Breakfast Habits in Patients Using Levothyroxine: Patient Experiences and Preferences

[helvella]

A regular point of discussion here!

It is yet another mystery why the issues of taking levothyroxine in a fasting or non-fasting state, despite being discussed for decades, still require research like this.

I think the authors have tried to avoid actually patient blaming - nonetheless, I think quite a bit of the paper actually does point its finger at patients. Whether taking too close to food, or missing doses - or whatever.

I suggest that one reason is that few patients have ever had this issues properly explained by the healthcare system - pharmaceutical companies, GPs, pharmacists, specialists, etc.

We might get told to take it every day, at the same time, and away from food. But I doubt many have had someone explain the details. The need for consistent, accurate dosing, and not achieving that can result in a roller coaster of thyroid hormone levels.

The impact of breakfast - or even tea or coffee.

Actually pointing out things like the percentage effects on the dose.

Most if it is quite readable but it does suffer from a feeling of repetition.

Still, it upholds the tradition of thyroid papers - more research needed.

Breakfast Habits in Patients Using Levothyroxine: Patient Experiences and Preferences

In conclusion, our study highlights the significant challenges and burdens associated with postponing breakfast to adhere to the current recommendation for fasting LT4 ingestion, leading to nonadherence, irregular LT4 intake, and omitting breakfast with potential adverse effects on QoL and cardiovascular health. Given the clear preferences towards LT4 ingestion together with breakfast, further research into alternative nonfasting administration methods without compromising treatment efficacy is warranted.

europepmc.org/article/PMC/P...

[Joant24]

very much blames the patients I would say 😔

[Tina_Maria]

The problem is that hypothyroidism is a long-term condition and as with many long-term conditions requiring daily medication, consistency and compliance can become difficult over time. It is not the patients fault, it is just a consequence of chronic conditions.

It requires discipline and a set routine to take your medication, then fast for at least half an hour and then have your breakfast. You need to plan this around your daily routine, so ensuring you have enough time to get ready to go to work, or drop your kids off at school or catch the train..... And patients do get sick from time to time, so that routine can easily get upset and hey hum you forgot to take your medicine. After all, we are just human.

So fast forward 20 or 25 years you have had this chronic condition, and you may have developed a good routine that work for you. However, if something out of the ordinary happens - it can throw you or your well-planned routine. And it is certainly not intentional that medicines are forgotten, and I am sure that particularly thyroid patients would rather take their medicine than have the unpleasant symptoms that go with it.

And researchers should perhaps focus on thyroid patients being optimally treated in the first place, so when they do forget their medicines on occasions, it does not have such a dramatic impact than for patients that have already been under-treated to begin with!

[helvella in reply to Tina_Maria]

If someone goes from being unwell to much better, then they might better appreciate the medicine.

If they go from unwell to a slightly different unwell, they are unlikely to feel the importance of taking consistently.

[Staffsgirl]

It would be helpful if one could adhere to this regime when in hospital. When I had a stay in hospital, the staff point-blank refused to enable me to take my medication away from food. They would not leave the medication with me, to take at a better time: I had to ingest it when it was delivered, which was often within an hour either side of breakfast. In retrospect, I wish I’d been more assertive!

[Tina_Maria in reply to Staffsgirl]

I had the same problem a few years back. However, I always carry a small amount of medicine with me all the time, just in case. I know, a bit OCD, but hey!

I just continued with my own medication at the hospital and told them that I already had my levothyroxine when they finally turned up with it at 10am!

[Staffsgirl in reply to Tina_Maria]

Rather stupidly, when they asked for any medication I had with me, I didn't hide the fact that I had brought all mine with me. They confiscated it all!😳

[Tina_Maria in reply to Staffsgirl]

I don't think they are legally entitled to do that.... I know they argue that they want to control what medication you take, however, it is your right and decision to take your levothyroxine according to your schedule, so they have to agree!

Or if they still insist, you can ask them to give you your thyroid meds the evening before, so you can take it upon waking.

[Staffsgirl in reply to Tina_Maria]

You’re right, but when you’ve been admitted as an emergency, and had surgery, you feel very vulnerable and aren’t thinking straight or wisely!

[Tina_Maria in reply to Staffsgirl]

That's true... 😢

[Mostew in reply to Staffsgirl]

If it was a few days whilst feeling woozy I doubt it would matter missing 2 or three tablets?

[arTistapple in reply to Staffsgirl]

I am training my husband. However there is a problem (or a number of problems) in that he has no ‘vision’. He does not comprehend the circumstances. I would be in hospital where I was getting cared for. Duh!

[Staffsgirl in reply to arTistapple]

Mine would be useless! Doesn’t help that he’s disabled.

[RydeBeach]

When taking T4 in the evening how long after food is optimal please?

[helvella in reply to RydeBeach]

Lots of opinions - I think this paper mentions three hours but we typically see two to four hours. Though it does make a difference whether you are talking of a small snack or a full meal!

[RydeBeach in reply to helvella]

haha that makes sense! Thank you

[TSH110]

Interesting they suggest higher doses and no starvation might be a more sensible approach given how some struggle with it. Also it amused me that the miscreants had better readings than the compliant! I’d say some of the medical profession need to smarted up their act on the instruction front according to the stats they give in this paper.

It made not one iota difference as far as I could tell if I glugged a cup of coffee close to taking it or not and same with NDT . I wonder if there’s well researched data available on how much is absorbed and how it varies over time with food ingestion? I supposed there must be studies of this kind to support the no food for a hour beforehand and two after I was told….or perhaps it was the other way round. I did adhere to it where food was concerned, I seldom feel like eating before 2pm - weird or what?