Monday, November 19, 2012

Thyroid Researchers Say Take T4 Medication Before Bedtime!

“When Should I Take Thyroid Medication?

I get this question asked a lot because of the difficulty often-times of taking Synthroid, Levothyroxine or Armour first thing in the morning and then having to wait 45-90 minutes before consuming anything else, even other prescriptions or supplements.
Why do medical doctors, particularly our endocrinologists, recommend taking the medications in the morning?
The main reason appears to avoid trouble falling asleep; as for some people thyroid medication can cause trouble with sleep.
The problem with food and thyroid hormone replacement medication is that foods alter the way in which the drug is absorbed with some published studies showing about a 20% drop if Synthroid is taken with food, compared to an empty stomach.
Taking Thyroid Hormones At Bedtime…
The results of two studies that have been done concerning dosage timing have shown that taking the same dose levothyroxine at bedtime may actually be better than taking it first thing in the morning. 
A 12-person Dutch study reported in the January 2007 issue of "Clinical Endocrinology" found that levothyroxine was better absorbed when taken at night than during the day
A study reported in the Archives of Internal Medicine (Arch Intern Med 2010;170:1996-2003 ) suggests taking levothyroxine or Synthroid on an empty stomach at bedtime, which  may be the key to lower TSH, higher T4 and T3 levels, and improved absorption of thyroid medication.
Why Would Taking Thyroid Medication Night Be Better?
The researchers suggested several explanations for the thyroid results:
  • The morning dose is questionable for most of us. Why? “On an empty stomach” varies for each person. So, even when waiting at least 30 minutes to eat, breakfast and vitamins and other supplements or medications may be interfering with the intestinal absorption of the medication.

  • “Bowel motility is slower at night,” which means that it takes longer for the levothyroxine tablet to transit through the intestinal system, resulting in longer exposure to the intestinal wall, and therefore, better uptake of the medication.

  • The conversion process of T4 to T3 may be more effective in the evening.
Taking Medication At Bedtime Instead Of In The Morning Is Also Just Easier Sometimes
  • It’s easier, as you don’t have to worry about when to eat breakfast, and then end up not having breakfast, which is adding fuel to the proverbial fire.

  • Taking the medication at night makes it easier to avoid other medications, supplements and foods. Taking your thyroid medicine with coffee, minerals or fiber such as bran cereal or Citrucel can interfere with its absorption. (Thyroid, March, 2008).

  • Plus, taking the medication at night might offer some improvement in symptoms to people who are just not getting optimal absorption by taking thyroid medication during the day.

Researchers Stated That Results Were “Striking”!

The studies were prompted by observation that some patients had improved thyroid hormone profiles after they switched from taking their levothyroxine from morning to bedtime.
Not only did they evaluate the impact of thyroid hormone levels by changing the time of medication, they also evaluated the impact this had on TSH and thyroid hormones and thyroid hormone metabolism.
The studies were fairly conclusive in their findings, which the researchers said were “striking” and which have “important consequences for the millions of patients who take levothyroxine daily.”

Researchers reported that taking medication at bedtime, rather than the morning, results in “higher thyroid hormone concentrations and lower TSH concentrations.”
TSH decreased and Free T4 levels rose in all patients by changing T4 ingestion from early morning to bedtime and T3 levels rose in all but one subject and TSH decreased irrespective of the starting TSH levels, suggesting better absorption of the thyroid medication when taken in the evening.

What I Am NOT Advocating…
To close please understand that I am not telling you that you should, in any way, alter your medication dosing as set by your treating physician. What I do recommend is that you bring these studies up with your doctor on your next visit with your doctor.

If you decide that you want to try taking your thyroid medication in the evening, make sure to check your thyroid levels via blood test within the following six to eight weeks so that your doctor may determine if there is any adjustment to the dosage of your medication.

The above research test were done using levothyroxine, which is purely T4 thyroid hormone (Synthroid and Tirosint are two examples) it was not done using hormone replacement drugs that contained T3, such as: NatureThroid, Armour Thyroid or Cytomel.

Because of this fact there is no way of knowing if your sleep would be altered on these types of hormone replacement medications.

Consult with your Primary Physician before altering any medication dosages.

Member Pastoral Medical Association
Chiropractic Clinical Neurologist
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