Levothyroxine and calcium

[Nattycake]

Hello Just looking for any advice. I started on levothyroxine a week ago. I was told by the GP to take it in the morning and leave an hour before tea and coffee, I was then told by the pharmacist to leave 30 minutes so for the past week I have been leaving an hour after meds before having a coffee with milk and my cereal with milk! I have now seen that I'm not supposed to have calcium for at least 4 hours after taking the meds and just wondering what people do in regards to this as I work shifts earliest starting at 7.30am, it is going to be very difficult not to eat breakfast! I also know i could have toast for breakfast but i don't like consuming too much bread. Thank you 😊

[Forestgarden]

Hi there, I've been taking levothyroxine for years and I can tell that it takes about 45 minutes from when I take the meds to when I can feel them start to take effect. Personally I take my meds as soon as I wake up with a glass of water, on an empty stomach - so nothing to stop the meds dissolving then leaving the stomach and being absorbed in the intestines. I then have my breakfast about 1 hour+ after taking them. Sometimes that includes caffeine and dairy free milk (living dangerously ). Try and leave as long a gap as possible, and see how it goes. Alternatively many people take their meds at bedtime, so you could try that if its easier (never really worked for me)

[Forestgarden in reply to Forestgarden]

You could also think about alternative dairy free, caffeine free breakfasts....

[Nattycake in reply to Forestgarden]

Thank you very much for your reply. I thought I was being smart yesterday and had almond milk until I realised that also has calcium in it! I will see what my next blood test comes back with and if I feel its too much of an inconvenience I can try evening dosing 😊

[KrazyKatMT70 in reply to Forestgarden]

I use coffeemate in my coffee and switch to cream an hour later. Never had a problem. In fact I went through having an extremely low TSH. So I went from 137 mcg, to 125 mcg, to currently on 100mcg. And never changed my habits on my dietary intake of coffeemate , then cream .

[SlowDragon Administrator]

You can take levothyroxine at bedtime ……it can be much more convenient and perhaps more effective if 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

[smwdorset in reply to SlowDragon]

forgive me for intervening in this thread but slowdragon’s reply has raised some questions for me . I have taken 50mg of Levo for five years following a hemithyroidectomy and been fine - TSH around 1.4 and T4 c 20. But I’ve recently been put on rivaroxaban and omaprazole for paroxysmal AF and also on calcium and vitamin D to cover osteoporosis medication. (Evenity) that reduces both . I am struggling to fit them in - I was told to take the Levo first thing then wait half an hour and take the PPI then wait half an hour before breakfast . And told to take the rivaroxaban with evening meal and finally 80mg of statins at bedtime ( as the osteo medication seems to have doubled my LSL in the six months I’ve been taking it ) . I was told to take the vitamin D and calcium with food so have been having them with breakfast

My T4 is still ok though dropped to 19 but my TSH has nearly doubled to 2.8 and I am worried about the direction of travel

In view of what you say I am worried that the PPI is interfering with the absorption of the Levo . Also what has vitamin D and calcium got to do with absorption ?

I can’t get any sense from my GP . She’s asked my cardiologist if I can drop the PPI because that can actually worsen osteoporosis but she can’t get any reply

But I am worried about my thyroid function being affected by the PPI after five years being stable

any advice would be much appreciated

[SlowDragon Administrator in reply to smwdorset]

smwdorset

Suggest you get FULL thyroid and vitamin testing now

50mcg is only standard STARTER dose levothyroxine

Just testing TSH and Ft4 is completely inadequate

Atrial fibrillation can occur with low Ft3 or low Ft4

pubmed.ncbi.nlm.nih.gov/175...

60 patients (22.4%) had low FT3 levels (<2 pg/ml) and 24 patients (9%) had low FT4 levels (<0.9 ng/dl).

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)

is this how you do your tests

Or change to taking Levo at bedtime (or in middle of night)

Move statins to early evening, at least 4 hours before levothyroxine if you start taking levothyroxine at bedtime

Ppi must be at least 4 hours away from levothyroxine

PPI will also lower vitamin levels, especially B12 and magnesium, possibly iron too

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG 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

high cholesterol and being hypo

nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

[smwdorset in reply to SlowDragon]

Thanks so much. I have booked a medichecks test for next Monday morning. I've been doing them six monthly for years and results have always been fine but my GP did a recent test (TSH/T4 only) 4 weeks after putting me on high intensity statins and this showed a doubling of TSH hence my concern about impact of PPIs on absorption. I don't know why but 50mcg of levo has always been enough for me - maybe the other half of my thyroid must be working well. I had no problems until the (in the end unnecessary) hemithyroidectomy.

What about any gap between taking PPIs (or Levo) and the calcium/vitamin D my rheumatologist has put me on for the osteoporosis? Its a bit hard to leave a four hour gap between levo and PPI and then another long gap before food/calcium- meaning no breakfast before about 1100? How big a gap do I need to leave between PPIs and these other supplements?

The cholesterol is a new problem - it was always fine until six months ago when I was put on this new osteoporosis medication which promptly almost doubled the non HDL to 4.7 and increased the total to 6.7 . A recent finger prick test showed that the statins are working but I guess I could get that retested when I do the TFTs.

I hate taking so many drugs but with three different conditions (PAF, osteoporosis and artheroslceroma of carotid artery ) I guess there are bound to be interactions. There are not enough hours in the day to keep them all separate and also eat!

[SlowDragon Administrator in reply to smwdorset]

What about any gap between taking PPIs (or Levo) and the calcium/vitamin D my rheumatologist has put me on for the osteoporosis? Its a bit hard to leave a four hour gap between levo and PPI and then another long gap before food/calcium- meaning no breakfast before about 1100? How big a gap do I need to leave between PPIs and these other supplements?

You don’t need to leave gap between PPI and supplements

The cholesterol is a new problem - it was always fine until six months ago when I was put on this new osteoporosis medication which promptly almost doubled the non HDL to 4.7 and increased the total to 6.7

So osteoporosis medication (containing calcium?) likely affecting levothyroxine absorption……hence TSH increase

Low Ft3 can cause osteoporosis…….ie due to being on inadequate dose levothyroxine and still hypo and/or poor conversion of Ft4 to Ft3

thyroidpatients.ca/2018/07/...

Osteoporosis and iron deficiency

healthunlocked.com/thyroidu...

ALWAYS test FULL Thyroid and vitamin levels at least annually, ideally twice year

Test TSH, Ft4 and Ft3 at every test

[greygoose]

The small amount in milk will have next to no effect on absorption. And what effect it does have can be compensated by an increase in dose, as long as you always have the same breakfast every day. The four hour gap is for calcium supplements, which contain a much higher dose of calcium that the amount of milk you're consuming. Don't worry about it.

[Nattycake in reply to greygoose]

Great thank you 😊 it does state on the NHS website that the 4 hours is also for calcium rich foods such as milk but like you say a small amount should be OK!

[greygoose in reply to Nattycake]

I think so, yes. Consistancy is the key. If you always have the same amount, your dose can be adjusted to make up for it.

[Judrops64]

I take mine just after midnight

[FallingInReverse]

This one hits home for me!!!

My whole life, I drank 1/2 to a 3/4 gallon of milk every day. That’s about 3 1/2 liters. Sounds crazy, but no reason except I just loved milk.

Then I learned about this Levo vs calcium thing and now hardly finish one gallon every week or so. And yes - can’t even enjoy a good oat milk either!

I miss it so much! But I just drink water instead, and when I treat myself to Cheerios I enjoy it even more. So so sad tho!!!

[Alex_p]

I take 2 doses of levothyroxine and 2 of calcium, so there’s always a timing issue with them needing to be 4 hours away. I can tell you how I do it: I have set up alarms, first dose of levo at 5AM, eat breakfast at 9AM, first dose of calcium at 9AM, second dose of levo at 1PM and second dose of calcium at 8PM. When I take iron, I take it at 5PM and move the second dose of calcium at 9PM. When I take magnesium, I noticed that it interferes with my calcium absorbtion if I take them at the same time so I take it 2 hours after the second dose of calcium. My point is that given there are so many doses and them needing to be away from each other, I find it best to set alarms for each so that I don’t have to think about it all the time. I have a smartphone connected to my phone and it vibrates with every alarm, telling me what time it’s for.

[Capan24]

I've been taking my Synthroid at bedtime, 11:00 pm. This way I don't have to worry about food and other supplements. I usually eat dinner around 5:00, have a cup of tea at 6:00, and don't snack in the evening so my stomach is empty before bed. Works for me.

[Nattycake in reply to Capan24]

Hello, that sounds ideal. Unfortunately I am a shift worker so often find myself eating dinner at 7-8pm and going to bed at 10pm to be up at 6.30am so it's a bit of a logistical nightmare