morning or evening

[Dirhams]

I have no thyroid and I am on 100ug Levothyroxine. Is it better to take morning or evening before bed. My dr says both are effective.

[pennyannie]

Hello and good morning Dirhams :

I think the main thing to consider is that any thyroid hormone replacement option needs to be taken on an empty stomach and you should take it with a glass of water and wait around an hour before you eat or drink anything -

and why I take mine in the middle of the night at a toilet break:

How are you doing - just looked back and see I wrote to you some months ago.

A fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1, T2 and calcitonin + a measure of T3 at around 10 mcg + a measure of T4 at around 100 mcg. with T3 said to be around 4 times more powerful than T4.

T4 - Levothyroxine is a storage hormone and pretty much inert until your body converts it into T3 and active hormone that powers the body.

Conversion of T4 into T3 can be compromised by low levels of core strength vitamins and minerals and we need optimal levels of ferritin, folate, B12 and vitamin D for optimal health.

There are 3 main treatment options but routinely the NHS only prescribe one - T4 - Levothyroxine.

Some people do get by on T4 monotherapy.

Others find that at some point in time T4 seems not to work as well as it once did and feel by restoring both T3 and T4 thyroid hormones they feel improved.

Some can't tolerate T4 and need to take T3 only - Liothyronine.

Whilst others find their health improved taking Natural Desiccated Thyroid which contains all the same hormones as the of the thyroid gland and derived from pig thyroids, dried and ground down into tablets referred to as grains.

The thyroid is a major gland responsible for full body synchronisation from your physical ability through to your mental, emotional, psychological and spiritual well being, your inner central heating system and your metabolism.

[Dirhams in reply to pennyannie]

Hi there - thanks for taking time to write - actually I'm feeling fine. Seems to be ding hat it needs and seems my blood tests are doing well too. Just found that the mornings are super busy and if I dont eat when I get up I dont eat until lunch time - hence the question of at night.

Not sure I am more or less stressed or anxious than normal - work though plays a big part on that and always has. Im actually pretty easy going.

[pennyannie in reply to Dirhams]

Good - glad you're doing ok -

I read breakfast the most important meal of the day and that you should put in the fuel before you plan to want to use it -

Car / petrol analogy !!

Otherwise -

Onwards and upwards - with or without this ' ding hat ' ???

[SlowDragon Administrator]

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...

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

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

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)

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

[Dirhams in reply to SlowDragon]

Thanks - I think I am going to try the bedtime routine. No food two hours before I believe is the way to go.

[SlowDragon Administrator]

Do you always get same brand levothyroxine at each prescription

Recommended that all 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)

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Monitor My Health now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65

(Doesn’t include thyroid antibodies)

monitormyhealth.org.uk/full...

10% off code here

thyroiduk.org/testing/priva...

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...

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

[Dirhams in reply to SlowDragon]

I always get the same brand - only had this operation done 9 months ago so not been getting other brands yet.

Thanks for all the links - I will take you up on some of them.

[SlowDragon Administrator]

How are you feeling on 100mcg Levo

That’s perhaps not much for a bloke

Depends on how much you weigh

[Dirhams in reply to SlowDragon]

yes - feel OK - weigh 85kg and 184cm. dont really suffer from tiredness or extreme anxiety levels - normal day to day work panics

[SlowDragon Administrator in reply to Dirhams]

So guidelines suggest eventual dose levothyroxine likely to be approx 136mcg per day (1.6mcg Levo per kilo of your weight per day)

So you quite likely need dose increase

Retest 6-8 weeks after changing to taking levothyroxine at bedtime

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

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.

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

[Hedgeree]

Hi Dirhams,

I split my levo dose so I take it during the night (25mcg) and also early afternoon (50mcg)

Hopefully at some point I'd like to take all of it during the night but as I'm still titrating up my dose of hormone and seem to be sensitive to it splitting is working for me.

[Dirhams in reply to Hedgeree]

Splitting will be tougher for me - firstly I won't remember and secondly I have a single tablet. One dose seems OK.

[Hedgeree in reply to Dirhams]

It is tougher and getting organised around eating meals can be a challenge. I only have a single tablet that I split into pieces. It works well for me as I'm sensitive to hormones so glad I do it this way currently 😊