Levothyroxine with breakfast? – Maybe not...

[helvella]

Happened to see two papers which compare taking levothyroxine in the morning well away from breakfast against taking it with breakfast.

The difference was, in my view, very significant in terms of TSH – which was all that they seemed to care about. Going from 1.06 (away from breakfast) to 2.93 (with breakfast) in one paper and from 1.9 to 2.89 in the other.

In some countries that would take people out of their standard reference ranges. And this is the processed, averaged, figure – some individuals will have shown even larger differences. Yet both papers calmly suggest this difference only matters if a precise TSH value is the target! (What happened to the concept of the patients being well as the target?) Reckon they are more or less saying that any TSH value in range would be good enough for most people. Not that many people here would agree.

Nonetheless, they do give some sort of measure to the difference it can make.

But the other important issue is variability. Both papers say that the TSH is more variable when taking it with breakfast. Which should not be a surprise. It is actually quite hard to have a breakfast with same impact every day. Maybe you switch between cereals (even between the "big brand" and a supermarket equivalent)? Or have a croissant on Sunday? Or a full English when travelling? Or tea with a little milk one day and coffee with lots of milk another day? Or fruit and toast when on a paradise island holiday?

The mean thyrotropin concentration was 1.06 +/- 1.23 mIU/liter when levothyroxine was administered in the fasting state. When levothyroxine was taken with breakfast, the serum thyrotropin concentration was significantly higher (2.93 +/- 3.29 mIU/liter).

ncbi.nlm.nih.gov/pubmed/195...

The TSH level was higher for levothyroxine administration during breakfast than during fasting (2.89 vs. 1.9 mIU/L, p=0.028).

ncbi.nlm.nih.gov/pubmed/233...

Rod

[shaws]

Thanks for that - if people aren't diagnosed - tuck in to a good breakfast.

[Hidden]

I wonder how many of us actually have breakfast?

now I make sure I have my vit D drops in a little milk, feed animals (previously fed kids) drag myself to work, then the 11 o'clock bell triggers the Pavlov thought that I should be hungry by now, nope, force feed banana or apple/fruit. (OK weekends - bacon & eggs brunch!)

or is it just me that doesn't feel like eating first thing? I know it's wrong, but I try to do everything else right! I gag at breakfast bars too, wish they made a bacon one! J

[isherwood]

No your not alone spareribs. I Always ate a breakfast asap until I turned 40, then could not bear to eat for several hours after rising, since. I have always taken my medication with my

first cup of tea, ie on an empty stomach. I think I was advised to do this when first diagnosed in 1966, and have continued to do so. Now aged 70.

[marram]

This research is irrelevant to me as I have almost always taken my Thyroxine at night, apart from the first few months when I foolishly listened to the doctors. Since they seem to know diddly squat when it comes to the thyroid I started taking it at night after reading a Japanese paper which concluded that most medication is more effective taken at night, and found that to be so in my case.

As far as breakfast is concerned, I always eat about one or two hours after waking - whenever that happens to be, depending when I managed to get to sleep!

[Lilybelle]

That is interesting but i have always taken my meds first thing with a cup of coffee for 22 yrs if ever i have taken it with breakfast this must of occured a few times over 22 yrs i havent noticed any difference.

[mirabelle in reply to Lilybelle]

I have always took mine in the morning around 7 o clock wait an hour drink my tea.then have breakfast only been on levo 25grms for 9 months so strtill adjusting.....

[Hidden]

I have for some time taken mine at night, don't feel any different for it but at least I can get up and have my breakfast without waiting. I have always believed that breakfast was the most important meal of the day, but understand that some (like my hubby) can't face anything in a morning. I do exercise classes so I need some sustinance before putting myself through the mill.

[thecookiemonster]

Like Isserwood, I take my Levo 100mcg as soon as I wake, its, habit, and I have my porridge about half hour later. My free T4

[thecookiemonster]

crikey don,t know what happened then, anyway my free T4 is 13.6 which apparently is normal & my TSH is 0.3 which I,ve been told is low but not suppressed. I hate to admit it, but this means nothing to me, I haven,t got a clue whether its good or bad. I have an appointment with an NHS Endo in March, but if someone from Admin could tell me if the above is OK I would be obliged, as I have been feeling really awful of late. Many Thanks, Kath

[Clarebear in reply to thecookiemonster]

Hi Kath - we need to know the range for the FT4 please, to be able to make sense of it. The range at my lab is 12-22 so your result would be low-in-range at my lab but at other labs that could be close to the top of the range. Your TSH looks OK - most people tend to feel better if is under 1. xx

[thecookiemonster in reply to Clarebear]

Thanks so much for replying, i,ll try and find out what the FT4 is and will let you know. Best wishes Kath xx

[Myrna]

How long after food can it be taken at night please?

Myrna.

[helvella in reply to Myrna]

Two hours or so is usually regarded as reasonable but longer is fine.

[deniD]

En thought it work other way around!!!!!

[Myrna]

So it is 2 hours or longer after food at night and 1 hour before food in the morning? Both times with a full glass of water. have I got that right?

What about tea and coffee? can I have that before bed and in the morning whenever I want? Or is it also restricted to the same time as food?

[Margaret]

When is it best time to take T3 as i always take it in the morning with my Levo and take another T3 in the afternoon an hour after food and an hour before food is this right.?

[Hidden]

there was a poll about when folks take their meds, with comments.

thyroiduk.healthunlocked.co...

[Clarebear]

Mmmmm - was that your breakfast in the photo Rod ?

[helvella in reply to Clarebear]

Doesn't look a bowl of porage oats and goats (goat's? goats'?) milk!

Came from Wiki commons.

[Hidden in reply to helvella]

nom nom! will pass on the hash browns and beans 'tho.

as for porridge, yuk (but good for horses apparently - & burgers! lol!)

Sheep eat well, no additives, Cows are just exploited, fed anything for high yield, as for Goats - I dunno, don't they eat anything going?

anyway, each to their own (er not implying anything)

[susie59]

I take my levo at 6.15 AM. but always have trouble sleeping as i feel more awake than in the day and also get night sweats if i try staying in bed, i was wondering if i should take my levo ay night, it may help? thanks for any advice.

[susie59 in reply to susie59]

i have just been reading your link spareribs, and it does seem to be the way to go,

[Duchy82 in reply to susie59]

I would definitely recommend it i sleep miles better taking levo at night

[susie59 in reply to Duchy82]

i am going to give it a go, i take nitrazepam about an hour before bed, and will try taking my levo as i lay down, heres hoping!

[Healthseeker]

Although my sister-in-law (who sees a thyroid specialist in the USA) warned me to take my thyroid meds at least an hour before breakfast I generally don't wait as I'm too hungry, and worked on the basis that if it makes a difference you will just need to take more meds to get the same result. However it has just occurred to me that when I go for a blood test I usually get my blood glucose tested as well, so apart from taking my thyroid pills with some water I fast. This means that on blood test days my TSH is likely to be lower than on my normal days, so my doc will think I'm doing better than I am. No wonder I still feel lousy! Time to start getting that hour gap in, and if you too go for fasting blood tests - beware!

[helvella in reply to Healthseeker]

I don't take my thyroxine before a test - even though I usually take mine at bed-time.

I wait until blood has been drawn, which I try always to be near 08:00, then take my thyroxine.