early morning. I now have peace of mind to put NDT dose in a pill pot next to bed before I go to sleep. If empty in the morning then yes I took it, it wasn’t a dream!!
Thanks, good idea which I will adopt.
in reply to DelicateInput
I have a pillbox by my bed with days on it and I put each days thyroid meds in. When I go to bed I open the box for the next day so when I get up to go to the loo if it’s around 5-6 am I take it then. With water. So I know if I’ve taken it because the box is empty!
DelicateInput in reply to
Thanks, I will do this in future. Hadn't thought of it.
I have a 5am alarm, wake up (sort of), pour my levo from the pill pot next to the bed into my hand, take with a couple of glugs of water from the glass next to it, head down, asleep until the ‘real’ alarm goes off between 6 and 7 depending on the day. Some days I get up for a wee, some days I’m lucky.
Then drag myself out of bed sometime between 6:30 and 7ish and I’m good to go with the coffee.
i take my levothyroxine when i wake up to go to the toilet around 3/4am in the morning i down them with water, so when i get up in the morning it’s already been a few hours since i’ve taken my meds, hope this helps?
Take if you get up every night at 3 AM.
I try not to get up in the night tbf as I struggle to get back to sleep! Might have to be decaf tea in the mornings from now on
Personally I would have nothing for an hour after meds. But that's up to you and how you feel.
I have cut out caffeine altogether - finally. I have felt better for it for sure. We're all different, but it might be worth a try. On the other hand you may find that the increased dose does the job. Trial and error, I reckon.
For the better part of 15 years I took my levo and had coffee at the same time. There was no evidence that I could see that the coffee was affecting absorption...sometimes I felt better than other times, but as far as blood levels, eyc., yes, my dose increased over time but no one ever said "omg, what's happening!"
Then, this spring, as I've been trying to deal with a new metabolic issue (osteoporosis) and started taking two new supplements that wanted an empty stomach, I started waiting that full hour for my coffee. Not too much later, I saw an endocrinologist for the first time. By then, I'd engaged in many new habits that should have improved absorption generally, but wouldn't you know, his test showed my TSH high and other things low. If I hadn't been absorbing before, (my thyroid had berm checked y a naturopath five months earlier and all was normal,) you'd think I would've been at this point, and things might look better, but now I'm on 112 mcg from 100.
So, I don't know.
That was helpful, eh?
I set my alarm for 5am to take thyroxine as I know generally there's no way I will be eating / drinking in next hour. If I wake up before then I will take it. We need to give ourseleves the best chance otherwise if not absorbed we will suffer, so setting alarm early for me to ensure good health is a no brainer.Some take meds late at night, I cant guarantee I have an empty stomach them, you just need to work out what best suits you.
Good luck 🍀
I had the same problem. I swapped to taking it around 10pm so it's now at least 2 hours from meals and stop coffee at lunchtime. I couldn't bare to give up my morning caffeine hit.
I always wait for a least an hour before having my coffee in the morning. Take meds as soon as I wake up, get ready for work and drink coffee on route to work.
Whatever you decide to do, consistency is important.
Some people always take their levo with food and drink. Some people even advise that this is the best way to take it.
The late Dr. Blanchard said that taking thyroid hormone on an empty stomach (as we are told to do) will cause insulin resistance (which of course increases cravings and hunger). His recommendation was to always take thyroid hormone with food to avoid this.
Dr Ken Blanchard also noticed that some of his thyroid patients felt ill if they took levo on an empty stomach. He suggested take it with food but on the understanding you may need a slightly higher dose
Dr. Myhill also recommends taking it with food.
And It was recommended by Dr Peatfield who said that it's better for the stomach.
This can work if your dose is a bit higher than you really need to account for the potentially poorer absorption. But of course there is no scientific way of measuring how much you are not absorbing.
I take most of my dose in the morning as soon as I wake and wait at least 30 minutes, often longer, before coffee with milk. I take a smaller part of my dose at bedtime (just experimenting with this split dosing until next blood test). I try not to eat or drink too close to bedtime but don’t always achieve a suitable gap, so I’ll probably change back to taking all my dose in the mornings.
I take my tablet last thing at night before I go to bed. I like coffee when my eyes open 😺
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