“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #156

Thyroid shape made of natural ingredients. Best food for healthy thyroid

When prescribing thyroid medications, there are a couple of things to keep in mind, the most important of which, is to make sure levothyroxine can be absorbed.  Levothyroxine is T4 and comes in a variety of forms:  brand name Synthroid, generic levothyroxine, and it is IN Armour and NP Thyroid medications. 

Because T4 is significantly “drawn” to or blocked by numerous substances, it is vital that we teach patients to take it on a completely empty stomach with no other food, coffee or milk, medicine, supplements or anything except water for about an hour.  Patients often think that the label that specifies “take on empty stomach” means that they can take it with their PPI, calcium channel blocker, or antibiotics.  However, that is not true due to a variety of factors.  It is up to us to provide education regarding the “empty stomach” rule. 

For patients who are saddened that they may have to wait on coffee, or other intake for that first hour upon awakening, there are a couple of alternatives.  One suggestion is to take the levo in the middle of the night, on the way to or from the bathroom.  Many people are “midnight pee-ers”, making a nightly trip to the restroom sometime in the early hours of the morning.  Placing one tablet of levo out into a small bowl or jar lid with a nearby glass of water, provides convenience without life interference (this strategy can also be used with a morning PPI dose that needs to be taken on an empty stomach). 

Another option is bedtime dosing, if there are no other meds, vitamins or other intake that might impact absorption of the levothyroxine. The only real problem with this dosing pattern is if prescribed Armour or NP, the T4 is IN those meds, since it’s not ideal to take these combinations at bedtime.

P.S.  One last consideration is for those who also take a PPI or H1 blocker – both of which ALSO need to be taken on an empty stomach, well away from other supplements, food, and medicine, especially T4.  Typical recommendation is to take thyroid med first, and an hour later take PPI/H1 blocker, and then an hour later, take other meds, food, coffee. So, it can be a real pain for patients on both of those medications!

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