Questions for all who take thyroid medicine in the morning

[Gingergrrl]

I take low dose Armour Thyroid every morning prescribed by my Endo for Hashimotos. My TSH without any med is right on the border (3.8 to 4.0) and with Armour is consistently at 1.0. I just have high levels of both Hashis antibodies which we are trying to lower. My Endo told me (back in Oct 2013 when it was first diagnosed and prescribed) that I cannot take any "minerals" for four hours after taking it or it can decrease the absorption of the med. If my memory is correct, he mentioned Calcium, Iron, and Magnesium.

I was talking to a good friend last night who mentioned that he Googled this and each doctor seems to give different opinions on this. Some say you can take this but not that, some say wait two hours, some say wait 1/2 an hour, etc.

I have always complied with the four hour rule but the reason I am asking is that this morning (for example) my BP is only in the 80's/50's again even after taking Midodrine and I am having quite a bit of shortness of breath. If I could take my Salt Stick tablets, they are often able to increase my BP and shakiness.

So my exact questions are:

1) Salt Stick contains two main ingredients, sodium and chloride, (but also contains small amounts of Vit D, magnesium, potassium, and calcium.) So, do I really need to wait four hours to take them? Are Sodium and Chloride allowed within the window?

2) I have been drinking Pedialyte when I first get up, as per my cardiologist, and does this also interact with thyroid med? Where does Potassium & Sodium in a liquid form fall within this rule?

3) What are you guys (who take any form of morning thyroid med) being told to avoid? Is it only "minerals" or is it all electrolytes? I do not take iron (so not an issue for me) but I want to know about all the other ones.

4) How many hours are you being told to wait (1/2 hour, two hours, four hours, etc.)

Any info would be helpful and thank you to all who answer!

 

[PennyIA]

I can't help with #1 & #2; but am also on low dose Armour Thyroid therapy. I was told to avoid EVERYTHING (i.e., not even my morning caffeine) until half an hour. And was told I could take all my supplements at the half hour mark without limitation.

Of course, my doctor could be ill-informed and telling me the exact wrong thing, as well. :-(

 

[acer2000]

I notice that if I take anything other than water for at least an hour the thyroid medication is less effective. The exception to this is taking the Tirosint brand, because it is a gel cap and is absorbed much quicker. It's T4 only, though.

 

[Gingergrrl]

I can't help with #1 & #2; but am also on low dose Armour Thyroid therapy. I was told to avoid EVERYTHING (i.e., not even my morning caffeine) until half an hour. And was told I could take all my supplements at the half hour mark without limitation.

Of course, my doctor could be ill-informed and telling me the exact wrong thing, as well. :-(

@PennyIA I wanted to add that my Endo told me not to eat any food for one hour after taking Armour and that part is very easy to comply with as I am rarely hungry or eat anything until around noon. He said all my other meds are okay to take at the same time as Armour (Famvir, Atenolol and Midodrine) but to avoid "Minerals."

I know he said Iron, Calcium and Magnesium to wait four hours but I am confused about the Potassium & Sodium (are these minerals or electrolytes?) and since the amount of the Mag & Calcium in the Salt Stick capsules are very tiny, is maybe just waiting 1-2 hours okay?

My former naturopath had a different opinion than my Endo but I stuck with the Endo's opinion since he is the specialist but now I am concerned.

 

[Gondwanaland]

I found a source of information with scientific references:
http://www.med.nyu.edu/content?ChunkIID=21646

And found another one on med interactions:

Other medicines may interfere with the action of levothyroxine - for example: carbamazepine, iron tablets, phenytoin, and rifampicin. If you start any of these medicines, or change the dose, then you may need to alter the dose of the levothyroxine. Your doctor will advise. Also, if you take warfarin, the dose may need to be altered if you have a change in your dose of levothyroxine.

 

[PennyIA]

So, there it calls out Iron and Calcium... so maybe the potassium and magnesium aren't a problem?

 

[Gingergrrl]

@Gondwanaland Thank you for the links and it does look like iron and calcium are the two things to avoid (which I know for certain my Endo mentioned.) I don't take iron but now I am wondering about the tiny amount of calcium in the salt stick tablets? Also, the link you sent said to avoid calcium carbonate and the calcium in the salt stick says it is calcium citrate and calcium gluconate (and it is only 2% of daily amount.) Any calcium experts out there?

 

[Ema]

I took all my thyroid meds sublingually so as to avoid all interaction problems. I did this with compounded T4/T3 troches as well as plain Armour.

I think iron and calcium are the biggies to avoid. I've heard half hour before meals or 2 hours after.

I would not worry about sodium or potassium with thyroid. They are minerals and their function is as electrolytes.

 

[Kati]

i have been told no food of meds for an hour after thyroid meds, but calcium needs to be 4 hours. I would not worry about the small doses of calcium in your other meds.

You coud do an experiment and try your regimen for a month or 2 and see where your TSH is at.

Also remember that calcium and iron tablets should not be taken together. Iron is not well absorbed in the presemce of calcium. iron is best absorbed with vitamin C contained food like citrus.

 

[Gingergrrl]

Thanks @Ema and @Kati for the additional info! It looks like calcium and iron are the ones to avoid and I will not worry about the tiny amount of calcium in the salt stick capsules (but take my regular calcium much later in the day) and I do not take iron.

 

[Helen]

I have good experience from learning the symptoms to check if the uptake of the hormones are OK. I think if you can do that you are much more able to observe if you take a supplement that interfere with the effect of the hormones.

Did you check this site ? www.stopthethyroidmadness.com

I think Dr. Jeffrey Dach has an excellent homepage with good articles and references about different subjects.
http://jeffreydachmd.com/hashimotos-thyroiditis-and-selenium-part-one-by-jeffrey-dach-md/

Maybe you have tried different strategies to lower the antibodies already. If not, I think it could be worth a try. I know people who could stop medicating after gluten removal e.g. Amalgam fillings are also studied and found producing thyroid antibodies, at least they decreased after amalgam removal. Selenium suplementation as proposed by Dach works in different ways to support the thyroid.

Do you think your very low blood pressure could be from low cortisol? Did you try T3-only instead of aT4 containing drug that is supposed to use cortisol to convert T4 to T3? Just an idea that you maybe could get some help from. Sorry I haven´t followed your situation so maybe this was all known by you before. Hope you will find good solutions. Best.

 

[CBS]

I take my synthroid before bed. Very long half-life and slow absorption. No issues with sleep and no worries about erratic amounts absorbed. If you do take it within a few hours of calcium/iron, make sure you always do so (easier said than done) to maintain steady blood levels.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139142/

 

[Helen]

I take my synthroid before bed. Very long half-life and slow absorption. No issues with sleep and no worries about erratic amounts absorbed. If you do take it within a few hours of calcium/iron, make sure you always do so (easier said than done) to maintain steady blood levels.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139142/

There might be a problem for those who have low output of cortisol to take T4 containing drugs in the evening, though, as usually the cortisol is highest in the morning which is optimal for the conversion of T4 to T3.

 

[caledonia]

I ended up taking Armour with food, because I can't swallow pills with water. It still worked ok. I moved my multi to lunch so it didn't interfere with the Armour at breakfast.

I was doing electrolytes (salt, magnesium and potassium) with breakfast, so at the same time as Armour. Seemed ok.

Some time after starting methylation, my thyroid healed. I'm off my med and all my labs are normal. This coincided with all the rest of my mercury coming out, and a small but noticeable increase in energy.

I'm also gluten free and have been for many years. Maybe mercury and gluten both factored in, as well as selenium and iodine, and removing chlorine, bromine and flouride, but mercury seemed to be the main culprit for me. And also getting in some methylfolate + B12.

Ben Lynch did an hour video on how MTHFR affects the thyroid and causes autoimmune thyroiditis. If I remember correctly, he says most everybody with autoimmune thyroiditis has MTHFR.

http://mthfr.net/mthfr-and-thyroid-disorders/2013/07/18/

 

[SDSue]

While I don't eat for at least an hour after taking my T3, I do drink 2 Nuun tablets in 32 oz water (each tablet delivers 360 mg Sodium / 100 mg Potassium / 25 mg Magnesium / 13 mg Calcium) at the same time as my T3.

Here's my thought on it: If any of those ingredients interfere with absorption of my thyroid med, they do it consistently every day. Therefore my blood work and dosage is based on my norm, which is me taking electrolytes daily. Should I stop taking the Nuun, then I will need to watch for symptoms of hyperthyroid. Until then, I don't worry about it.

 

[CBS]

There might be a problem for those who have low output of cortisol to take T4 containing drugs in the evening, though, as usually the cortisol is highest in the morning which is optimal for the conversion of T4 to T3.

@Helen

I get that life is far from as it should be for ME patients and that docs are more likely to try levothyroxin before suspecting, let alone addressing, a cortisol deficiency. BUT, while hypothyroidism can cause cause severe disability and complications that will hasten death over an extended period, an adrenal crisis (made more likely by treating a thyroid deficiency before treating an adrenal deficiency) can kill you today or tomorrow. I failed two trials (as in damn near died) of Synthroid within a matter of days. This was before being diagnosed with secondary adrenal insufficiency. Low dose (physiological) cortisol lead to significant improvements. Ten years after my adrenal insufficiency was under control, my docs were willing to try Synthroid again (using it before ruling out adrenal insufficiency and precipitating a crisis lead them to the incorrect conclusion that I was euthroid in spite of chronically low TSH and low T4), leading to further improvement. Even so, I personally would never take Synthroid without ruling out adrenal insufficiency first (and i don't know if I'd trust a doctor willing to prescribe it without doing the same).

 

[Gondwanaland]

I take my levothyroxine 1 hour before breakfast. This past Saturday I started taking psyllium husks at breakfast and dinner. Boom, I'm hypothyroid. I will cut out the psyllium from breakfast since it seems to be reducing my absorption, plus I'm switching doctors and to compounded T4/T3 .

 

[Gingergrrl]

@Helen

I have good experience from learning the symptoms to check if the uptake of the hormones are OK. I think if you can do that you are much more able to observe if you take a supplement that interfere with the effect of the hormones.

At this point, I really do not notice any difference in my symptoms from the Armour but it keeps my TSH, T3 & T4 numbers at the right range and is hopefully lowering the attack of the two Hashi antibodies on my thyroid. I am familiar with the STTM book and website although I didn't even think to check them re: the questions that I asked in this thread!

I think Dr. Jeffrey Dach has an excellent homepage with good articles and references about different subjects. http://jeffreydachmd.com/hashimotos-thyroiditis-and-selenium-part-one-by-jeffrey-dach-md/

I had not heard of him and will check out his website.

Maybe you have tried different strategies to lower the antibodies already. If not, I think it could be worth a try. I know people who could stop medicating after gluten removal e.g. Amalgam fillings are also studied and found producing thyroid antibodies, at least they decreased after amalgam removal. Selenium suplementation as proposed by Dach works in different ways to support the thyroid.

I have been gluten free since January (almost one year) and I have never had any amalgam fillings. I also just started taking 200 mcg Selenium about 2-3 weeks ago and hoping this will also help. So from your suggestions, it sounds like I am on the right track!

Do you think your very low blood pressure could be from low cortisol? Did you try T3-only instead of aT4 containing drug that is supposed to use cortisol to convert T4 to T3? Just an idea that you maybe could get some help from. Sorry I haven´t followed your situation so maybe this was all known by you before. Hope you will find good solutions.

I am confused re: the cortisol issue at this point and my CFS doctor just sent me a kit yesterday to re-do my 24 hour saliva cortisol test. I did one earlier this year with my former ND and the results showed slightly low cortisol for certain parts of the day (but normal for other parts.) Prior to that I had blood and urine cortisol tests that were normal. Then in Sept while I was in the hospital, I had an ACTH stim test that was normal (although the hospital screwed up the times of the two blood draws so I question the full accuracy of the results.)

ETA: Does low blood pressure mean that someone has low cortisol? Sorry if this is a stupid question!

 

[Ema]

@Gingergrrl, low systolic pressure often corresponds to low cortisol and low diastolic pressure with aldosterone.

 

[Gingergrrl]

I take my synthroid before bed.

@CBS My Endo told me specifically that I must take Armour in the morning so this is not an option for me.

Some time after starting methylation, my thyroid healed.

@caledonia I remember you mentioning this before and it brought me a lot of hope that if I tried methylation, it would heal my thyroid and improve my symptoms but I was unable to tolerate the methylation supplements. I know at one point I was going to send you a PM to ask you some questions about trying hydroxy B-12 (vs. methyl-B12) but then I got so side-tracked by a horrible reaction to IV saline, that I totally forgot and now I don't even remember what my specific questions were!

While I don't eat for at least an hour after taking my T3, I do drink 2 Nuun tablets in 32 oz water (each tablet delivers 360 mg Sodium / 100 mg Potassium / 25 mg Magnesium / 13 mg Calcium) at the same time as my T3.

@SDSue I am so impressed that you are able to drink 32 oz of water in the morning! Right now I am trying to drink 16 oz of 1/2 Pedialyte & 1/2 water mixture in the morning and it is still a struggle for me (but I am doing it.)