hypothyroid

Yes I think so Riverwalk. I have only skim-read bits of the article but it said somewhere that the participants in the study who were taking the levothyroxine at night didn't have late-night snacks - it was several hours since they had eaten anything.

DH is on thyroxine as well as my DD - he had half his thyroid removed about 15 years ago. He takes his pill when he gets up in the middle of the night so that is several hours after food and before food.

Hi Puddles. Difficult to comment as you haven't stated what the problem is. I would imagine there would be guidelines they have to adhere to though, before they prescribe tablets.

Jane do you think the AMA recommendation to take at night is because it's more likely to be on an empty stomach, and remain so for the subsequent hours of sleep, rather than for some circadian reason that night-time is better?

As you know, Thyroxine, as prescribed in the UK, should be taken at least 30 minutes before breakfast to ensure maximum bio-availability; maybe the time of day doesn't really matter as long as it's on an empty stomach and remains so until absorption.

Oh dear it's not good when one doctor tells you one thing and another tells you something different
I didn't sleep well during the menopause, that was before I went onto thyroxine. The only thing that worked for me was investing in some silk nighties which seemed to reduce the number of times I woke up drenched in sweat
I would definitely try taking the thyroxine in the morning.

However, here is an article from the Journal of the American Medical Association which concludes that thyroxine absorption is better when taken at night (on an empty stomach) and it may be better for some patients
jamanetwork.com/journals/jamainternalmedicine/fullarticle/776486
"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."
(QOL = quality of life)

Thank you for the link Jane.

No I'm not sleeping well at night, but I attribute that to the menopause, the reason being when I briefly went on HRT patches, I slept better than I had for quite a few years. However, during a recent consultation with a doctor at my practice, not my regular one, she told me that my blood pressure was raised and it would be a good idea to come off it. When I subsequently saw my original doctor who prescribed HRT., she told me that reading was not sufficiently raised to discontinue, took my b/p there and then, normal. This doctor is a great believer in the benefits of HRT and I now wish I hadn't been persuaded to come off it, so may reconsider that. Back to your point though. I may also switch to going back to taking my Thyroxine in the morning to reap the metobolic benefits. I can't remember who posted and her reason as to why she thought it was better to take it at night.

drmalcolmkendrick.org/2015/05/01/treating-thyroid-patients-like-children/
Link to Dr Kendrick's article.

Terribull does it make any difference to you taking it at night?
I've always taken it first thing in the morning as per instructions. I would worry that as it acts on your metabolism it might cause problems sleeping if you take it at night?

You could google Dr Malcolm Kendrick who doesn't follow the orthodox view and I have read that he is of the opinion that some doctors "treat their patients like children" on the matter.

endocronologist - didn't get it right.

Puddles you don't say whether your doctor has prescribed Thyroxine or not. When I was first diagnosed with an under active thryroid, probably getting on for 20 or so ago, the doctor I saw at the time told me I was borderline and didn't need to take anything, I was feeling terrible back then just simple tasks were a supreme effort. Shortly afterwards I saw another doctor in the same practice who told me I most defintely should be taking it. I think I started off on less than 100mcg but now take 150 and was told that according to my latest blood test this should be upped to 175. I saw an endcronologists quite a few years ago who advised that high doseages of Throxine can compromise bone density and as my mother had Osteoporosis towards the end of her life, I was reluctant to take a very high dose so with my doctor's agreement I'm sticking to 150, which is quite high anyway. I have never found Thyroxine a silver bullet as far as depleted energy levels are concerned, but I have to admit that I also have peri menopausal symptoms which also contribute to how I feel. I have often read about "Armour" derived from pigs which is prescribed in America in some cases, when Hillary Clinton made her medical records available, I saw that she was on that. It's thought that it's more effective in treating the symptoms of an under active thyroid, but unfortunately not approved by NICE in the UK, it's much more expensive to produce than synthetic Thyroxine. You can google doctors, who I think will prescribe Armour privately in the UK, I believe there was one at Northwick Park Hospital the last time I looked, I think they tend to be a bit circumspect about doing so. From the various threads on GN and other forums on under active thryroid its seems to be a bit of a lottery as to how effective conventional Throxine is in treating the condition as it seems that some do not absorb it well. One of the posters here on GN advised it was better taken at night and I have been doing that for a while. Good luck in your quest.

Forgot to add Puddles that I hope you get treatment that you feel happy with.

Depending on other hormones in some people the TSH is not absorbed into the system - if you take any form of HRT whether both hormones or just the oestrogen they alter the absorption into the system. I am surprised that any GP is prescribing thyroxine without referring the patient to a specialist - a great majority of GPs do not know enough about the thyroid to do this - it is not often one they specialise in. DD has seen a few endocrinologists over the years and more than one has said this to her. She moved to another part of the country and was given blood tests she had never had in over twenty years of having problems. She also takes T3 as well as the normal Levothyroxine. Levels of cortisone also play a part - DD has recently jad a test of her adrenal glands but fortunately she is witting normal levels. A specialist will go by how the patient is generally and not just the result of a blood test which is only part of the story as the results can change within a few hours.
The drug prescribed in USA is a natural for. Of thyroxine rather than the synthetic one one prescribed in Europe. It does cost many more times that so the synthetic one but you cannot even buy it yourself here.
Despite what many people believe it is not just a question of being given thyroxine.

You could try The London Clinic, this is their Endocrinology page.

Clinic

It is very complicated for some though Anno - as an example my DD is one who cannot metabolise the thyroxin into something or other. I've temporarily forgotten what the medical terms are. In the USA those with this inability are given something else (can't remember what either) that's not abilable on the NHS here.

Not much use I know but I understand where Puddles is coming from. Best of luck.

It's never seemed very complicated to me. I was prescribed 20mg thyroxine and, over 20 or so years of regular blood tests, have progressed to 100mg. All quite routine. I hope you get yours sorted out Puddles. There shouldn't be any great drama about it.

In what way are you dissatisfied? Has S/he prescribed thyroxine? Are you not happy with that? I'm sure you will have had blood tests to ascertain the extent of your deficiency,

Maybe give your local BUPA or Nuffield hospital a ring and ask them.