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What no iron and no calcium food do you eat for breakfast?
I have just been put on levothyroxin (50 mcg) for hypothyroidism. The instructions say to take levo an hour before breakfast, but FOUR hours before having any iron or calcium. All the usual breakfast foods have iron and/or calcium in them, even fruit! So what can I eat for breakfast? What foods have no iron and no calcium? I've also read I should avoid soy and walnuts. Help!
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I think what they mean by no iron or calcium for four hours after levo is supplements.  If you wait the hour after taking your pill before breakfast, you can have whatever you want for breakfast.

Soy is basically cattle feed and undigestible unless it is fermented...soy sauce, tempe, etc.  Some of us hypos have a hard time with it, others not.  

You are going to be dealing with this condition for the rest of your life.  My philosophy is to change as little as possible from what you were doing prior to diagnosis.  If you notice something bothering you, then by all means, discontinue it.  Otherwise, have at it!
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I think those instructions are mainly to prevent having any interaction or absorption problems, so that you get the full benefit of your dosage.  Some people just go ahead and have their normal breakfast and take their meds at the same time.  If you lose some of the T4 that way, it will only mean that your dosage may have to be adjusted slightly higher after next blood test.  The main thing is consistency in your approach.  Some people have avoided the issue by just taking their thyroid meds at night.  This can work fine, unless you have some immediate reaction to the T4 med, which interferes with your sleep.  This isn't usually the case since T4 is more of a storage hormone that has to be converted to the far more active T3.

For future reference, please note that the best way to treat a thyroid patient is to test and adjust the levels of the biologically active thyroid hormones, FT3 and FT4, with whatever meds are required to alleviate symptoms, without being constrained by resultant TSH levels.  Symptom relief is all important.   Frequently we hear from members that this requires that FT3 is adjusted into the upper part of its range and FT4 is adjusted to at least midpoint of its range.  FT3 is four times as active as FT4 and FT3 correlates best with hypo symptoms.  TSH is a pituitary hormone that is affected by many variables and it does not correlate well at all with hypo symptoms.  Also, just in case you should incur a low TSH while taking thyroid meds, that does not mean that you are automatically hyper.  Only having hyper symptoms makes you hyper.  

Sorry if this was more than you wanted to hear, but we hear so many times from patients who are misdiagnosed and undertreated that I thought I should make you aware of all this as you proceed with your treatment.
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219241 tn?1413541365
You must not have any supplements like the iron or calcium four hours after taking your medication.  The thyroid medication binds to the iron or calcium and is no longer usuable in your body.  Having a cereal with milk however is not going to cause any problems. The level of calcium and iron in these is not in the form of a supplement and has little values of amounts to cause problems.
   There are many juries still out on the soy issue. Some say don't have it, some say do.
Soy is fermented soy bean and whilst grown in the ground, it does have amounts of oestrogen in it. This oestrogen can interact with some people's levels in their body causing issues whilst on thyroid medication.  
  I have never heard of walnuts being an issue for thyroid patients. If anything they are a little power pack of essential fats and vitamins!  Personally I don't like walnuts they make my tongue get little blisters.
  
So get up in the morning, take your meds, do some housework, have a shower whatever to fill in the hour, have a nice healthy brekky and get on with your day!


  
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You're wrong.

Milk has calcium in it. You can not have a cereal with milk in it.
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2127613 tn?1335365029
I too am on levothyroxine and was concerned about the same thing.  So I was taking the pill at night so I could eat regular foods.  Today I took it in the morning and am starving, but my doctor did say just supplements 4 hours after the pill. So now I'm getting something to eat.  Thanks for information.
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No, no, no, no. You can't EAT any calcium, or take supplements with calcium or iron. The advice of taking your pill and just trying to eat the same amount of calcium every day so they just up your dosage is terrible. This medication controls your heart rate and body temperature. What happens if you ingest calcium and it blocks 25% of your medication uptake, then one day you're running late and miss breakfast? Your heart rate and blood pressure is going to increase for the day, causing a dramatic risk for heart attack or stroke. I specifically asked my doctor about this during my testing after 90 days, and she was horrified that anyone would give that as advice. Especially since you sound like you're a medical professional. I had thyroid cancer and now that that's gone and I'm moving into a more long term treatment plan (since my thyroid was completely removed), I asked my new endo the same questions and he was just as appalled. It was hard at first, but now that I've found foods that work it's not too bad to have a calcium free breakfast...

Egg WHITES only
Margarine (I use Country Crock original)
Coffee / tea
Coffee Creamer (I use liquid Coffee Mate flavors)
Whole Grain Bread (Check the nutrition facts though, only some are full whole grain. I eat Natural Ovens Sunny Millet bread)
Lots of cereal (again, check the nutrition facts, and obviously don't eat with milk. I've found Corn Pops, Crunch Berries, Frosted Shredded Wheat, and Crunch Berries. I saw more in the store but don't remember now)
Marshmallows
Kashi Granola Bars
SOME canned fruit and vegetables, if you want to stay low calorie get No Sugar Added fruits
SOME canned soup, most of condensed, even creamy soups
Rice
Pasta
Boxed mashed potatoes (made without milk)
Sauerkraut
Pepperoni / Turkey Pepperoni
Turkey Breakfast Sausage (probably pork too, I don't eat it so I never checked)
WonTon / Egg roll wrappers
Lettuce (but don't get mixed salads without looking at nutrition fact since lots of leafy greens have calcium)
Italian dressing
Maple syrup

There's more I'm sure. The biggest thing is to check the labels, even during other meal times just so you know. It's not always the things you think that will be calcium free, and you might be surprised by things like creamer and margarine and breakfast cereals. I usually have egg whites, toast, and sausage for breakfast, but you could also make french toast, or make cereal bars with cereal and marshmallows.
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Thank you so much for this list. Very helpful.

I fear for the people who think there's a difference between a supplement and eating food with the mineral in it.  Blows my mind...
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You might want to talk to a dietician about this.  Doctors tend to not have a real grasp on nutritional matters.

I wait 0.5-1.0 hours after taking my meds to eat, but when I have breakfast, I eat anything I want. If you are having an absorption problem, you might have to be more careful, otherwise not.

"What happens if you ingest calcium and it blocks 25% of your medication uptake, then one day you're running late and miss breakfast? Your heart rate and blood pressure is going to increase for the day, causing a dramatic risk for heart attack or stroke."

I think you're being just a bit dramatic.  Adjusting your thyroid meds by 25% for one day just does not have that kind of effect on your HR and BP.    

If you watch your calcium intake not only at breakfast, but at other meals as well, how's your calcium level?
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649848 tn?1474485941
I, too, wait 0.5 to 1.0 hrs after taking my med, then eat whatever I want.  I can't imagine sitting down to a bowl of dry cereal for breakfast, especially, corn pops, frosted shredded wheat or crunch berries, that are loaded with sugar.  

Calcium is necessary for strong bones and teeth.  As you age, you're going to need that calcium to prevent osteoporosis.  Iron prevents anemia, provides energy and is necessary for the metabolism of thyroid hormones.  
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6555161 tn?1382385462
Um...forgive me if I'm reading this wrong, but are you saying that people taking levothyroxine shouldn't  need calcium and iron at all?? Or do you mean in the morning for breakfast? Thyroidless or not, everyone needs iron and calcium for their body to function properly (unless they have some sort of disease or problem that makes too much of these in your body naturally.) If you're going to eat a breakfast that's a bit higher in calcium and iron and know you are, then it's perfectly fine to adjust your dose just a bit that morning to compensate for it. A day here and there of adjusting your meds to make sure you're getting the right amount of levo isn't putting you at risk for heart attack or stroke. I could see if you consistently took too much "just in case" could put your heart at risk since you're over-medicating yourself, or not adjusting at all if you're one to eat a lot of iron and calcium rich foods in the a.m. constantly, since you can get problems with your heart from hypothyroidism as well, but seriously, I have to agree here-you're not going to hurt yourself adjusting accordingly if you know you're going to have a breakfast rich in these, and you're honestly pretty much fine eating iron and calcium rich foods throughout the day as long as everything else in order.
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Wrong...wrong..wrong.

You can't adjust accordingly.

You can't eat calcium or iron for breakfast.
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649848 tn?1474485941
Adjusting T4 dose on a daily basis to accommodate your breakfast is a lesson in futility, since it takes approximately 4-6 weeks for an adjustment to take effect.  

Just take your med and eat what you're going to and don't take supplements w/in 4 hrs... it really is that simple.
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I agree, let's not overcomplicate this.  I don't think there's any possible way that you can adjust meds on a daily basis to compensate for the food you eat and how it might affect absorption.

FT4 levels build slowly (and decrease slowly as well), so minute differences in what you absorb are easily going to be compensated for.  It takes weeks for a legitimate dosage adjustment to affect levels enough to cause symptoms or symptom relief.  

If you have a demonstrated absorption issue, i.e. meds just aren't getting into your blood stream, by all means check your habits.  Otherwise, just wait half to one hour before eating or drinking and take any supplements 3-4 hours away as stated on the bottle.  
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First off, a person shouldn't go trying to adjust their own meds on their own, especially since you don't know just what it should be adjusted to. And as both Barb and goolarra said, it take about 6 weeks for the levels to adjust.  Each person is different on how they handle the meds and food. Personally, since it has been hard to get my levels straightened, I have to be careful what i eat, and it isn't easy. Beadheadblonde, it isn't that we can't have it.. it is a matter of being told we can't have it for 4 hrs, because it will bind with the medication, and the body won't absorb enough, throwing the levels off
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I talk to pharmacist yesterday and it means no foods or supplements for  four hours after taking levothyroxine.
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649848 tn?1474485941
Your pharmacist is incorrect!!  

This is from Mayo Clinic:  "It is best to take this medicine on an empty stomach. Take it with a full glass of water at least 30 minutes to 1 hour before eating breakfast."

Also:  "This medicine should be taken at least 4 hours before or 4 hours after these medicines: antacids (Maalox®, Mylanta®, Tums®), calcium supplements, cholestyramine (Prevalite®, Questran®), colestipol (Colestid®), iron supplements, orlistat (Alli®, Xenical®), simethicone (Gas-X®, Mylicon®), and sucralfate (Carafate®)."


This from Synthroid: "Take Synthroid alone. Do not take Synthroid within 4 hours of ingesting medications, supplements, or foods that may interact with Synthroid. Antacids, iron, and calcium supplements, dietary fiber, soy, and even walnuts can affect your body's absorption of Synthroid. Talk to your doctor to learn more."

Note that both sites clearly say to avoid antacids, iron and calcium "supplements" for 4 hours.  There's not enough iron OR calcium in most foods to warrant not eating them, because of thyroid med.
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You are dead wrong.

It's scary to think that you think there's a difference between eating a supplement and eating food with calcium in it.  IT IS THE EXACT SAME THING. You need a new doctor.
I've been to Endo's all of my life as I have congenital hypothyroidism. I was put in the hospital for a week, out of work for 2 more, and almost died because of this very issue we're talking about.
You CAN NOT eat any food, take any supplement...you can NOT ingest any sort of calcium or iron within 4 hours of taking levothyroxine....synthroid...any thyroid medicine. ANY calcium will block absorption. Omg....
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As you stated, the manufacturer of Synthroid says "Do not take Synthroid within 4 hours of ingesting medications, supplements, or **FOODS** that may interact with Synthroid."   (emphasis added)  So this is not just about supplements.


My FT4  got out of whack after I started eating tahini in the mornings.  So my endocrinologist told me specifically to stop putting tahini (sesame seed paste) on my bagels because it contains too much calcium.  She told me to wait 4 hours after my synthroid if I wanted to eat it.  She said to avoid foods high in iron for 4 hours as well.  





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649848 tn?1474485941
Foods "high" in iron are not necessarily the same as those "containing" iron.  Everything has to be within reason.
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No....
No there's nothing "within reason"

You can ingest any sort of calcium or iron within 4 hours of talking your medication.  It's pretty black and white.  There's no reasonable amount you can ingest.  If you want to eat calcium or iron with your medication than you're eating your time? I'm not sure why so many of you think there are exceptions? It's really quite simple. No calcium or iron of any sort 4 until 4 hours after.
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I agree, Barb.
Personally I wait 4 hrs to eat after taking meds during the week basically because I wake up to get my husband ready for work (5am) then eat breakfast with the kids (9:30am) later. It's the weekend that screws me up cause my husband is home and we all sleep in so no supplements for me, unless I set my alarm to wake me up at 5am to take my med but that's nutty. Haha!
Totally agree, I think it has to be within reason, I highly doubt breakfast foods are super "high" in iron or calcium. My husband was born without a thyroid and has been on Synthroid/Levothyroxine since then and up until December of last year when he switched to Armour. A few weeks before going on Armour, He found out he should've been waiting an hour to eat and that's when he started experiencing hyperthyroid symptoms so they lowered his dose and eventually moved to Armour.
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My dermatologist prescribed Doxycycline for my cystic acne. The warnings regarding iron and calcium intake while using Doxy are virtually identical to those given for the thyroid meds discussed in this thread.  My GO TO calcium and iron-FREE food I take to help with any nausea is the #InkaChips brand of Plantain Chips... They are all natural, no trans fat and gluten free...AND they are delicious.  They are manufactured in Peru, but I find them at Gelsons Grocery Store in Los Angeles.  The number for their US Customer service is 800-808-0858.  Hope this helps.    
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First, let me thank everyone who mentioned not to take calcium or iron "supplements" within 4 hours of a thyroid med. I'm on my second day of one, and it does not say the word "supplements". So I was starving myself for 4 hours -- well, really 3 hours, cuz I just couldn't stand it any longer-- not finding any food label that didn't have at least 1mg of calcium or iron on it.

Secondly, about the list of foods written by Andrea -- they may be fine for people with no thyroid. But for those of us who still have a thyroid, egg YOLKS are supposedly one of the top 3 foods high in iodine, and therefore we SHOULD eat the whole egg. Unless your cholesterol is at a dangerous level.

Also, whole grains were listed there. Again, I say this for people WITH a thyroid -- whole grains decrease our absorption of iodine, which the thyroid needs. I'm not saying to never eat whole grains. I'm suggesting not to eat whole grains often, and certainly not while purposely eating a meal high in iodine, such as seafood or eggs.
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You can eat the whole egg...just not for breakfast!
I'm not sure why so many people are trying to fight this?
Is really simple...if you eat calcium supplements or foods with calcium in it within 4 hours of taking your meds....they won't work! You're wasting your time. You can have the iodine for lunch or dinner.
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That's not what my doctor said. He said no calcium in foods. Also he said no soy anytime.
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16428684 tn?1460088684
This may help some of you if happen to get up at night to use the loo--- I do get up in the middle of the night and have my levo pill and a glass of water then, because I really enjoy having coffee & breakfast as soon as I get up.  I take my sublingual NDT while the coffee is brewing....
There is no magic for taking levo upon awakening in the morning.  The stomach just has to be empty.

Here's a study which supports taking levo at bedtime:
"Effects of evening vs morning levothyroxine intake: a randomized double-blind crossover trial."
http://www.ncbi.nlm.nih.gov/pubmed/21149757
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Its not a big deal at all. Even if you take soy, calcium with levothyroxine the amount of levo absorbed will be slightly less some 10%. The key is to take the levo consistently at a suitable time everyday. You can even take it with food but make sure you do it same everyday, same time. This way the problem is solved by simply adding a little higher dose when compared with empty stomach ex: if your dose is 50 mcg then take 56 mcg.

Anyway for best results especially if you have trouble converting T4 to T3 then taking it at bedtime is best.
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22 years a ago when I was diagnosed with hypothyroidism there were no studies relating to iron or calcium causing any issues while on thyroid medication. I took my pill in the morning as close as I could to the same time  everyday and waited 1 hour before I ate breakfast and ate whatever I wanted. I was taking  my multi vitamin containing iron and calcium at the same time. I had issues for many years and my dosage changed almost every time I was tested. That may have been the reason for all of the inconsistency in my numbers over the years . Finally the studies came out that iron was an issue and not to take a multivitamin within 4 hours of my Synthroid. So I started taking my multivitamin with my dinner. Then it was don't take antacids within 4 hours. In the last four years or so these studies that calcium may cause issues came out but I never changed what I ate and all I can say is I'm still alive have not had any heart issue. The hardest part is finding the right dosage for you, it took a long time for me. I am now and have for years been taking 150 MCG. Find what works for you food wise. Read more and get educated, you will for the rest of your life have this diagnosis. Eat right and exercise regularly. I control my hypothyroidism, it it does not control me :)
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OMG.
This is so wrong it's scary
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You can NOT take it with food. Ever. If you're an infant you can wash it down with a little apple sauce. That's it.

You can't take it with food. Ever. Or calcium..or iron.
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649848 tn?1474485941
Nobody is talking about taking the medication "with" food - we're simply talking about eating a healthy breakfast 30 minutes to an hour after taking thyroid hormones, as it states in the instructions... There's not enough calcium or iron in most foods to inhibit absorption of thyroid medications if one waits the recommended hour after taking the med before eating.  

If one does have an issue, most doctors would be willing to adjust medication upwards to accommodate.

I've been on replacement thyroid hormones for 8 yrs and have never had an issue with absorption and I eat anything I want for breakfast, including cereal with milk, eggs, etc.  I have never had any trouble with absorption or with my thyroid hormone levels fluctuating because of it.  
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649848 tn?1474485941
I agree that consistency is the key, and that thyroid med can be adjusted accordingly, as long as you do the same thing every day, or nearly so.

Taking thyroid med at night will not do anything to help with conversion of T4 to T3, though.  Also, taking thyroid med at night may not be easy for some, because you have to make sure the stomach is empty, which means you can't eat for several hours prior to taking the med.  What you  have for dinner will depend on how long it takes for the stomach to empty.
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Yes taking a bedtime have no special benefit but for people who have problem taking it a morning find bedtime best. For example some (me too) gets a deep sleepy feeling few hours after taking levothyroxine at morning so not suitable to take it if going outside. Also I am a late riser also have no specific wakeup time too. Sometimes wake at 11, sometimes 8, 7 etc so taking levo at consistent time and giving breakfast sufficient time is often tough on mornings.

In short if the person is late sleeper then taking pill at bedtime best while if early riser then mornings best. Its completely based on individuals preference, consistency is all important.
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Hi Andrea,
My name is Susana, my sister Corina suffers from hypothyroidism.  She had a surgery last year but decided not take the medicine.  Now, is getting worst and doctors think she may have another tumor.  Everything she eats has calcium intake, she was used to drinking vegetable juices, now she feels scary and she is not old, she is in her earliest 50th but every time she walks she feels weak and sore. This is a horrible disease.  Thanks.
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This is an old thread and it is doubtful that you will hear from Andrea.  If you want, others will be glad to try and assess your sister's situation and offer suggestions.  If so, we will need further information.   For example we would need to see her thyroid related test results and reference ranges shown on the lab report.  Also, please tell us about all  of her symptoms.  

What medicine did she decide not to take, and why not?
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