Dairy Reduces Levothyroxine Concentration
The study examined 10 healthy subjects with normal thyroid function to assess whether consuming cows milk has a direct effect on levothyroxine absorption.2
Following an overnight fast, serum total thyroxine concentrations were measured at baseline and at 1, 2, 4, and 6 hours after the participants took 1000 g of oral levothyroxine alone or when coadministered with 12 ounces of 2% milk.
Results showed that the TT4 concentrations were significantly lower when levothyroxine was taken at the same time as the milk as compared to levothyroxine alone.2 Also, peak serum TT4 concentrations dropped significantly when cows milk was coadministered with levothyroxine than with the levothyroxine alone.
The researchers believe that both the calcium content of the milk and the presence of protein might directly interfere with the proper and full absorption of levothyroxine, complicating the management of hypothyroid.2
Our results show that calcium-rich foods should be consumed apart from thyroid hormone medication, as much as possible, Dr. Leung tells EndocrineWeb. This will help ensure that thyroid blood tests remain constant, thus decreasing the need for potentially unnecessary changes in the dose of thyroid replacement needed to manage your hypothyroidism.
Calcium-rich foods including cows milk, yogurt, cheeses and ice cream and frozen yogurt. Also, non-dairy milk like those made from almond, soy, and rice, which; are fortified with calcium.4
Your Pharmacist Changed Brands
Imagine this: you are cruising along, totally fine, using Naturethroid of WP Thyroid. Things are fine, youre feeling well, and everything is stable.
Next thing you know, after a quick refill, you are feeling just awful.
Things that werent happening before are now back, including:
- Your fatigue coming back
- Weight shooting back up
- Your mood changes dramatically
The whole time youre wondering, everything has stayed the same, hasnt it? But, it could have happened that your pharmacy gave you a different brand than was prescribed.
When a doctor prescribes a medication, they can either specify which brand needs to be used, or they can check off a box that says substitution permissible.
But, even when a doctor checks the other box titled dispense as written, specifying a very particular brand, patients have come back with a different brand.
In many cases, that occurred after many times they got the right brand.
While the active hormones dont vary much from brand to brand, the inactive ingredients do vary. This can change the way it breaks down in your body.
Its almost like starting from scratch to determine your optimal dose, and the same applies to generic brands .
At Integrative Health, our doctors give you the sealed bottle directly from the manufacturer. No more guessing if the pharmacy substituted brands without your knowledge.
Things That Can Mess With Your Thyroid Medication
Generic levothyroxine and brand-name Synthroid are two of the most commonly prescribed medications in the U.S. for the treatment of hypothyroidism. Other similar medications include Levoxyl, Tirosint, and Unithroid.
Synthetic thyroxine, the active ingredient in and , is a prohormone, which means that it needs to get processed in our bodies to be converted to the active thyroid hormone. Once you start taking thyroid replacement, your healthcare provider will monitor your thyroid stimulating hormone levels with blood tests and make adjustments to your dosage, as needed.
If you find that your thyroid medication isnt working very well, here are eight common scenarios that could explain why.
All The Answers Involved In When To Take Your Thyroid Medication
Heres the thing, I have patients that come in so frazzled about taking their thyroid medication in the proper way and at the proper time. Ive heard some insane;expectations around doing this.; Surely, these imperious rules are being implemented by someone who has never actually had to take thyroid medicine. Ive heard to take it FOUR HOURS BEFORE OR AFTER FOOD OR SUPPLEMENTS.;Are we serious, people? If we are condemned for a twice daily dose of medication, what then? I guess we must resist the temptation to eat at all! Let me preface this post with, I am all about realistic expectations.; What good do dogmatic rules do us if they are so rigid its impossible to abide? I dont live in a vacuum, I have children, run a business, have laundry and crazy hair. I dont have the time or capacity for dogmatism.; Im just assuming you dont either. If not, check out my non-vacuum-living-advice below.
1.;;;; The food debate:
NO:;you do not need to wait four hours before or after eating. Who really can do this? If thats you, I bow down to your willpower.
YES:;take it on an empty stomach.;; Wait 30-45 minutes before eating and wait an hour after eating before taking it.
2.;;;; The supplement debate;
NO:;Again with the four hours Really?
YES:;Wait a full hour after taking your medication for all supplements and wait a full hour after taking your supplements to take your medication.
;3.;;;; What are the best times to take my thyroid medication?
Armour Vs Synthroid For Underactive Thyroid:
Q. My thyroid was removed 38 years ago. I did very well on Armour;thyroid replacement all of those years. Recently, my endocrinologist insisted that I take Synthroid instead. It made me feel awful.
Finally he put me back on Armour, but kept reducing the dosage. He insisted that the blood work showed that I was getting too much.
I reached a point where I was so fatigued that I could do nothing. When I saw another specialist, she said that my thyroid dosage was too low. In three weeks on the higher dose she prescribed, I have begun to feel better. Quality of life is important!
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Not Talking To Your Doctor Before Taking Supplements
Your healthcare provider should know about any;supplements;you take because they may affect your hypothyroidism treatment particularly iodine. While iodine is essential for your body to produce thyroid hormone, the vast majority of people in the United States get enough iodine from food and water alone, Dr. Adimoolam says. Because taking too much iodine can cause thyroid hormone levels to go too high or too low, its best to avoid this supplement.
Additional reporting by Deb Shapiro.
Make Your Meds Work For You
Too often, I think we can get fixated on getting your thyroid levels in check. Truthfully, that shouldnt be our only area of focus.
As you can see from the list above, there are a whole host of reasons why your thyroid medications might not be working for you.
The answer may lie in one of the reasons above, or a combination of them.
This is why it is so important to work with an expert to help determine and treat your symptoms.
You can feel better, and you shouldnt settle for anything less than best. Start by taking the Thyroid Quiz today , as Im sure it can help set you on the right path for your best health.
P.S. Whenever you are ready, here is how I can help you now:
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Plus How To Get The Absolute Most Out Of Your Thyroid Meds
The time of day you take your thyroid meds, and how you store them, can make or break your thyroid disease management.
Levothyroxine is the name of all synthetic forms of the thyroid hormone T4. This manufactured hormone mimics the natural hormone produced by your thyroid and is prescribed as the primary treatment for hypothyroidism, or an underactive thyroid.;
Levothyroxine dosage is highly individualized, and your dosage may change as you and your doctor work to find what works best for you. See our levothyroxine dosage chart below to get an idea of where your treatment might begin and when to expect your doctor to check for adjustments.;Starting dosages are often calculated based on your weight, but because in some cases your thyroid still makes its own T4, some doctors will start you with a lower dosage to avoid over-treatment symptoms that mimic hyperthyroidism . They also may start you on a lower dose if your body might need extra time to adjust to the effects of hormone replacement.;Your doctor will then check your thyroid stimulating hormone levels over the first few months to see if your dosage needs any adjustment. Hormone replacement therapy is usually a lifelong treatment, so you should get your TSH levels checked every year to ensure youre still taking the right dose.;
Infographic by Lauren Hunter
You can find more information about levothyroxine, including dosage,;here.
- Increased sweating
Taking Too Much Thyroid Hormone And Thinking Its Harmless
The synthetic thyroid hormone T4 is relatively safe, and you shouldn’t worry if you accidentally take an extra dose, Bianco says. But taking an excessive amount could have side effects it can make you feel tired, affect your sleep and concentration, lead to bone loss, or cause irregular heartbeats, according to the Cleveland Clinic. If you take combination therapy, which contains both T4 and T3, the medication needs to be taken precisely as prescribed, as taking too much can be dangerous. The ATA notes that potential side effects of taking too much combination therapy include a racing pulse, anxiety, trouble sleeping, and problems with your heart and bones. Contact your healthcare provider immediately if you accidentally take more than prescribed.
Recommended Reading: How To Improve Thyroid Function Naturally
Best At The Same Time Every Day: Birth
While doctors will generally encourage you to take your medications at the same time every day, this is especially important when it comes to progestin-only birth-control pills, also known as mini-pills. According to Healthline, if you take a progestin-only pill more than three hours later than you normally do, it wont be fully effectivewhich means that youre not fully protected and could risk pregnancy. On the other hand, combination pills, which also contain estrogen, should be fully effective as long as theyre taken within the same 12-hour window every day. Discover these additional;13 things you must know about birth control pills if you dont want to get pregnantor do!
Cbd Oil And Thyroid Medication
Thyroiditis and the condition in which it develops into, hypothyroidism, is a debilitating disease which many people suffer from daily. The question has been raised concerning just how CBD oil interacts with thyroid medications? Here in this article we will detail the specificities behind CBD oil and Thyroid medication; equipping you with the knowledge that you need to use your CBD oil with a peace of mind.
Read Also: Can Soy Milk Affect Your Thyroid
The Wrong Potency Dispensed
Over the years, I have learned the importance of assuming as little as possible.
Thats because I have witnessed so many times, someone coming in and saying I was on what you prescribed and it wasnt working well.
Following that statement, I would always ask people to bring in their medication when they came in for an appointment. The results were always eye-opening.
In fact, youd be surprised how often I would look at the prescription bottle and the potency was not at all what the patient was supposed to be getting.
There are also times where it may say the potency, but the tablets do not line up with the potency that it is supposed to have.
Any tablet that you have, based upon the code imprinted upon it, as well as the color and the scoring , you can put that code into Google and determine what you have.
The thing to know is that there are times where the label may say one thing, and the tablets themselves are something completely different.
Those things happen, and they matter. It may seem like an obvious thing, but it is always a good idea to double-check and make sure.
How And When To Take Levothyroxine
Take levothyroxine once a day in the morning, ideally at least 30 minutes before having breakfast or a drink containing caffeine, like tea or coffee.
Food and caffeinated drinks can both stop your body taking in levothyroxine properly so it does not work as well.
If you stop taking levothyroxine your symptoms are likely to come back.
What Is The Best Time To Take Thyroid Medication
An extremely common problem for many people is thyroid trouble. In fact, around 12 percent of the U.S. population will experience thyroid trouble at one point in their life. Because an underactive thyroid gland is the most common cause of thyroid troubles, many people are prescribed levothyroxine . This is a hormonal supplement with the intention of boosting the thyroid gland production. But now there is speculation over when is the best time to take the thyroid medication.
Onset And Duration Of Action
The half-life of thyroxine in euthyroidism is 67 days. This is reduced to 34 days in hyperthyroidism and prolonged to 910 days in hypothyroidism. Thyroxine has a full therapeutic effect 34 weeks after starting treatment and will continue to have a therapeutic action for 13 weeks after treatment stops. In view of the long half-life, dose changes should only be made every 34 weeks. Despite undergoing both hepatic and renal clearance, there is no evidence that dose adjustment is required for patients with liver or kidney disease.1,2
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How To Take Levothyroxine
1) Not just for the morning
Because absorption is better on an empty stomach, the standard recommendation is that levothyroxine be taken one half to one hour prior to breakfast. But sticking to that recommendation is a problem for people with unpredictable or variable schedules.
Taking levothyroxine at night is another option. Studies show taking levothyroxine before bedtime is just as effective as one hour before breakfast.
2) Foods to avoid
Know this: Foods high in dietary fibers , grapes, soybeans, papaya, and coffee reduce the absorption of levothyroxine and may make it less effective.
3) With T3 liothyronine or without?
This has been a source of ongoing debate for years in folks taking levothyroxine alone. Whats the issue? The thyroid gland secretes both T3 and T4 hormones , so studies have focused on whether or not to also replace low T3 levels in hypothyroidism with synthetic T3, . In other words, should people with hypothyroidism take levothyroxine plus liothyronine?
Clinical trials in humans have not shown clear advantages of this approach over taking levothyroxine alone. Current guidelines suggest that until clear advantages of levothyroxine plus liothyronine are demonstrated, levothyroxine alone should remain the treatment of choice for hypothyroidism.
Medical Conditions That Affect Absorption
There are a number of medical conditions that may affect the absorption of thyroid medications, and, hence, the effectiveness of a particular dose. Some of these include:
- Lactose intolerance
- Pancreatic diseases
- Liver disease
Gene differences may also result in decreased effectiveness in some people, such as those who have polymorphisms in iodothyronine deiodinase 2.
For people with health conditions that affect digestion such as inflammatory bowel disease , or celiac disease, the Tirosint brand of levothyroxine with fewer ingredients that may be better tolerated. In addition, the liquid or gel cap form of levothyroxine may be better absorbed than levothyroxine pills.
If you have any of these conditions, it will be important to have your thyroid tested regularly.
Overindulging On Certain Foods Which Can Also Affect How Your Thyroid Meds Work
For the most part, you shouldn’t have problems with most foods if you wait at least 45 minutes after taking your thyroid medication before you eat. But if you dont wait long enough, certain foods;may impair absorption of the hypothyroid medication more than others, says;Deena Adimoolam, MD, an assistant professor of medicine, endocrinology, diabetes, and bone disease at the Icahn School of Medicine at Mount Sinai in New York City. That includes foods that are high in calcium, such as milk, cheese, yogurt, kale, and spinach.
Eating a lot of soy has also been thought to impair the absorption of thyroid hormone, but a;review of studies published in December 2016 in the journal Nutrients noted that its not necessary for most people with thyroid disease to avoid soy foods because medication dosage can be adjusted accordingly, if necessary. If you eat about the same amount every day, your healthcare provider has probably found the proper dose of thyroid hormone to counteract soys effects. So just be sure to stay consistent with your soy intake.
Bedtime Vs Breakfast Levothyroxine Administration May Boost Free Thyroxine Level
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Adults with hypothyroidism taking levothyroxine therapy may derive a greater benefit when taking the drug at bedtime vs. before breakfast, according to findings published in Clinical Endocrinology.
The timing of levothyroxine administration has become a hot topic in recent years,Ru Sun, of the department of blood transfusion at the Affiliated Hospital of North Sichuan Medical College, China, and colleagues wrote in the study background. The Chinese Society of Endocrinology recommends that levothyroxine should be consistently taken 60 minutes before breakfast. However, the American Thyroid Association recommends that, if possible, levothyroxine be consistently taken either 60 minutes before breakfast or at bedtime , for optimal, consistent absorption. Recently, some studies have been conducted in which the efficacy of levothyroxine administration before breakfast and at bedtime were compared. Some studies reported that the efficiency of levothyroxine at bedtime was better than administration before breakfast. However, other studies showed no significant difference with bedtime vs. morning intake.
In a random-effect analysis performed on nine studies, researchers found that levothyroxine administered at bedtime was associated with a higher free thyroxine level when compared with breakfast administration .
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