“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 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.”
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.
***CAUTION***
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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