[Anonymous]

#1149715

Hi Bobbi

I am doing this for my friend who has Hashimoto’s hypothyroidism. He has his whole thyroid removed and is now taking two hormones, testerostone and synthyroid. I do not know how much he takes. He is seriously overweight and has sleeping problems. He says he takes synthyroid every evening before going to bed. Is it bad for him to take it at nights? He says he always feels sleepy in the morings and during the days. He would be fully awake in the evenings. He is now working on his weight loss by banishing all the sugars, all the carboys, and all the starches to force his body to use up the excess fat. What does it tell you about that? I am doing a favour for him because I do not want to lose a good friend like him.

Many thanks

[Anonymous]

#1050615

The technical name for the T4 replacement hormone is LEVOTHYROXIN SODIUM. It is available under several brand names, and also under the generic “levothyroxin”. The chemical used in all of the brands, and the generics, is the same. This synthetic — i.e. man-made– product is chemically identical with our own thyroxin (T4). There are differences, however, based on the additives and food colors added to the chemical in the manufacturing process, in order to make it into a “pill”. For this reason, a brand that is tolerated well by one patient may not be tolerated well by another. One of the brands contains (according to the Physicians Drug Handbook) lactose as an additive, for instance, and lactose-intolerant patients may not have good results on it. Similarly, some patients might be sensitive to the dye used in one pill, but not the dye in another. There are also some doses that come “dye-free” for that reason.

In both of my pill reference manuals the following information is given. I’ll quote from Physicians Drug Handbook, 7th edition (p. 565-566). And, BTW, I took this information from the pages for the generic levothyroxine and not for one of the Brand names.

“Administer a single dose before breakfast.”

“Instruct patient to take the medication at the same time each day; encourage morning dosing to avoid insomnia.”

“Advise patient not to store the drug in warm, humid areas, such as the bathroom, to prevent deterioration of the drug.” And: “Protect from moisture and light.” In other words, store it in a dry, dark, cool location if possible.

Then, there is a bulletin provided by the NGDF — It is Bulletin #40 — entitled “Thyroid Hormone Replacement Therapy and Other Medications”. If you haven’t gone through the list of resources available from NGDF, I really recommend that you check them out at the main web site. They are very helpful. Some excerpts from this bulletin that pertain to the question:

“It is now known that food interferes with the absorption of thyroid hormone. Therefore, it is advisable that it be taken on an empty stomach. It is recommended that the thyroid hormone be taken when first arising in the morning.” (The issue here is ABSORPTION — the process that takes place from the time you take the pill until it has gone into your blood. Once the hormone is IN the blood, these cautions do not apply. But there are medications, and foods, which can interfere with the contents of the pill getting into the blood, which is what you want to try to avoid.)

“If iron is taken at the same time as the thyroid pill, the iron will bind to some of the thyroid blocking its absorption. therefore, take the thyroid pill in the morning and the iron in the afternoon or evening.” There is typically iron in multivitamins, and in smaller quantities in some foods.

“In addition, the cholesterol medications…bind up the thyroid hormone pill and prevent its absorption. It is important to not take these at the same time. Allow at least four hours between taking one of these medications and the thyroid pill.” I left out the brand names given in the article to avoid bulletin board complications. If you are taking a medication for cholesteral problems, check with your doctor or pharmacist as to whether that medication has been shown to cause absorption problems with your replacement hormone.

“There can be some binding of the thyroid hormone if it is mixed with fiber tablets” or products used to relieve constipation. In addition, some antacids like aluminum hydorxide can interfere with the absorption. It is important to take the thyroid pill well before any of these products are taken.”

There are a few other drugs listed in this bulletin as possible sources of problems. This same information is also in drug reference manuals, or, if in doubt, talk with your pharmacist, who can provide the latest information from their own reference materials.

I am unable to find another source I had — so I cannot double check this information — that indicated that “bran” products and soy-based products could also cause absorption difficulties. If I find that source, I’ll give it to you. I mention it simply to be complete, here, but you might want to double check this information with your own doctor since I am relying on memory (and we all know how good Graves’ memories are!!).

I hope this helps.

Bobbi — Bobbi1436@AOL.com

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