Your body won't able to absorb enough medication. Your symptoms—fatigue, constipation, dry skin, brittle nails, and so forth—should diminish within a few days. However, it will take from four to eight weeks for your TSH blood levels to reflect the effectiveness of your medication. Your endocrinologist likely will test your blood six to eight weeks after you start treatment or begin taking a different dose. Dairy products and coffee both have been found to prevent adequate absorption of levothyroxine.
Other foods that may interfere with the drug include soybeans, walnuts, and foods that are high in fiber. Grapefruit and grapefruit also may be problematic. Losing weight with thyroid disease can be a struggle. Our thyroid-friendly meal plan can help. Sign up and get yours free! Effects of evening vs morning levothyroxine intake: a randomized double-blind crossover trial.
Arch Intern Med. Timing of levothyroxine administration affects serum thyrotropin concentration. J Clin Endocrinol Metab. J Thyroid Res. Cytomel liothyronine sodium. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Hypothyroidism underactive thyroid. Updated March Do not take levothyroxine and go back to your doctor to discuss your treatment if you have : had an allergic reaction to levothyroxine or any other medicines in the past an overactive thyroid hyperthyroidism a health problem that affects your adrenal glands your doctor will be able to tell you if you're not sure Check with your doctor before taking levothyroxine if you have : a heart problem including angina , heart disease or heart failure high blood pressure had a heart attack diabetes — the dose of your diabetes medicine may need to change because levothyroxine can raise blood sugar levels.
Dosage You may need to take several different tablets to make up your dose. Your doctor will tell you how many tablets to take each day. The dose of levothyroxine varies from person to person. How to take it Swallow the tablets whole with a drink of water. What if I forget to take it? What if I take too much? Taking an extra dose of levothyroxine by accident is unlikely to harm you. Speak to your doctor if: you accidentally take more than 1 extra dose you get side effects such as a racing heart beat or chest pain — these may not happen straight away, it can be several days before they come on Blood tests Your doctor will do regular blood tests to check the levels of thyroid hormones in your body before and after starting levothyroxine.
These will allow your doctor to adjust the dose to suit you. You may need blood tests more often if you: are pregnant start or stop a medicine that can interfere with levothyroxine have any symptoms that could mean your dose is not quite right. Common side effects and self-help advice The common side effects of levothyroxine usually happen because the dose you're taking is more than you need. Feeling sick Stick to simple meals and do not eat rich or spicy food.
Being sick vomiting or diarrhoea Drink plenty of water to prevent dehydration. Headaches Make sure you rest and drink plenty of fluids. Feeling restless or excitable, or problems sleeping These symptoms should improve as your body gets used to levothyroxine. Flushing or sweating Try cutting down on coffee, tea and alcohol. Muscle cramps If you get unusual muscle ache, which is not from exercise or hard work, talk to your doctor. Shaking, usually of the hands Talk to your doctor as you may need to have your dose reduced.
Serious side effects It happens rarely, but some people may have serious side effects when taking levothyroxine. Call a doctor straight away if you get: chest pain fast or irregular heartbeats, or palpitations Serious allergic reaction In rare cases, it's possible to have a serious allergic reaction anaphylaxis to levothyroxine.
Information: You can report any suspected side effect using the Yellow Card safety scheme. Visit Yellow Card for further information. Levothyroxine and pregnancy Levothyroxine is usually safe to take in pregnancy. Levothyroxine and breastfeeding It's usually safe to breastfeed while you're on levothyroxine. Non-urgent advice: Tell your doctor if you're:. They include: medicines for fits or seizures — such as carbamazepine and phenytoin rifampicin amiodarone oestrogens — such as in combined contraceptive pills or hormone replacement therapy HRT Levothyroxine can change how other medicines work, so their doses may need to be altered.
These medicines include: medicines for diabetes — either insulin or tablets the blood thinning medicine, warfarin Some medicines should not be taken at the same time of day as levothyroxine as they can reduce the amount of levothyroxine your body takes in, including: antacids calcium salts iron salts orlistat, a medicine used for weight loss sucralfate, a medicine used to treat stomach ulcers some cholesterol-lowering medicines such as colestyramine, colestipol or colesevelem Read the information leaflet supplied with these medicines or speak to your pharmacist for advice on how much time to leave between taking these medicines and taking levothyroxine.
Mixing levothyroxine with herbal remedies and supplements There's very little information about taking herbal remedies and supplements with levothyroxine. Important: Medicine safety Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
How does levothyroxine work? Some of the most common symptoms of an underactive thyroid gland are: tiredness feeling cold difficulty concentrating weight gain feeling depressed Levothyroxine is a synthetic version of thyroxine. How long does levothyroxine take to work?
How long will I take levothyroxine for? Is levothyroxine safe to take for a long time? Will it affect my fertility? Can I drink alcohol with it? Will it make me lose weight? Can I drive or ride a bike with it? Yes, levothyroxine should not affect your ability to drive or ride a bike. Is there any food or drink I need to avoid? Our study shows that if this fasting regimen can be achieved at bedtime, then resulting thyroid hormone levels are better than those associated with levothyroxine intake 30 minutes before breakfast.
The crossover design of our study has the advantage that each patient served as his or her own control. Therefore, a statistical difference in thyrotropin values at baseline will not influence primary and secondary outcomes of the study. The study design has potential limitations, including order and sequence effects. We found no first-order carryover effect between the 2 periods, but we looked at no other order or sequence effects. It should also be noted that this was a single-site study in the Netherlands, where eating habits might be different from those in other countries or cultures.
Based on the results of our study, clinicians should inform patients with hypothyroidism that levothyroxine intake at bedtime is a good alternative to levothyroxine intake in the morning, provided that levothyroxine is taken on an empty stomach. For patients who do not attain normal thyrotropin or FT 4 levels with morning levothyroxine intake, a switch to bedtime is recommended.
Recommendations on timing of levothyroxine intake and on uptake interference by food are found in few guidelines about the management of hypothyroidism.
In conclusion, bedtime intake of levothyroxine in our study significantly improved thyroid hormone levels. This may be explained by better gastrointestinal bioavailability at night or by less uptake interference by food or medications. As shown in this study, bedtime administration is more convenient for many patients. Clinicians should inform their patients about the possibility of taking levothyroxine at bedtime. A prolonged period of bedtime levothyroxine therapy may be required for a change in QOL to occur.
Authors Contributions: Dr Bolk had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design : Bolk, Visser, and Berghout. Acquisition of data : Bolk, Jongste, and Berghout. Critical revision of the manuscript for important intellectual content : Visser, Tijssen, and Berghout.
Statistical analysis : Nijman and Tijssen. Administrative, technical or material support : Nijman and Jongste. Study supervision : Berghout. Additional Contributions: Liesbeth Ruygrok, PhD, oversaw preparation of the levothyroxine and placebo capsules and randomization of the patients. Maasstad Hospital Rotterdam laboratory technicians processed the blood samples, and employees of the Department of Internal Medicine assisted with patient assessment.
We thank the patients who participated in this study for their cooperation. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Download PDF Comment. Figure 1. View Large Download. Table 1. The spectrum of thyroid disease in a community: the Whickham Survey. Liel YHarman-Boehm IShany S Evidence for a clinically important adverse effect of fiber-enriched diet on the bioavailability of levothyroxine in adult hypothyroid patients.
Altered intestinal absorption of L -thyroxine caused by coffee. The clinical spectrum of postpartum thyroid disease. Handbook of Statistics. Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis.
Cognitive functioning and well-being in euthyroid patients on thyroxine replacement therapy for primary hypothyroidism. Hamilton TEDavis SOnstad LKopecky KJ Thyrotropin levels in a population with no clinical, autoantibody, or ultrasonographic evidence of thyroid disease: implications for the diagnosis of subclinical hypothyroidism.
Combined therapy with levothyroxine and liothyronine in two ratios, compared with levothyroxine monotherapy in primary hypothyroidism: a double-blind, randomized, controlled clinical trial. Woeber KA Update on the management of hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association, Treatment guidelines for patients with hyperthyroidism and hypothyroidism. Save Preferences. Privacy Policy Terms of Use. Limit characters. Limit 25 characters. Conflicts of Interest Disclosure Identify all potential conflicts of interest that might be relevant to your comment.
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Limit characters or approximately words. The following information is required and must be completed in order to submit a comment:. Thank You. Your comment submission was successful. If you do miss a dose, the ATA says to take the missed dose as soon as possible, or to take two pills the following day — one in the morning and one in the evening.
And never stop taking your medication without talking to your doctor. Always take your medication on an empty stomach. Food and other medications can bind to levothyroxine and prevent its absorption, meaning that you may not get the full dose of your medication. So avoid eating or taking any other medications within an hour of taking your daily dose of thyroid replacement hormone.
You should take your medication with a glass of water, however. But for those who want to eat within an hour of rising, this approach may not work. Just as food can, antacids and iron supplements can bind with your hypothyroidism medication and prevent its absorption.
Build a time buffer between taking your thyroid medication and taking any other medications, as well as any antacids, multivitamins, or other supplements, like iron.
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