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Effects of evening vs morning thyroxine ingestion on serum thyroid hormone profiles i

Discussion in 'Thyroid and Other Autoimmunity' started by Ellen, Dec 14, 2006.

  1. Ellen

    Ellen Senior Member

    Oct 22, 2005
    Clinical Endocrinology
    Volume 66 Issue 1 Page 43 - January 2007
    doi:10.1111/j.1365-2265.2006.02681.xVolume 66 Issue 1 ORIGINAL ARTICLEEffects of evening vs morning thyroxine ingestion on serum thyroid hormone profiles in hypothyroid patientsNienke Bolk *, Theo J. Visser *, Andries Kalsbeek , Ron T. van Domburg and Arie Berghout §
    SummaryObjective Standard drug information resources recommend that l-thyroxine be taken half an hour before breakfast on an empty stomach, to prevent interference of its intestinal uptake by food or medication. We observed cases in which TSH levels improved markedly after changing the administration time of l-thyroxine to the late evening. We therefore conducted a pilot-study to investigate whether l-thyroxine administration at bedtime improves TSH and thyroid hormones, and whether the circadian rhythm of TSH remains intact.
    Design Patients were studied on two occasions: on a stable regimen of morning thyroxine administration and two months after switching to night-time thyroxine using the same dose. On each occasion patients were admitted for 24 h and serial blood samples were obtained.
    Patients We investigated 12 women treated with l-thyroxine because of primary hypothyroidism, who used no medication known to interfere with l-thyroxine uptake.
    Measurements Patients were admitted to hospital and blood samples were obtained at hourly intervals for 24 h via an indwelling catheter. Following this first hospital admission, all women were asked to switch the administration time from morning to bedtime or vice versa. After 2 months they were readmitted for a 24-h period of hourly blood sampling. Blood samples were analysed for serum TSH (immunometric assay), FT4 and T3 (competitive immunoassay), T4 and rT3 (radioimmunoassay), serum TBG (immunometric assay) and total protein and albumin (colourimetric methods).
    Results A significant difference in TSH and thyroid hormones was found after switching to bedtime administration of l-thyroxine. Twenty-four-hour average serum values amounted to (mean ± SD, morning vs bedtime ingestion): TSH, 5·1 ± 0·9 vs 1·2 ± 0·3 mU/l (P < 0·01); FT4, 16·7 ± 1·0 vs 19·3 ± 0·7 pmol/l (P < 0·01); T3, 1·5 ± 0·05 vs 1·6 ± 0·1 nmol/l (P < 0·01). There was no significant change in T4, rT3, albumin and TBG serum levels, nor in the T3/rT3 ratio. The relative amplitude and time of the nocturnal TSH surge remained intact.
    Conclusions l-thyroxine taken at bedtime by patients with primary hypothyroidism is associated with higher thyroid hormone concentrations and lower TSH concentrations compared to the same l-thyroxine dose taken in the morning. At the same time, the circadian TSH rhythm stays intact. Our findings are best explained by a better gastrointestinal uptake of l-thyroxine during the night.

  2. BrendaK

    BrendaK Neonatal Diabetes Registry

    Oct 29, 2005
    I'm medically literacy challenged. Does this mean you should take it in the am or pm?
  3. Amy C.

    Amy C. Approved members

    Oct 22, 2005
    I think it is saying to take it at night. I have tried, and the medicine makes my heart beat harder and keeps me awake. I take mine with breakfast -- even though it isn't the best timing.
  4. frizzyrazzy

    frizzyrazzy Approved members

    Dec 23, 2006
    ahhh that's good to know. We had terrible trouble with my daughter and trying to get her meds on an empty stomach at breakfast so we switched to night time and she's done remarkably well since (probably too well..got to get those levels checked next week actually)
  5. wdhinn89

    wdhinn89 Approved members

    Mar 31, 2007
    I wonder what the results would be if the med was taken middle of the day? After school, before snack? Any ideas?

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