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.