thyroxine: Best Time of the day to take.

[mallorcasara]

Hi, I

[Totie]

Take mine first thing in the morning on an empty stomach.  Have always been consistent with that for the last 14yrs.

[emma0212]

Hy i have been taking my thyroxine tablets at irregular times since 2 yrs not knowing that it should be taken at a specific time.I have been suffering from constipation,hair loss,dry skin,fatigue.My blood tests also was always high.The problem is that i work on a night basis.I dnt knw what time to take the tablet at a specific time since the next day am off.please help.any advice?
Thanks
emma

[EmpatheticJenny]

Dear Sara,

Since your thyroid gland is not doing its job at all, I can understand your concern about taking your medication with food...as you say, if you were to lose 20% of the help the medication is providing, where would that leave you?

The answer, according to my endocrinologist, is that you would increase your dosage enough to compensate for the 20% that was not being absorbed. Unless you are taking the maximum dose of levothyroxine that a physician would be willing to give any patient for any reason--and I do not know what the maximum dose is or even if there IS an absolute maximum--then the advice given to me, who only needs to support a struggling thyroid gland with medication, is no different from the advice that would be given to someone like you, who needs to do the thyroid gland's entire job.

I was certain that my endocrinologist was being sensible when he gave me the aforementioned guidance. He seems like an excellent and prudent physician. Still, this discussion thread made me want to check my physician's advice against another source. I think that Mary Shomon can be counted on for rational guidance. When I went her website (www.thyroid.about.com), I found that her advice echoed my endocrinologist's: Taking medication with food is okay as long as a person is consistent.

The difficulty in your situation might be access to your endocrinologist. Do you see him or her once a year because you do not need your specialist's input any more frequently, or are you in some way limited to yearly access? If you are able to see your endocrinologist before your next yearly visit is due, it might be worth your while to have a discussion about changing your medication regimen. After six or eight weeks of taking your medication with food, you would need to have blood tests to see if your medication dosage needed to be increased--and I would not assume that without any doubt, it would have to be increased. There seem to be almost no absolutes about the way the body works. It seems true twice over to me where thyroid gland functioning is concerned.

I see that in my previous comments, I did not say the following. Although it may be self-evident, maybe I should say it anyway. Taking thyroid medication with food means being highly self-disciplined, in that it means eating approximately the same amount of the same kind of food just before every medication dose. I am guessing that this sort of self-discipline would seem to you like a small price to pay, considering the discomforts that you have to endure when you take medication the usual way.

I hope that you can talk about this with your endocrinologist without waiting for a long time.  I also hope that if your physician is dogmatic and says that no, you may not vary from the first-in-the-morning, empty-stomach routine, you have a way to find another endocrinologist for a second opinion.  If you go to Mary Shomon's website and put "food" into the search box, I think you will find an article that tells you: I and my endocrinologist are not just being careless kooks! Since I have had experiences that seem very similar to yours: sick, dizzy, tired, and weak...and sometimes that form of unwellness deteriorates into a migraine-like headache for me, I am sorry to think of your going through so much discomfort when it easily might be prevented.

Wishing you well,
Jenny

[mallorcasara]

I thank everyone for responding to my post!
The only think I didn

[EmpatheticJenny]

I really AM fuzzy today. I am not having a good thyroid day, which I knew even before it took me three tries to post one coherent message. I apologize, though, for the multiple posts.

If you decide to try taking your Thyroxine with food, then of course you will need to have your dosage level reassessed--no two ways about it--and probably increased. Assuming that you have a good endocrinologist, it would be good to talk with him or her about your wish to experiment, just on general principles.

You should know, though, that taking your medication with food reduces the absorption to a degree that is predictable and not huge, so taking your medication after "padding" your stomach with food and then adjusting for the absorption reduction is not a radical approach. I want you to know this because I have seen physicians who went strictly "by the book" as they provided medical care, which was wise in some situations but which, in other situations, caused a patient to suffer needlessly.

[EmpatheticJenny]

P.S. Please pardon my cognitive fuzz! In the comments I posted earlier today, I failed to make something clear. I said that my endocrinologist has advised me: Whatever you do, just do it consistently. He means consistently in every way. I am accustomed to a very high-fiber diet, which he says is entirely all right as long as I keep it that way consistently. Any time of day for taking my medication is fine, but I should be consistent there, too, once I have made a decision about what sort of timing seems best. Same deal with empty stomach versus full stomach: Just do the same thing every day.

I probably do not need to say the following, but I am adding it just to be sure I do not leave any base uncovered. Once you have figured out what medication routine works the best for you, your endocrinologist should reassess your Thyroxine dose to be sure that it is still at the right level for you.