My wife made me read a short article in her hollywood gossip mag that reported that a recent study from the U of Amsterdam concluded that it was better to take the thyroid meds at bedtime rather than 1st thing in the am.

I know my doc told me to take it in the am and I have no idea whether to believe this article and I don't have the time to even google it right now but I thought I would throw this out here.

Better in what way? Two endocrinologists and my primary doc have told me to take it in the morning and my levels are checked and maintained.

I wonder if people aren't good about taking it on an empty stomach and then waiting before eating or drinking.

Weird.

Maybe it also depends on what kind of medication you are taking. I know that I was also told to take it in the morning on an empty stomach with lots of water.

I was told to take it in the morning 4 hours before I take anything with iron or calcium. Nothing about waiting on eating and drinking. How long were you told to wait Margaret?

Take care,
Eileen

Ditto. I was told to take in the a.m., one hour before eating and before taking any supplements.

Eileen,

My first endo said to wait at least an hour but the levoxyl website says a 1/2 hour. Apparently, its a very wimpy medication.

- Margaret

The article discussed Synthyroid for Hypothyroidism. The article is titled "Thyroid Medicine is better at bedtime". It was a 6 month study involving 105 patients and their conclusion: "Taken at bedtime, levothyroxine significantly improved thyroid levels."

David

I did a personal experiment in this after reading a Yahoo article about a 2007 study. Bottom line, after three months of taking my thyroid medication before bedtime, my TSH level got even better as proven by my blood tests, than when I was taking the same dose in the morning. I was getting tired of getting up early to take Levoxyl so I could share my "breakfast" (coffee and 2 cans of Jevity 1.5) with my wife at our usual time together.

I discussed this very issue with my endocrinologist. As usual, I cross examined her on the basis for her recommendation that I take my levoxyl in the morning. She readily admitted it was what she was taught in medical school and that these were the instructions from the FDA insert. She had no independent basis and just had not questioned it. So I am not surprised that all the posters' doctors told them to take it in the morning. I like to know why my doctor thinks something and feel better when it's as a result of having done an operation or seen it in patients rather than hearing it in a lecture.

This last visit she agreed that while my TSH levels had been good and stable with morning dose, they were even better after I switched to evening.
Here is the link to Yahoo Should You Take Your Thyroid Medication at Night?

Last but not least, I found an article that in getting FDA approval, the hormone tests showed that some people, a very small percentage but statistically significant, found that taking their thyroid medication at night caused sleep problems. My understanding is that's the one and only documented reason for the generic recommendation to take thyroid medication in the morning. That way there is no requirement to list insomnia as a possible side effect.
Also the "take lots of water" thing was just because some people choked on the little pill, nothing else.

Thanks for posting about this study. It has really been nice to just wake up and eat breakfast (plus have coffee)
Charm

Yes, I have always been told to take on an empty stomache, an hour before eating. This of course makes it hard to take in the morning when you need to eat before leaving for work. I usually couldn't get an hour. Lately I am trying to take mid morning, an hour before lunch. We will see how that goes. Taking at bedtime might mean better compliance with the empty stomache requirement.

That's very interesting. I usually take mine in the morning but usually take it after I have eaten and have not had any problems. I have also taken it while on 24/7 tube feeds. I had a reaction to the first medication when they raised the dose but haven't had any issues with synthroid. I take other meds at night so it works better for me in the morning.

Well I started taking mine at night and I'll see if I notice any difference. At least after 2 nights I don't. I doubt it but I'm ready to mix things up a bit.

Re the problems sleeping at night...with my 2 85 lb Pit boys and usually at least 4 cats and of course my wife somewhere all trying to fit on a king size bed I already have sleeping problems so I don't think I'll notice a difference with the pill.

So funny how we all take it differently. I was told to take mine on an empty stomach at least 30 minutes prior to eating and to drink lots of water too.

So I usually take mine 30minutes prior to eating but if I wake up starving and in a rush, I don't take it until mid day. I also don't take with lots of water.

I think I may try to switch my time up and try it at night. My symptoms have improved a little but I still run high. Docs won't increase the dosage in fear of me losing more weight from the increase, I'm barely holding down triple digits.

Instructed for A.M. before breakfast, plenty of water also. Dr. increased doseage once. Not sure night would work for me as I take no meds in evening. Been on for four months, new dose for two of that, blood work last week shows now under control. Energy back as well!

Thyroid meds are easily affected by other things you might eat which is why your doctors ask you to take it before food. This means if you have food, it doesn't absorb so well and your blood levels may not be high enough. If you really want to take your meds with breakfast, or at night, it is just a matter of working with your doctor, to ensure your blood levels don't change. If they do, your dose needs adjusting. Simple. The trick is, once you have the routine and the correct blood levels, stick to the routine.

So here is my question: When should I get Alex's thyroid levels checked and how many nuked patients need thyroid meds? He completed radiation at the end of August last year (5 months ago).

An interesting discussion. I too take my generic Synthroid as soon as the 50 pound dog on the bed next to me has decided she (at any rate) has had enough sleep and awakens me. This is typically before 7 a.m. I then wait half an hour or so before eating or drinking anything else as per the instructions on the bottle.

Last blood test my doc said my TSH levels were too high so he told me to double the Synth from 25 mcg to 50. I'll be rechecking blood next week so we'll see if that does the trick. I'll ask him about the time of day issue then too.

On a side note, when I asked my GI doc what I should put in my stomach first thing in the morning here was his answer: "Anything but coffee".

d2

Karen, if one is aware of the need, the recommendation would have been to det the thyroid "baseline" prior to radiation, so that you know what your normal is after radiation. It appears from discussions on the forum that most doctors don't suggest this so you have to ask for it. I on the other hand was already on synthroid prior to my cancer.

I pose a different question...has anyone else had their thyroid "zapped" with radioactive iodine, and then diagnoised with oral cancer. I will always wonder if their was a connection and I know I will never really know the answer but it does make me wonder if their was a connection.

Sharon

From what I hear most people that have had radiation even if it wasn't on their head and neck area have thyroid issues. I have a friend who had radiation for cancer and she is on thyroid meds. My RO worked with my general dr I think to get blood work done to check my level sometime after radiation was over. It is a simple blood test that you can request be done.

I had radiation and do not have thyroid problems. I wouldnt agree with most patients having that problem. Sure it affects some but not most. Just like trismus, it affects some but not most. Seems we all end up having out own unique set of after effects. Just like the side effects, we all had varying degrees of issues. How I wish there was an easier cure for oral cancer! Something that wouldnt involve so much suffering and long lasting effects.

Everything that I have read and heard is that most people will have some issues. But I have also read that some people the issues won't show up until years after the treatment is over. I am glad to hear that you don't have any issues and pray that it continues that way. I wish that there was an easier way too.

Finally, a nasty side effect or terrible consequence of this cancer that Christine does not have. Yea! I'm am so glad to hear your thyroid works (I can't say "like a charm" since mine doesn't). As Brian and others have pointed out, it depends on the path of the radiation. RO's try to avoid the thyroid but it can't always be helped, especially for base of tongue tumors.

I'm glad to see this thread. I think that thyroid medications can and should be taken at night, on an empty stomach, for the majority of patients and that the warnings and advice against that are not based on science nor statistically significant studies. I am so glad my endocrinologist is young and open minded: as she says: It's hard to argue with the facts of blood tests. She readily admitted her morning advice was based on med school and that no one in her class challenged this "wisdom" nor does she recall seeing any studies in her journals actually documenting the validity of morning doses, only some studies questioning it and the ones I listed discrediting it.
Charm

Regarding Sharon's question:
Just to present yet another scenario:
Last summer I had a CT scan that showed suspicious areas on my thyroid and also showed the lesion in my mouth (CT scan was done because my ear was stopped up and ENT couldn't figure out why-- the ear problem cleared on its own and apparently had nothing to do with the cancer). A fine needle biopsy confirmed thyroid cancer (but the radiologist could not get a good specimen of the mouth lesion). I had a total thyroidectomy and an excisional biopsy of the mouth lesion all at the same time. Both came back as different types of cancer-- totally unrelated to each other. Weird-huh?

Hi Susan

what I'd like to know is how can they tell??

My mother has had 3 bouts of cancer - not oral, but still relevant to this thread. Number 1 was breast, followed by the second in the kidney 6 months later. Not related. That is not so suprising but the doozy was when she was diagnosed a second time with breast cancer 12 months after the first one. Still not related. Except for the fact she is one body with 3 different unrelated cancers, her treatment has been very straightforward and she is alive and kicking showing absolutely no signs of damage. Doctors told her a 2nd cancer in the same place happens in about 1% of patients, so you are both definitely special.

I wrote a summary of the principles of use of thyroid hormone replacement therapy on my blog that may be useful to the redaers at http://dribrook.blogspot.com/p/general-medical-and-dental-issues.html
I hope that you will find it useful.
Itzhak Brook MD

Hey Doc. Your summary did not address whether there is any valid medical reason not to take thyroid medication at night instead of having to get up and not eat Breakfast until at least 30 minutes (many doctors recommend a full hour). So I question the "should" in your summary. Again, it does not appear there is any scientific validation of the superiority of morning dosage over bedtime, in fact quite the opposite if you consider the studies I linked to earlier in the post.
I will be very interested to see if DavidCPAs switch to evening dosage has the same positive effect mine did.
But I wanted to add this comment since as you know many posters ascribe validity to a doctor's statements. Plus, that's one heck of an example of a breakfast you used: ( eggs, bacon, toast, hash brown potatoes, and milk ). I think whoever is on that diet daily should also be seeing a cardiologist as well as an endocrinologist
Charm

Thanks for your comments. The breakfast is the most convenient time of the day to take the medicine for most people because their stomach is generally empty at that time. The medication is recommended to be used at that time of the day because it was studied and approved by the FDA to be used at that fashion. This is why the package insert of the drug states this as the time to use it.
In my opinion it is OK to take it at any time of the day as long as it is the same time and on an empty stomach. The practical difficulty, however, is to know how empty is the stomach at that time.
I modified my blog to clarify it better. Thanks again for your comment.
I Brook MD

Thank you Doctor Brooks. Your explanation makes perfect sense. Being on the feeding tube for these last two years made me forget that people eat late night snacks many of which are high fat. We all agree it's important to take thyroid meds on an empty stomach. I should have mentioned that my endocrinologist also quizzed me about this before supporting my decision to take Levoxyl at night and she was satisfied that since there is always as least four hours between my last meal or any food at all and bedtime, my stomach would be empty - especially since all my food is already liquid.
I'm impressed with you changing your blog to clarify this.
Keep up the good work. I look forward to reading your future posts
Charm

Today my blood test results came back, still elevated TSH at 5.9, but at least lower than the 6.8 from a month ago. In the interim I'd upped my synthroid from 25 to 50 mcg. My doctor now tells me to go to 75.

When I asked him about taking it at night vs. day he said he didn't feel that it mattered too much... only that patients can tend to forget to take medication at night, so he advises doing it in the morning. I'm pretty good about that kind of thing and more concerned with maximizing the effectiveness of the med.

DavidCPA - any changes to your energy level, etc. from nighttime use yet?

thanks.
d2

Ok, here's more: reading, and therefore becoming increasingly confused by, some synthroid dosing pages, I caught a cue that concurrent consumption of calcium is contraindicated. But I wasn't able to ascertain whether this was referring to supplements or, for example, milk. Does anyone have an insight into this issue? thx.

Well I switched back to am mainly because of the empty stomach thing. Thanks Dr B. Owning a restaurant with my wife I tend to eat later than 8pm and always enjoy something sweet (night stuff as my Mom used to call it) before bedtime so there's no way I go to bed on an empty stomach.

Ah so. Thanks for that, David.
d2

I always drink an Ensure before I go to bed, then use my flouride trays so it is easier to take mine in the morning. I was told to wait at least a half hour after taking it before eating so I take it as soon as I get out of bed, then shower, and by that time, I can eat something. RE: calcium - my pharmacist told me I could have a yogurt or something in the morming, but I should wai ar least 4 hours to have a calcium supplement. I also take a liquid vitamin in the evening.

Thanks for that as well, Zengalib.
d2