OK to take synthroid at night?

[rayneweather]

I know from reading the forums that synthroid is to be taken in the morning at least an hour before eating.  This is difficult for me to do as I need to eat after I wake up, otherwise my blood sugar drops and I get very shaky.  Would it be fine to take my synthroid before I go to bed after all my eating is done for the day as long as I do it consistently?

[charley1986]

I would take it as soon as you get out of bed.  It works better on an empty stomach - all I know is that the pharmacist and my endo told me the same thing...maybe ask your pharmacist - he should be able to give you more info.
Charley

[venora]

HI there.Take it for 1st thing in the morning like charley said.It will keep you awake if you take it at night.I loearned that the hard way.I thought I would take it with my bi polar meds at night and I would stay up half the night.I now take it in the am and I dont eat for at least an hour and boy do I feel good.
Love Venora

[GravesLady]

As long as you are consistent and at leat 2 hours after eating.  I tried this but it didn't work out for me.  I am like you with low blood sugar and I do get a little sick before I get a chance to eat, but I suffer through it. Now I eat little something before going to bed or an hour before going to bed which helps in the AM most of the time.

Remember be consistent and at least if not longer 2 hours after you last ate or drank something other than water.

[EmpatheticJenny]

You might try taking your Synthroid before you go to bed to see what happens. It cannot hurt, and GravesLady pointed out that you are thinking accurately: As long as you are consistent.

When I started taking medication, I asked my endocrinologist the reasons for the standard "take your medication in the morning: advice. He said that preventing wakefulness at bedtime was the only reason. He said that many people are kept awake if they do not take their levothyroxine in the morning, but not everyone.

Indeed, I have been an exception to the general rule. I sleep noticeably better with a late-day dose than I did when I dosed myself in the morning. A piece of advice: If you take your Synthroid at bedtime and you are WIDE awake, give your brain a few more days to adjust to the surprise of a bedtime dose of thyroid hormone before you conclude that the timing just will not work for you.

If a bedtime medication schedule does not work for you, then you might ask your endocrinologist if it is okay to take your medication with breakfast, have your TSH level reassessed after some time has gone by, and then adjust your dosage level upward to compensate for the fact that you are taking your medication with food. Mechanically, levothyroxine works no differently in the presence of food as in its absence. What changes is how much of the drug is absorbed (about a fifth less if it is taken with food, compared to an empty stomach).

Reducing the absorption of your medication would be a big problem IF the reduction were dramatic or if only one or two dosage levels were manufactured. With some drugs, a lack of choice in dosage levels makes it difficult or impossible to fine-tune a medication regime. Levothyroxine is a different story, of course.

[Lake Lover]

Really?  

It keeps you awake if you take it at night. I have issues sleeping and happen to take my thyroid med's when I wake, usually around 2 a.m.

I struggle with sleeping but never connected the two.

It was my understanding that those with thyroids have the highest thyroid levels at night so I assumed taking the T-4 replacement would mimic that event.

[EmpatheticJenny]

Since lists of hypothyroidism's symptoms and effects--even lengthy lists--do not include an inability to sleep among hypothyroidism's symptoms and effects, it probably is an unusual effect. Making the decision to begin taking levothyroxine was scary for me, because I was afraid that it would make my sleeping difficulties even worse. When I asked my endocrinologist if my thyroid gland's inadequate production could be having paradoxical effects (meaning: exactly the opposite of what seems logical), he thought very long and hard before saying, "It could be...we (meaning the field of endocrinology) just do not know enough to say."

By the way, I have an endocrinologist who seems to have a thorough grasp of the endocrinological research literature. This is something that--as a social scientist--I can judge pretty accurately (although whether a physician is thinking sensibly about what he or she has read is a separate question!). In addition to having a thorough grasp of the research literature, my endocrinologist pursues continuing education with more zeal than any professional I know. Each time he has said, "We just don't know," and he has said it more than once in one of our discussions, I assume he has an accurate idea of what is and is not known.

Back to my personal saga for a moment. Although I was glad to have levothyroxine seem to cure my feeling abnormally warm almost all the time (one paradoxical effect), and although I have been pleased by the way a dose of levothyroxine soothes the very odd jittery-ness that I had developed in recent times (another paradoxical effect), I have been almost euphoric to see that my thyroid gland IS related, apparently, to my troubles with sleep. Mechanically, it makes sense that it could. The brain chemical serotonin is vitally important for sleeping, and the thyroid gland helps regulate serotonin.

The first time I increased my levothyroxine dose (a little bitty increase, from what my endocrinologist and I termed a "sissy dose" of 12.5 mcg. to 25 mcg.), I noticed my blood pressure increasing by quite a bit about an hour after the day's 25 mcg. dose. After two days of that, I began dividing the day's dose into two, which did seem to be easier on my blood pressure. When I mentioned that to another specialist, he said that I should check with my endocrinologist to be sure that a divided dose was okay. He said that it might be important to try to mimic the way a normal thyroid gland functions.

I wasted no time in asking my endocrinologist, and guess what? The way a normal thyroid gland works within a 24-hour period is in the realm of "We don't know." What is known is that TSH (thyroid stimulating hormone) rises a LOT in the middle of the night. The question is, what causes the rise and what happens in response? Scenario 1: TSH naturally rises in the middle of the night, and the thyroid gland responds with its greatest output of the day. Scenario 2: The thyroid gland naturally gears back its production substantially during the night, causing TSH to rise in response. If Scenario 2 is the correct one, then as TSH stimulates the thyroid in a big way, how energetically does the thyroid gland respond...or does it respond enough to notice?

In short: It is possible that the thyroid's output reaches a low point, not a high point, in the middle of the night. Maybe a late-in-the-day levothyroxine dose helps me because it compensates for my thyroid gland's low-output time of day which is now even lower-output than before (since the gland no longer can do a fully competent job), or maybe the levothyroxine dose adds to the high-output time of day which no longer is high enough. Who knows? The whole endocrine system is SO complex, and the more I talk with a really top-notch endocrinologist, the more I realize how many areas are still not well understood. That probably is why my doc defines the best medication regime for me as being the one that I tell him works the best. All he cares about is that I be consistent.

[GravesLady]

Also, T-4  takes 7 hours before starting absorptions, last  6 days in our system and is accumative. What you take today/night will be tomorrows effects.
TSH has a pulsate action, being lower in the early AM and highest in the PM. That is probably why for 6 years I woke up 2 hours or so after going to sleep and staying awake. Also the reason it is suggested that Hypers get their test done early in the AM as possible and hypos in the PM as late as possible, some doctors claim that it doesn't make a difference (?).

GL
Please don't shoot the messenger!

[rayneweather]

Thanks for all the feedback.  I will definitely discuss this with my endo and the pharmacist.

[EmpatheticJenny]

When GravesLady says that T-4 takes 7 hours before starting absorption, I am wondering if this is related to the body's conversion of T-4 into T-3? My grasp of physiology in this area is not strong, but I learned from what seemed to be a reputable source that after taking a dose of levothyroxine, the drug reaches its peak in the bloodstream about two hours later (with the usual individual differences that cause the time to vary from person to person).

What seems odd, if you back off and think about it, is that synthetic levothyroxine affects sleep in any way, for any of us. As an endocrinologist commented, the slowness with which our bodies excrete levothyroxine means that each day's dose is not adding dramatically to the level of the drug that already is there. If you stopped taking levothyroxine tomorrow, you would have 50% of the current level in your bloodstream a week from now. The endocrinologist I am quoting said that given the slow-excretion situation, the post-dosage "peak" is really a mini-peak.

The mini-peak must matter, because as we all know, the standard advice about levothyroxine is "take it in the morning." I do not know how many people are kept awake at night if they take levothyroxine any later than in the morning, but it must be many people...possibly most, since the "take it in the morning" advice is indeed the standard? All the same, not everyone turns into an insomniac by taking levothroid in the afternoon, or at least that is what I was told before I began experimenting with dosing myself late in the day.

I want to say to Lake Lover that I never connected my struggles with sleep and hypothyroidism, either, especially because for many years, the same kinds of sleep struggles were a pre-menopausal and post-menopausal symptom of a low level of estrogen. Most descriptions of thyroid disorders make a person think that the LAST thing in the world she wants to do if she has trouble sleeping is take levothyroxine. I wonder how unusual I am, which is an unanswerable question, of course, but you can't blame me for wondering!

[GravesLady]

Pharmacokinetics: Levothyroxine (T-4) Synthroid, Lexovyl, etc.

Half-life is 6 to 7 days in the euthyroid subject.

Half-life is shortened in hyperthyroidism 3-4 days

Half life is prolonged in hypothyroidism and in pregnancy
9-10 days

Absorption amounts up to 80%, rest is eliminated through the urine.

Max absorption time is approximately 5 to 6 hours. (OK so I was a little off)

[EmpatheticJenny]

So you were a little off...it was only a little, and you provided an excellent overview. Thank you! You filled in some knowledge gaps for me.

[HypothyroidTim]

Just discovered this board. Interesting reading your long and informative posts, Jenny. Something with one little piece related to the symptom of insomnia, which I also had...

I went two years without a diagnosis of hypothyroidism. During that time, I got progressively worse. Exhausted, detached feeling, dizzy, slow pounding heart beat at night, numbness and other neurological problems, and reactive hypoglycemia. My whole body was going wacky and I felt like a wreck. The hypoglycemic attacks -- I could get from drinking a glass of juice -- and during one I fainted and smashed my head. I've never fainted in my whole life. On a daily basis almost, for about six months, I felt I was going to faint at some point. I learned to control my diet. (After I got on medication, that and all my other symptoms disappeared.)

In the beginning of the two years, my symptoms were mild and I was oversleeping by about an hour compared to my usual eight hours, which is classic. However, it turned to the opposite, and for over a year, I had insomnia and would fall asleep only to awaken after four or five hours at most, unable to fall back asleep. I would awaken at night feeling dead, a few times during the night. My limbs would be asleep, my heart pounding out of my chest practically, and very slowly. For a minute after I awoke at night, I would feel really dead, and then I would revive a bit.

Through this period, I kept running -- I run every day and am a former professional athlete -- because I found that if I didn't run or bike or do something, even though I felt like a zombie, I would feel so horrible I couldn't stand it. Later I would find out from an endo, that physical activity stimulates the thyroid to produce hormone.

I belonged to a medical plan, and saw my doctor frequently. At first, he said I may have a virus, and adopted a "wait and see" posture. Twice I went to an ER, following hypoglycemic attacks, and had a regular blood workup (not including TSH) and a brain scan for tumor. No tumor. After many visits, every one where I prepared a list and narrative of my symptoms and experience, my doctor would do nothing. Finally, on one visit, I saw him through a crack in the door, talking to a nurse right after both had been in the office with me, and he made a drinking motion with his hand, and they laughed. I realized, he thought I was an alcoholic, and for over a year, had just been dismissing my symptoms as connected to those of a drinker! After all, he gave me finger stick tests to proove my blood sugar was not low. (Of course it was normal, because I couldn't drink a few glasses of juice and drive to the doctor and pass out on the way.) Oddly, I do not drink, at all. I'm a health fanatic and even a glass of wine makes me feel bad the next day. I discovered that when I was 20.

My doctor had a clinical basis for suspecting I drank though, aside from my behavior. In the blood test I got at an ER, all it showed was that my potassium was low. I would later read that low potassium is a problem found in alcoholics. Alcohol leaches the body of potassium, or something.

I got so discouraged, I quit my job and moved to a remote place so I could die or just start getting well. I controlled my diet strictly to avoid hypoglycemic attacks.

But, I ended up going to another doctor, because my heart started doing even weirder things, like fluttering. He gave me a TSH on the first visit. TSH was 11 and he started me on levothyroxine and in two weeks I popped back into reality. I was born again. Cured. I could sleep again. Took me almost an entire year to recover my health fully though.

Anyway, the thing about insomnia vs. oversleeping is what prevented me from diagnosing myself, via the extant information available on the web at the time, including Thyroid Mary's "comprehensive" site. That, and the red herring symptom I had of hypoglycemic attacks. At the time, 1997, there were very few medical sites on the web, and it just so happend that none of them listed the extended symptom set of hypothyroism, which would include insomnia, and reactive hypoglycemia. (The latter found in maybe 5% of hypothyroid patients.)

Back to dosing. The cummulative effect is real, so I agree with what some of the other posters wrote about that. You get a small bump from what you take that morning, but it is the cummulative amount for 6 days or so. You could overdose by 50% one one day, and may not even feel it, but if you continue to overdose, even by 10% for several days in a row, you are in for a feeling of hyperthyroidism after three days, as it builds.

I went to an endo once, about 6 months after my diagnosis, because I had so many questions that my GP couldn't answer. (Some GPs know very little about thyroid, including a close friend of mine.) I wanted to know things like, how damaging was it for me to be so ill for two years with this condition untreated. Most of the questions I had, the endo said she didn't have an answer.

She said the thyroid requirement could fluctuate in some people, and that I shouldn't be afriad to take a bit more, on a day I feel hypo, or reduce it on a hyper day, but always by small amounts.

A lot of exercise can stimulate the thyroid, so if I worked out for two or three hours, I could take that into consideration.

The first year, I was confused about dosing and symptoms or being hypo or hyper. Doctor said I was fine with a TSH of 1.5, but I discovered for me, that was WAY to low, and I'm more comfortable with a TSH of over 5 but under 6. You have to find YOUR best level. Not what the doctor thinks is fine from a number within that huge range.

When I am too hyper (for me below TSH=4.5) I feel tight, can't sleep well, and may get ringing in the ears, and a faster pulse rate, up in the 80's.

When I am hypo, I feel slightly tired, a little bit foggy, and my pulse rate may drop to below my regular resting pulse of 62. I'm very sensitive to it and better than any TSH test at regulating my dose.

Anyway, back to the original topic. Because of the great explanation Jenny gave, how the thyroid may secrete less hormone at night, I believe that to be true, since its main function is controlling metabolism. Naturally, at night, you aren't eating or digesting as much food in the middle of the night as we are in the middle of the day. I don't eat at least 2 hours before I go to bed anyway.

I've experiment with night time dose, and split dose, but morning dose works best for me, and now, I actually prefer waiting one hour before I wake up, before I eat anything. But, although you should probably ask your doctor, I doubt that having a glass of juice would interfere with the dose of hormone, if you wanted to eat or drink something first thing in the morning.

The worst foods for blocking absorption are calcium and soy I think, or anything containing cations.

If you want to eat a full breakfast in the morning, you can also ask for a bigger dose, by 8% I think it is. But then you kind of have to wonder, what foods you eat may be blocking the absorption more than others. So, empty stomach is most reliable.

Sorry for writing so much. Didn't want to blind anyone!  

[DOCHDOCH]

I, too, want to take my thyroid medication in the afternoon. It gives me such a stomach ache to take it first thing in the morning. Any one else out there that has experienced taking their med's at some other time than in the morning? I would love to hear about it from you.

Thanks

Dianne

[devushka]

I wake to an alarm and take my thyroid medication at 6 a.m. (water and pill right next to my bed) and promptly go back to sleep for one hour (waking to second alarm). This works for me--I have no trouble falling asleep again. Might work for others as well.

[Newbee2000]

FYI, in the beginning of my treatment I was also taking prevacid (a proton pump inhibitor) for gerd and heatburn first thing in the morning (and I also wanted to eat shortly after taking the prevacid), so my endo MD told me to take the synthroid at night!  It must be taken on an empty stomach, so I take it three hours after lunch!! Then I wait at least 30 minute after taking synthroid until I eat something, I usually try to wait an hour. I've also taken it at bedtime when my dining/eat schedule strayed from my normal routine and I was able to sleep normally, no problem.

[rachel73]

I've found that I have a terrible time staying awake in the morning.  Not right away when I get up, but about an hour after.  I have to pull of the road and close my eyes for 10 minutes almost every day on my way to work.  I take the meds as soon as I wake up.  Although many of my other hypo symptoms have improved since I started taking the synthroid, this particular symptom seemed to develop only after I started on the meds.  I've wondered if it's possible that it is a reaction to the synthroid. Anyone else ever feel this way from taking it?

[mystic_firefae]

I'm having the same problem Rachel. Thats why I cam on here, to see if anyone else was going through this. Mine is Very strange (I just started it 3 days ago) About 33min, like clock work after taking the med, I get dizzy, like bad vertigo. Then about 30 min after that (After I have eaten something) I get really groggy and have to go lay down. I will sleep for 4-5 hours and my husband came and woke me up, I still am groggy the rest of the day, it seems strange, but my husband could tell the first day that it helped, he said my color looked alot better(I've been pale since I felt sick) and he said my eyes weren't near as puffy as they had been, so it is working, I just don't like the effects its doing to fix the problem..

[bittsy]

A research reported in the journal Clinical Endocrinology found that taking the same dose of levothyroxine (i.e., Synthroid) at bedtime, as compared to first thing in the morning, might be better.
That's good news for me, too.

http://thyroid.about.com/od/thyroiddrugstreatments/a/bedtime.htm

[Armour99]

I take Armour, which is natural T4/T3. I take it at night at 10pm after 2 hours of not eating so it is well absorbed. I have absolutely no problem falling and staying asleep. I too was told that naturally your thyroid hormone peaks at night so I am just mimicking what my body would do naturally. The 'take it in the morning' is for convenience so you can take it on an empty stomach. But then you have to wait at least 1/2 hour before being able to eat. I don't have sugar problems but I can't go without eating for that long after I wake up. Once again taking it at night does not interfere with my sleep at all. Those of you who said you won't be able to sleep at night, are you talking from personal experience or just from what you think or have heard?  I had to change endos just because my old one refused to prescrive Armour (the natural one). I was not doing well anymore on Synthroid. I alwasy had that 'I'm just not feeling totally well' feeling. Armour has made a big difference to me. And I had not had any of the issues that are floating around about it.

[Smilerdeb]

I have taken thyroxin at night only to find I wake up during the night with wild nightmares so I went back to taking it in the morning and have no problems with it.
After a while the body gets used to some of the side effects and they either 'lessen' or go away.
Persevere with the side effects...they are short lived.
I also take mine around 5.30am with a coffee (even though they say not too) and have had no ill effects.
When I go for bloods at 8am in the morning, I have to eat a sandwich beforehand as my blood sugar goes low and without it, feel I am going to faint when blood is taken.
I then take my thyroxin straight after in the Pathology waiting room....probably 15 mins after bloods and have had no effects from doing this too.
Stick to the same routine consistantly and you will be fine.

[lds45]

I have started taking Synthroid at night.  I sleep better, wake up feeling great,  and feel 100% better during the day.  I am 65 and take no other medication.

[MichelleH.]

I take my Levothyroxine at night (a few hours after eating) to avoid side-effects and interactions with other medications. I have no problem falling asleep, but then again I'm usually extremely exhausted anyway.

[OHO58]

I take levothyroxene 137 and I have been taking it at night for several months ( I had my thyroid removed due to papillary cancer in April ) I do not sleep well but i have more energy since I started taking it in the evenings....I also have joint pain now that I never had before the surgery..after I am up and running, it pretty much goes away...headaches that come and go and fluctuating BP....anyone else had these symptoms while on the med? Also has anyone had the full body scan using the med that tricks your brain into thinking it is hypo? Wondering how it went? Thanks for the info...

[zyphlus]

I take it at Night 112mcg... I never had problems sleeping 95%I'm able to fall asleep in 10 mins.  No noticed n changes except I seem to lose more weight with calorie restruction.  My rules... No liqour, food or milk/soda 2.5 hours before I take it.  If I do eat it I wake up 2 hours into my slumber and pop it with full glass of water. I do alot of protein (muscle drinks) & calcium in mornings to help my body retain muscle and wanted to keep the Levothyroxine far away from the these vitamins and minerals I thought were messing with the drugs effect. My TSH is still in proper range...