Time if day for taking medicine

[FinneUK]

I want to try taking medicine at night. Is natural thyroid or thyroxin likely to interfere with sleep?I'm completely shattered all the time apart from waking due to work stress so I doubt I would notice a small effect.

[greygoose]

Speaking for myself, I don't find it makes any difference when I take it. But, a lot of people find they sleep better if they take it at night. You just have to try it and see how it works for you.

[FinneUK in reply to greygoose]

Thanks. I could definitely do with that.

[FallingInReverse]

My first reaction to your post is whether you are optimized in general.

“completely shattered all the time apart from waking due to work stress” …. Relatable!!!!!

In my early days of being really underwater with horrible free Ts I would so easily dip below the surface of functioning.

Now 18 months in and closest I’ve ever been to creeping up towards optimal, I am now struggling BUT functioning (sometimes barely sometimes ok.) A taxing work week by end of week (like today!) and I’m dragging.

Regards to Levo a.m. or p.m., I’m an upon-waking kind of person and also hear others here echo what gg says - try it! For me it’s been helpful to understand a little about the half-life of Levo being about a week, and so it’s not like T3 where there’s more a chatter about whether time of day matters. One thing I find interesting is to think about the 24 hour cycle of our hormones and the role T hormone plays. For example - I know the past I’ve taken my T3 mid day because it helped me perk up and not pass out for an afternoon nap. But I also take half my T3 at night - because our bodies are very busy at night making use of those same thyroid hormones for other purposes. So in one case it’s keeping me awake, and later on it helps with restorative sleep processes.

Reiterate what GG says - Id make sure nothing else is changing (doses, new vitamins, etc) and give it a test for a while. Whether you feel any different is worth a try finding out, and easy to switch back if it even matters.

[helvella Administrator]

helvella - Bed-time dosing of levothyroxine

Discussion about taking levothyroxine at bed-time.

helvella.blogspot.com/p/hel...

[FallingInReverse in reply to helvella]

Amazing!

[SlowDragon Administrator]

How much levothyroxine are you now taking

Previous post 10 months ago only increased to standard STARTER Dose of 50mcg

Typically dose Levo is increased slowly upwards in 25mcg steps until on approximately 1.6mcg per kilo of your weight per day

Unless extremely petite that’s going to be at least 100mcg per day

Are you still taking Metavive ……this will lower TSH and prevent you getting dose levothyroxine increase

ESSENTIAL to test vitamin D, folate, ferritin and B12 at least annually

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

[FinneUK in reply to SlowDragon]

I'm on 75mcg at the moment.

I'm not taking Metavive anymore for the reason I want NHS to treat, but if I don't get an increase after test today, in the long term I might try it again in addition as it felt very gentle.

I've taken Adrenavive for tiredness in the past but I am it bit wary it possibly resulted in me behaving more assertively than usual, then anxious about that, and then ultimately more stressed and tired.

Just got little time to think about it at the moment because I'm trying to keep going at work, but something is wrong as I have painful legs, feet (plantar fasciitis), hard to walk upstairs and am not functioning. I am getting older I must accept, but worry about heart failure or cancer. I suppose I should discuss with NHS GP.

[SlowDragon Administrator in reply to FinneUK]

75mcg is low dose unless very petite

What are your most recent results

Which brand Levo are you taking

Always same brand?

Plantar fasciitis common when under medicated or poor conversion rate of Ft4 to Ft3

And linked to low vitamin D too

Weak leg muscles can be hypo symptom…..and low vitamin D too

When were vitamin D, folate, ferritin and B12 last tested

What vitamin supplements are you taking

[FinneUK in reply to SlowDragon]

I'll see what the tests say when they come in and the set before which prompted GP to say I need to increase from 50mcg - I was too stressed by work to look at - so I don't know. It would only have been TSH I imagine.

[FinneUK in reply to FinneUK]

I won't get a further increase and I don't expect they will contact me as TSH is a bit over 2 and previously a bit over 4 which prompted the increase from 50 to 75mcg. In Feb 23 my FT4 was in upper part of range. FT3 has always been normal range in previous tests. I see my ferritin was 80 and IgM was abnormal in February. I might do Medickecks in a while.

I'm still going to contact the GP to discuss aches and pains and tiredness.

[tattybogle in reply to FinneUK]

TSh abit over 2 ... is still higher than is recommended for optimal treatment on levo. see these references and put some of them under the nose of GP : healthunlocked.com/thyroidu.... list-of-references-recommending-gps-keep-tsh-lower-in-range-

also , this shoe size analogy may come in useful : healthunlocked.com/thyroidu... the-shoe-size-analogy.

[FinneUK in reply to tattybogle]

Thank you. I will ask to try a further increase to 100 mcg, especially if they have nothing else to suggest.

[SlowDragon Administrator]

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

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.

Some people need a bit less than guidelines, some a bit more

Graph showing median TSH in healthy population is 1-1.5

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

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).

[Sat2]

I started taking levothyroxine in the morning as suggested by GP but found it difficult to take the tablets and then wait an hour before eating or drinking, I need to eat when I wake up. I swapped to taking them around 22:30 and have noticed no difference in my sleep but much easier to manage the medication around food intake. I don’t tend to eat after my evening meal around 17:30, if you tend to nibble through the evening I could see that being an issue affecting absorption, depending on what and how much you eat.

[FinneUK in reply to Sat2]

Thanks. good to know.

[Enuffisenuf]

I take mine at bedtime, and it made a noticeable difference to me.It had no impact on my sleep.

[FinneUK in reply to Enuffisenuf]

Thanks. I have now tried and I think I slept better! Still exhausted after a couple of hours though.