Should i take thyroxine at night

Trial Registration isrctn. Because the prevalence of primary hypothyroidism is high among the general population, 1 , 2 levothyroxine sodium is one of the most prescribed medications. A pilot study 11 confirmed this observation among 11 patients. The mean SD plasma thyrotropin level significantly decreased from 5.

The circadian pattern of thyrotropin rhythm remained intact, which was important regarding the time of blood sampling for thyrotropin levels to monitor levothyroxine therapy. Accordingly, we conducted a randomized double-blind crossover trial to confirm whether levothyroxine taken at bedtime leads to lower thyrotropin and higher FT 4 and T 3 levels. Hypothyroidism can have major effects on health and quality of life QOL , as it is associated with fatigue, weight gain, cold intolerance, depression, neuromuscular symptoms, diastolic dysfunction, and impairment of renal function.

The primary objective of this study was to determine whether a change occurred in thyrotropin and thyroid hormone levels when levothyroxine was taken at bedtime vs in the morning. We further investigated whether a bedtime regimen would affect creatinine and lipid levels, body mass index, heart rate, and QOL. A randomized double-blind crossover trial was performed among consecutive patients with primary hypothyroidism who visited our clinics.

The patients had to be 18 years or older and have been on a stable levothyroxine regimen for at least 6 months. Patients with a gastrointestinal tract disorder, those with thyroid carcinoma, and those who were pregnant were excluded from the study.

Also excluded were patients who were taking medication known to interfere with the uptake of levothyroxine. After informed consent had been obtained, patients were randomized to start the study period with 1 capsule of levothyroxine in the morning and 1 capsule of placebo at bedtime or with 1 capsule of levothyroxine at bedtime and 1 capsule of placebo in the morning. After 3 months, patients were switched from levothyroxine in the morning to placebo and vice versa for another 3 months. Double-blind study medication was provided by the hospital pharmacy, which performed the randomization.

Commercial levothyroxine sodium tablets Thyrax Duotab, 0. Every patient received study capsules containing a similar dose of levothyroxine as before entry into the trial. Placebo and levothyroxine capsules were visually identical. Patients were instructed by a research nurse to take the morning capsule on an empty stomach half an hour before breakfast and the bedtime capsule at night just before going to bed.

At baseline and every 6 weeks, patients were seen in our clinics by a research nurse. At these visits, blood samples were obtained to determine plasma thyrotropin, FT 4 , T 3 , creatinine, and lipid levels, and blood pressure, heart rate, and body weight were measured. The remaining capsules in the containers were counted to check for compliance.

Quality-of-life questionnaires were completed by patients at baseline, at 3 months, and at the end of the study. Blood samples were drawn on the morning of the planned visit to the research nurse. Capsules were not withheld on the day of blood sampling. Serum thyrotropin levels reference range, 0. Levels of FT 4 reference range, Three QOL questionnaires Item Short Form Health Survey, Hospital Anxiety and Depression Scale, and Item Multidimensional Fatigue Inventory and a specific questionnaire about symptoms of hypothyroidism and hyperthyroidism were completed by patients at baseline, at 3 months, and at the end of the study.

Patients completed the questionnaires under the supervision of a research nurse. After the trial ended, patients were free to choose at what time of day they preferred to continue taking levothyroxine, in the morning or at bedtime. One year after the trial, we asked every patient at what time he or she was taking the levothyroxine tablet. The primary end point was a change in thyroid hormone variables thyrotropin, FT 4 , and total T 3 [TT 3 ] levels between 12 weeks of morning levothyroxine intake and 12 weeks of bedtime levothyroxine intake.

Secondary end points were changes in QOL measured by 3 questionnaires , thyroid symptom score, body mass index, heart rate, and serum lipid and creatinine levels.

The direct treatment effect among all variables was measured by performing an independent-samples t test between the differences of week 12 and week 24 in the first group started with morning levothyroxine and the second group started with bedtime levothyroxine. All P values were 2-sided and were not adjusted for multiple testing. All calculations were performed using commercially available statistical software SPSS To calculate the sample size, we assumed that a difference in thyrotropin level of 1.

From previous results in a pilot study, we calculated that the standard deviation of the difference between morning and bedtime administration would be between 2. Between April 1, , and November 30, , a total of consecutive patients with primary hypothyroidism were assessed for study eligibility.

Ultimately, patients met the inclusion criteria and gave written informed consent. Fifteen randomized patients withdrew their consent shortly after enrollment in the trial and had baseline data only. The baseline characteristics of these patients did not differ from those of patients who completed the trial. Baseline characteristics of the 2 groups are given in Table 1.

There were differences between the 2 groups in the proportions of male patients, levothyroxine dosages, and thyrotropin levels. On average, patients missed a mean SD of 1. Because there were no severe symptoms related to hypothyroidism or hyperthyroidism, no patient required a change in levothyroxine dosage during the trial. Results of the primary outcomes are summarized in Table 2 and in Figure 2.

Among the group that received morning levothyroxine first, the mean SD thyrotropin level decreased from 2. In contrast, among the group that received bedtime levothyroxine first, the mean SD thyrotropin level increased from 2.

When overall changes were compared between the 2 groups, bedtime levothyroxine intake was found to have a direct treatment effect, with a decrease in thyrotropin level of 1.

The mean SD FT 4 level in the group that received morning levothyroxine first increased from 1. In the group that received bedtime levothyroxine first, the mean SD FT 4 level decreased from 1. Create a personalised content profile. Measure ad performance. Select basic ads. Create a personalised ads profile. Select personalised ads. Apply market research to generate audience insights. Measure content performance.

Develop and improve products. List of Partners vendors. Managing an underactive thyroid gland requires you to take a thyroid drug every single day. Consistency is key, meaning it's important to take your thyroid pill at the same time daily. Most are told to take their medication first thing in the morning, rather than before they go to sleep.

But the truth is that either time of day works, although one time may better suit your lifestyle. In addition, there is some research suggesting that taking your dose at bedtime may allow for better thyroid hormone absorption.

Discuss when to take your thyroid medication with your healthcare provider. These pros and cons can help guide your conversation. Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Taking your thyroid hormone replacement medication most commonly, levothyroxine first thing in the morning with water and waiting at least an hour before eating breakfast or drinking coffee is what has been traditionally recommended for years by thyroid experts. In addition to waiting an hour before eating food or drinking coffee, experts also recommend waiting at least three to four hours before taking any other medications or supplements that may interfere with levothyroxine's absorption.

Some studies reported that the efficiency of levothyroxine at bedtime was better than administration before breakfast. However, other studies showed no significant difference with bedtime vs. Studies were conducted between and , with duration ranging between 2 and 6 months. All formulations of levothyroxine were in tablet form. Researchers used random- and fixed-effects models to estimate pooled effects of levothyroxine administration at breakfast vs.

In six of the studies, researchers found that levothyroxine administration before breakfast vs. Thus, a 1-hour interval does not seem to be sufficient. In addition, breakfast may contain foods that could affect the absorption of levothyroxine, such as coffee, soybeans and fiber. Following oral administration, the absorption of levothyroxine is incomplete and variable, especially when taken with food. Interference with Levothyroxine has been documented with cholestyramine resin, sucralphate, iron sulphate, calcium preparations, aluminum antacids, raloxifene, activated charcoal, various soya products, and food and herbal remedies [ 4 — 7 ].

Also fiber-enriched diet, the traditional Indian diet, has been shown to adversely affect the absorption of Levothyroxine [ 8 ]. Intake of coffee in early morning is a social habit in this part of the country, which may interfere with the absorption of levothyroxine [ 9 ]. So as convention the drug is given at least half an hour before breakfast, and failure to follow this advice results in variable absorption of levothyroxine sodium.

However, many patients with hypothyroidism find it inconvenient to take the drug on an empty stomach in the morning because of their lifestyle, and intake of multiple other drugs which they are regularly consuming and often request their treating physicians to prescribe the drug at some alternate time of the day.

The results of the study conducted by Bolk et al. They found it to be safe and well tolerated. They found out that changing the timings of thyroxine ingestion does not affect the circadian rhythm of TSH and iodothyronine secretion, and hence, testing the thyroid profile of the patients in the morning after ingesting levothyroxine at night bears no significance in the outcome of the study. Keeping these facts in mind, this study was planned to compare the efficacy of morning versus bedtime dose of thyroxine in patients of hypothyroidism.

All patients were having Hashimoto's thyroiditis as underlying cause of hypothyroidism. A written consent was taken from all patients.

Patients in group 1 were given levothyroxine in the morning minimum half an hour before breakfast, and in group 2 the drug was given minimum 2 hours after dinner. None of the patients used medication known to interfere with levothyroxine absorption, nor were they known to have gastro-intestinal disease.

Pregnant and postpartum patients with hypothyroidism were not included in either group. Initial dosage was calculated as 1. The study was carried for a time period of 12 weeks, and assessment of quality of life by RAND- Research and Development 36 scoring system [ 11 ] and clinical profile according to the clinical scores given by Billewicz et al. Biochemical parameters were assessed at baseline before start of treatment and at the end of six, and 12 weeks. TSH normal range 0.

Lipid profile was assessed by Konelab 30i using analyzing kits by Randox. Patients were studied on the basis of change in clinical symptoms at presentation, improvement in Quality of life and change in the biochemical parameters with special reference to thyroid function tests and lipid profile. Clinical symptoms were scored according to the scoring system given by Billewicz et al. The scale score ranged from 0 to for every subscale, with a higher outcome meaning a better health status.

Primary end point was a change in the thyroid profile of the subjects and achievement of euthyroidism in each group measured at the end of six and 12 weeks.

Secondary end points of the study were change in QoL, thyroid symptom score, and lipid profile. For calculation of sample size, results from the pilot study conducted by Bolk et al. Z test was used to compare the difference in mean of free T3, free T4, and lipid profile between each group at the beginning, six and 12 weeks.

Paired t -test was used to assess the intragroup change at six and 12 weeks. The value of TSH in either group did not follow Gaussian data distribution on followup as most of the data were clustered in a narrow range in both the groups at 6 weeks and 12 weeks. Hence, nonparametric tests: Wilcoxon two-sample test was applied for intergroup comparison and Wilcoxon sign-rank test was applied for intragroup comparison.

For intergroup comparison of total score of clinical signs and symptoms and QoL, Wilcoxon two-sample test was applied. For intragroup comparison of total score of clinical signs and symptoms and QoL, Wilcoxon sign-rank test was applied. The mean age of patients in group 1 was At the end of 12 weeks the mean weight was It was seen that at the end of 6 weeks, 32