Timing of dosage

[NotAllWhoWonder]

Stumbled across something on YouTube that recommended taking levo just before bed due to low stomach and gastro activity while sleeping facilitating better absorption, and to better manage side effects (fatigue, etc). Also argued that first thing in the morning is very busy time for the gut, and the body has to deal with the cortisol spike, etc.

Decided to give it a go last night, and while I struggled a bit to fall asleep (nothing new - I've had sleep issues for more than a decade), I somehow managed to get a full 1.5hrs of deep sleep according to my Apple Watch, which is a great "side effect" (I usually average around 30mins, and my highest ever was around 1hr).

Thoughts? Opinions?

[helvella]

Have you seen my blog?

helvella - Bed-time dosing of levothyroxine

Discussion about taking levothyroxine at bed-time. Several linked references to relevant papers.

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

[greygoose]

A lot of people prefer taking their thyroid hormone at night. But it, like most things, it doesn't suit everyone. Personally, I don't find any difference.

However, I'm no expert but I question their reasoning:

- hypos usually have low stomach acid 24/7 but I cannot see how that helps absorption - quite the opposite, I would have thought

- if you always take your hormone on an empty stomach, be it late at night or early morning, there's no gut activity, anyway

- fatigue is usually a hypo symptom, not a levo side-effect and it's managed by taking enough hormone

- the morning is not a busy time for the gut if you haven't eaten and you shouldn't eat until one hour after taking iit

- the body doesn't have to 'deal' with the cortisol spike, the cortisol spike happens to help the body get out of bed and get ready for the day, and it doesn't happen in the gut so why would it make any difference to absorption - once again, quite the opposite I would say.

[thyreoidea]

that’s good if you are going in the right direction, let’s hope it increases even more. I tend to wake up whilst dreaming so not sure if REM sleep period as just finished. Just out of interest I am looking to get an Apple Watch, do you mind saying which model and what the battery life is like please? A private message if admin doesn’t allow a response to this product question maybe.

[NotAllWhoWonder in reply to thyreoidea]

Hi there. Mine is the Series 7 that came out around 3 years ago. I don’t use the always on function, so battery is still on around 60% when I put it on charge before I go shower every night.

[thyreoidea in reply to NotAllWhoWonder]

Thank you, food for thought regarding battery life.

[helvella in reply to thyreoidea]

I have an Apple Watch 8. Most often I charge it in the morning when I am using my computer for something - so take it off and plonk it on the charger which is plugged into my USB power brick.

Occasionally I forget and don't recharge until it warns me that if I don't charge before bedtime, it won't last the night! Always annoying.

And I do not use the always-on feature, though I tried it. It affects battery life just too much but is a useful option for some circumstances.

I assume you do already have an iPhone?

This link takes you to a so-called buyer's guide for the SE model. (And they have articles about other models.) In particular, they point out when new models are likely.

macrumors.com/roundup/apple...

[thyreoidea in reply to helvella]

Thank you, very useful.

[thyreoidea in reply to helvella]

Yes I have an iPhone.

[NotAllWhoWonder]

update: day 2, and slept like a log again (except for waking up for my early morning pee). Dreams were quite vivid! But felt very sluggish the whole day. Will keep monitoring.

[NotAllWhoWonder]

Been on the levo at night since Sunday, and have felt completely floored for most of the next day, every day. Not sure what the cause is, but it's this almost zero energy lethargy. Sleep has been amazing for the first time in what feels like years, though, so that's a plus. Had my follow up with my GP because my TSH reading finally came back: 4.56. Was 3.96 in August, and 9.06 in June (when I'd stopped taking levo completely when TSH was down to 0.19 in March and I didn't feel great).

Anyway, told him I had to basically drag myself around the flat everyday, so we've decided to go up to 50mcg, and then test again in a couple of months. I'll also have done my private test by then, but hopefully this moves me in the right direction. FYI, I started the 50mcg last night, and haven't felt as floored today (still not 100%, though).

[helvella in reply to NotAllWhoWonder]

That sounds fairly positive with the increase.

And maybe you were just about managing within the day - and being hypo all night every night? But not really noticing that much because you were sleeping and least some of the night.

But now you are ending up in that state during the day and really do notice it.

[NotAllWhoWonder in reply to helvella]

It’s only like 9hr difference between when I used to take it in the morning (8AM) and now at night (11PM). So if your theory is correct, I should’ve been hypo every evening after taking it in the morning, which I don’t recall. My symptoms have always been present during the day for some reason, and I actually feel “better” from around 8PM onwards. They’ve just seemed a lot stronger during the day this week that I’ve taken it at night. What is the half-life of levo? Could I be running out by the time I wake up?!

[helvella in reply to NotAllWhoWonder]

I understand what you are saying. But if you overlay all the various things that happen on a daily rhythm, some will emphasise a low thyroid state while others will seem to worsen it.

Not saying I know what exactly is happening, but trying to suggest that the simplistic approach we all apply sometimes needs to be revised in the light of experience.

[NotAllWhoWonder in reply to helvella]

Thank you. Yeah, I just hate having to wake up thinking like a scientist everyday just to try and feel normal.