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Pikapolonica
Pridružen/-a: 24.06. 2006, 12:56
Prispevkov: 658
Kraj: Domžale
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 Objavljeno: 30 Mar 2007 08:43 Naslov sporočila: Jemanje tiroksina zvecer (ang) |
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Should You Take Your Thyroid Medication at Night?
From Mary Shomon,
Your Guide to Thyroid Disease.
Stay up to date!
Every thyroid patient has heard the advice that for best results, we should take our medication first thing in the morning, on an empty stomach, and wait at least 30 minutes to an hour before eating. (And also, that we should wait at least three to four hours before taking calcium or iron, which can interfere with thyroid hormone absorption.)
But research reported in the journal Clinical Endocrinology found that taking the same dose of levothyroxine (i.e., Synthroid) at bedtime, as compared to first thing in the morning, might be better.
The small pilot study was prompted by observation that some patients had improved thyroid hormone profiles improved after they switched from taking their levothyroxine in the morning, to bedtime. The purpose was to look at the impact on thyroid hormone profiles by changing the time levothyroxine was taken from early morning to bedtime.
They also evaluated the impact of this change on the circadian rhythm of TSH and thyroid hormones and thyroid hormone metabolism.
The study, while small (12 subjects), was fairly conclusive in its findings, which the researchers said were “striking” and which have “important consequences for the millions of patients who take l-thyroxine daily.”
Researchers reported that taking medication at bedtime, rather than the morning, results in “higher thyroid hormone concentrations and lower TSH concentrations.” TSH decreased and Free T4 levels rose in all patients by changing thyroxine ingestion from early morning to bedtime and T3 levels rose in all but one subject. And TSH decreased irrespective of the starting TSH levels, suggesting better absorption of the thyroid medication when taken in the evening. Interestingly, the researchers found that the circadian TSH rhythm -- the typical daily fluctuations of TSH that occur during a 24-hour period -- does not vary.
The researchers suggested several explanations for the results:
Even when waiting at least 30 minutes to eat, breakfast may be interfering with the intestinal absorption of levothyroxine thyroxine.
“Bowel motility is slower at night,” which means that it takes longer for the levothyroxine tablet to transit through the intestinal system, resulting in longer exposure to the intestinal wall, and therefore, better uptake of the medication.
The conversion process of T4 to T3 may be more effective in the evening.
The researchers have suggested that given the results of this pilot study, a large double-blinded randomized study will need to be performed to confirm their results.
From Mary Shomon: What are the Implications for Thyroid Patients?
Taking medication at bedtime instead of in the morning could have major implications for many thyroid patients.
First, it’s easier, as you don’t have to worry about when to eat breakfast.
Second, it’s easier to avoid medications, supplements and foods, like calcium, iron, and high-fiber foods that can interfere with thyroid medication absorption.
Third, it might offer some improvement in symptoms to people who are just not getting optimal absorption by taking thyroid medication during the day.
While this was a small study, it confirms what many patients anecdotally have been reporting for years -- that they feel better if they take their thyroid medication in the evening, rather than the morning. You may want to talk to your practitioner about changing the time you take your levothyroxine (i.e., Synthroid, Levoxyl, Levothroid, Unithroid, Eltroxin) to bedtime, versus morning. And if you decide to change to taking your thyroid medication in the evening, be sure to have your thyroid levels evaluated -- six to eight weeks is a reasonable timeframe -- after you’ve made the switch. The blood test results, along with any improvements or worsening of symptoms, will help you and your doctor to determine if you need to adjust the dosage or timing of your medication.
Note, however, that this study was conducted with levothyroxine -- a synthetic form of the long acting T4/thyroxine thyroid hormone. This form of the hormone must first be converted in the body to the active form (T3) and this can take days. Thyroid drugs that contain T3 -- Cytomel, Thyrolar, and the natural desiccated thyroid drugs like Armour can by used directly by the body within hours. These drugs were not evaluated in the study.
Anecdotally, some thyroid patients have reported improvement in symptoms when taking their T3-based thyroid hormone replacement medications in the evening. But some thyroid patients also find that if they take a medication with T3 later in the day or in the evening, the slight stimulatory effect of the T3 medication can make it difficult to sleep.
So keep in mind that while it’s very possible that if a similar study were conducted with T3 drugs, the results would be similar, there is some chance that it would impact sleep quality. Only make such a change after discussing it with your doctor.
Optimally, some doctors have suggested that patients who take medications with T3 split their doses to take them throughout the day, leaving a dose for bedtime. This approach seems to minimize sleep interference.
Again, if you do make a change to how you take your T3 thyroid medication, you’ll want to have a reevaluation of blood levels and symptoms after several weeks, to determine if you need to adjust the dosage or timing of your medication. |
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GozdnaVila
Pridružen/-a: 09.08. 2006, 09:43
Prispevkov: 325
Kraj: Ljubljana
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| Objavljeno: 30 Mar 2007 13:31 Naslov sporočila: |
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Zelo zanimiva zadeva!
Zanima pa me naslednje:
- Mogoče kdo jemlje tiroksin zvečer ali pa v dveh odmerkih čez dan?
- Je kdo o tem že govoril s svojim tirologom in zanima me, kaj pravijo na to?
Lp, Karmen |
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Pikapolonica
Pridružen/-a: 24.06. 2006, 12:56
Prispevkov: 658
Kraj: Domžale
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| Objavljeno: 30 Mar 2007 13:45 Naslov sporočila: |
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Ja, na ameriskem forumu sem brala, da nekateri jemljejo po dva odmerka dnevno. Tiroskin ima itak razpolovni čas 7 dni, tako da se nekaj ur verjetno ne pozna toliko, bi bilo pa zanimivo slisat mnenje stroke.
Lp Pika |
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Lara
Pridružen/-a: 17.09. 2006, 19:24
Prispevkov: 270
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| Objavljeno: 30 Mar 2007 16:17 Naslov sporočila: |
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Jaz imam občutek da če jemljem pozno tablete (okoli 12ih) težje zaspim. Mogoče se pa motim.  |
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GozdnaVila
Pridružen/-a: 09.08. 2006, 09:43
Prispevkov: 325
Kraj: Ljubljana
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| Objavljeno: 30 Mar 2007 16:57 Naslov sporočila: |
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| Ja jaz imam zadnje čase prou težave, ker sem še vedno v hipo stanju in rabim izredno velik spanja, lahk spim tud 14 ur skupaj in potem vzamem tablete ob 12,13h kar pa ne vem, če je uredu. Nekak bi mi bolj pasalo tablete jemati zvečer predn grem spat. |
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Lara
Pridružen/-a: 17.09. 2006, 19:24
Prispevkov: 270
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| Objavljeno: 31 Mar 2007 13:06 Naslov sporočila: |
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| Jaz ko lahko, spim 10 ur v povprečju. Moti me edino to da zjutraj ne morem vstati, oziroma težko, sicer na faks nikoli ne zamujam. :D |
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maga
Pridružen/-a: 23.08. 2006, 06:45
Prispevkov: 137
Kraj: primorska
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| Objavljeno: 30 Apr 2007 09:54 Naslov sporočila: |
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Zivijo metuljcice in metuljcki.
Ker se mi zdi pomembno in ker mogoce se koga zanima, sem se odlocila da vam napisem mojo (enomesecno) izkusnjo.
Minil je en mesec odkar sem zacela Evtirox jemati zvecer. Tablete so se iz kuhinje preselile na nocno omarico. Niti ene od teh noci nisem imela motene od nespecnosti, je pa res da meni zelo malo stvari uspe motit spanec. Zjutraj se zbudim malo lazje, pa tudi kriza sredi dneva (po navadi okoli 10h ali 11h, vstanem pa okoli 6.30) ni tako mocna ali pa je tudi ni. Tako da zaenkrat js ostajam na tem nacinu jemanja tablet.
V prvem letu terapije s tiroxinom sem tudi js spregovorila zdravnici o moznosti jemanja zravila v dveh obrokih, ker se mi je popoldne, po kosilu, grozno spalo, pa mi je razlozila, da je ura zjutraj v bistvu "posnetek" naravnega izlocanja hormona zdrave scitnice. In glede na to da je razpolovni cas T4 vec ur oz. celo dni, jemanje na obroke nima smisla.
Najbrz pa je ravno ta razpolovni cas razlog, da se jemanje zvecer obnese. Ce pomislimo, da pride v zelodec zvecer in da je presnova ponoci pocasnejsa, je logicni zakljucek, da se tableta absorbira boljse in bolj nemoteno kot ce jo vzamemo zjutraj. Do jutra bi se moralo tudi ze delocena kolicina T4 presnoviti v T3 in najbrz zato telo lazje "zalaufa". Pocutje je tekom dneva bolj konstantno.
Pred nekaj tedni sem bila pri osebnem zdravniku in mu povedala, da poskusam ta nacin jemanja tablet, pa ni nic protestiral. Vzel mi je kri za pregled TSH in mi reku, da mi bo sporocu, ce kej ni v redu. In do zdej ga se nisem cula, torej je izvid najbrz dober.
In kar je najbolj pomembno, moje pocutje je kr v redu. Razen dnevov s tako nizkim pritiskom, da mi mozgane ob lobanjo stiska, ki pa niso norma, ampak se pojavljajo cca na 10 dni, predvsem v povezavi z dolocenimi vremenskimi spremembami.
Ce se katera od vas jemlje tablete zvecer, naj pove svojo izkusnjo.
Drste se.
_________________
Življenje je tisto kar se nam dogaja, medtem ko mi delamo drugačne načrte...
Kar nam je namenjeno, nam ne uide. Kar nam ni namenjeno, ne bo nikoli naše. Se torej izplača razburjati, če stvari ne gredo tako, kot hočemo mi?? |
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n.sostaric
Gost
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| Objavljeno: 02 Maj 2007 10:14 Naslov sporočila: Re: Jemanje tiroksina zvecer (ang) |
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| Pikapolonica je napisal/a: | Should You Take Your Thyroid Medication at Night?
From Mary Shomon,
Your Guide to Thyroid Disease.
Stay up to date!
Every thyroid patient has heard the advice that for best results, we should take our medication first thing in the morning, on an empty stomach, and wait at least 30 minutes to an hour before eating. (And also, that we should wait at least three to four hours before taking calcium or iron, which can interfere with thyroid hormone absorption.)
But research reported in the journal Clinical Endocrinology found that taking the same dose of levothyroxine (i.e., Synthroid) at bedtime, as compared to first thing in the morning, might be better.
The small pilot study was prompted by observation that some patients had improved thyroid hormone profiles improved after they switched from taking their levothyroxine in the morning, to bedtime. The purpose was to look at the impact on thyroid hormone profiles by changing the time levothyroxine was taken from early morning to bedtime.
They also evaluated the impact of this change on the circadian rhythm of TSH and thyroid hormones and thyroid hormone metabolism.
The study, while small (12 subjects), was fairly conclusive in its findings, which the researchers said were “striking” and which have “important consequences for the millions of patients who take l-thyroxine daily.”
Researchers reported that taking medication at bedtime, rather than the morning, results in “higher thyroid hormone concentrations and lower TSH concentrations.” TSH decreased and Free T4 levels rose in all patients by changing thyroxine ingestion from early morning to bedtime and T3 levels rose in all but one subject. And TSH decreased irrespective of the starting TSH levels, suggesting better absorption of the thyroid medication when taken in the evening. Interestingly, the researchers found that the circadian TSH rhythm -- the typical daily fluctuations of TSH that occur during a 24-hour period -- does not vary.
The researchers suggested several explanations for the results:
Even when waiting at least 30 minutes to eat, breakfast may be interfering with the intestinal absorption of levothyroxine thyroxine.
“Bowel motility is slower at night,” which means that it takes longer for the levothyroxine tablet to transit through the intestinal system, resulting in longer exposure to the intestinal wall, and therefore, better uptake of the medication.
The conversion process of T4 to T3 may be more effective in the evening.
The researchers have suggested that given the results of this pilot study, a large double-blinded randomized study will need to be performed to confirm their results.
From Mary Shomon: What are the Implications for Thyroid Patients?
Taking medication at bedtime instead of in the morning could have major implications for many thyroid patients.
First, it’s easier, as you don’t have to worry about when to eat breakfast.
Second, it’s easier to avoid medications, supplements and foods, like calcium, iron, and high-fiber foods that can interfere with thyroid medication absorption.
Third, it might offer some improvement in symptoms to people who are just not getting optimal absorption by taking thyroid medication during the day.
While this was a small study, it confirms what many patients anecdotally have been reporting for years -- that they feel better if they take their thyroid medication in the evening, rather than the morning. You may want to talk to your practitioner about changing the time you take your levothyroxine (i.e., Synthroid, Levoxyl, Levothroid, Unithroid, Eltroxin) to bedtime, versus morning. And if you decide to change to taking your thyroid medication in the evening, be sure to have your thyroid levels evaluated -- six to eight weeks is a reasonable timeframe -- after you’ve made the switch. The blood test results, along with any improvements or worsening of symptoms, will help you and your doctor to determine if you need to adjust the dosage or timing of your medication.
Note, however, that this study was conducted with levothyroxine -- a synthetic form of the long acting T4/thyroxine thyroid hormone. This form of the hormone must first be converted in the body to the active form (T3) and this can take days. Thyroid drugs that contain T3 -- Cytomel, Thyrolar, and the natural desiccated thyroid drugs like Armour can by used directly by the body within hours. These drugs were not evaluated in the study.
Anecdotally, some thyroid patients have reported improvement in symptoms when taking their T3-based thyroid hormone replacement medications in the evening. But some thyroid patients also find that if they take a medication with T3 later in the day or in the evening, the slight stimulatory effect of the T3 medication can make it difficult to sleep.
So keep in mind that while it’s very possible that if a similar study were conducted with T3 drugs, the results would be similar, there is some chance that it would impact sleep quality. Only make such a change after discussing it with your doctor.
Optimally, some doctors have suggested that patients who take medications with T3 split their doses to take them throughout the day, leaving a dose for bedtime. This approach seems to minimize sleep interference.
Again, if you do make a change to how you take your T3 thyroid medication, you’ll want to have a reevaluation of blood levels and symptoms after several weeks, to determine if you need to adjust the dosage or timing of your medication. |
Hi,
zelo zanimivo. Sem prebrala 3 x. Meni so predpisali jemanje doze, ki jo moram porazdeliti na trikrat na dan /dnevna doza je 15 mg/, kar pomeni 50 zjutraj, 50 popoldan in 50 zvečer. O tem ali je to doziranje pravilno nisem sigurna. Vem, da mi srce dela 100 na uro, da imam enkrat srčni utrip 90, drugič 45 itd. Imam vojno, ki traja že več kot eno leto.
Nataša |
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n.sostaric
Gost
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| Objavljeno: 02 Maj 2007 10:18 Naslov sporočila: |
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| Pikapolonica je napisal/a: | Ja, na ameriskem forumu sem brala, da nekateri jemljejo po dva odmerka dnevno. Tiroskin ima itak razpolovni čas 7 dni, tako da se nekaj ur verjetno ne pozna toliko, bi bilo pa zanimivo slisat mnenje stroke.
Lp Pika |
želim vam sonček,
zelo zanimivo temo si našla. Hvaležna sem ti. Sem temeljito prebrala. Vprašanje bom postavila 10 v Lj., ko imam kontrolo.
Sedaj jemljem dnevno dozo 3 x na dan, kar pomeni 50 mg zjutraj, 50 popoldan in 50 zvečer. Tako mi je onkolog predpisal. Da pa je to prav, ne vem. Vem le, da imam težave. Srce mi dela 100 na uro. Enkrat imam utrip 90, drugič 45. Se mi že kar meša. Po enem letu bi skoraj pričakoval človek, da bo bolje, pa n i.
Nataša |
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n.sostaric
Gost
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| Objavljeno: 02 Maj 2007 10:27 Naslov sporočila: |
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| n.sostaric je napisal/a: | | Pikapolonica je napisal/a: | Ja, na ameriskem forumu sem brala, da nekateri jemljejo po dva odmerka dnevno. Tiroskin ima itak razpolovni čas 7 dni, tako da se nekaj ur verjetno ne pozna toliko, bi bilo pa zanimivo slisat mnenje stroke.
Lp Pika |
želim vam sonček,
zelo zanimivo temo si našla. Hvaležna sem ti. Sem temeljito prebrala. Vprašanje bom postavila 10 v Lj., ko imam kontrolo.
Sedaj jemljem dnevno dozo 3 x na dan, kar pomeni 50 mg zjutraj, 50 popoldan in 50 zvečer. Tako mi je onkolog predpisal. Da pa je to prav, ne vem. Vem le, da imam težave. Srce mi dela 100 na uro. Enkrat imam utrip 90, drugič 45. Se mi že kar meša. Po enem letu bi skoraj pričakoval človek, da bo bolje, pa n i.
Nataša |
Še nekaj sem pozabila. V materialu Podiplomska šola za zdravnike - Bolezni ščitnice, sem prebrala, da ščitnični hormoni začnejo najbolj delovati okoli 4. ure zjutraj.
Po tej logiki bi bilo res m ogoče bolje, če jemljemo zdravila zvečer. Ne vem. Povejte.
Nataša |
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Športnica1
Pridružen/-a: 04.07. 2006, 21:12
Prispevkov: 115
Kraj: Celje
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| Objavljeno: 03 Maj 2007 20:05 Naslov sporočila: |
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Tudi sama sem se po prebiranju članka odločila začeti jemati odmerek Eltroxina zvečer (ne terapiji sem po 8-ih letih spregledane bolezni sedaj leto in pol).
Rekla sem si, da slabše kot se počutim sedaj se že ne morem in bom pač preizkusila to varianto jemanja zdravil na sebi.
Po treh tednih jemanja lahko rečem, da se mi je počutje izboljšalo. Zjutraj lažje vstanem, nisem več omotična oz. vtroglava, tudi jutranji glavoboli in težka glava so izginili...vsaj zaenkrat....Prej sem poleg slabega jutranjega počutja ugotavljala, da sem okrog 13 ure v službi postala neznasko zaspana (bi se lahko kar dol poknila in zaspala), pa možgane sem imela nekako plavajoče, tako da sem bila dobesedno "počasna"-možgani niso in niso hoteli delati. Potem je bilo kakšne dve uri takšno stanje in do treh se je nekako umirilo. Doma sem potem morala obvezno počivati pol ure, da sem prišla malo k sebi in proti večeru je bilo že vredu in tudi energije je bilo takrat več oz. vsi simptomi so nekako poniknili neznano kam-kot bi bila zdrava.
Zdaj nekako z več energije in moči preživim delovni čas, ampak ugotavljam, da sem pa okrog 17 ure bolj omotična.... 
Sem že razmišljala, da bi jemala zdravila 2x na dan.
No, skratka....zdaj bom stestirala na sebi najprej večerno jemanje zdravil (bom šla tudi na odvzem krvi, da vidim še vrednosti hormonov)....bom še poročala. Če pa ne bo bolje pa bom začela jemati zdravila2 x na dan.
Zgleda, da se nam, ki nam je ščitnica odmirala več let to zelo pozna na zeloo slabem počutju (kot bi bil v začaranem krogu nihanja počutja)  in bi mogoče res morali tudi zdravila jemati drugače...ne vem no, moje razmišljanje pač.
Mogoče se pa tudi stroka kaj nauči od nas....samo prisluhniti nam bo morala in ne goniti samo eno in isto....  : "Pri normalnem TSH in ustezni terapiji mora biti počutje vredu"...Pa ni in težko je nekomu dopovedat, da životarimo iz dneva v dan in čakamo na to, da nam zdravila "primejo"....a kaj, ko se s počutjem ne spravimo na zeleno vejo (kljub jemanju zdravil, zdravemu prehranjevanju in športanju). Ja, to je hudo nekomu razložiti in ga prepričati v to, da ti je slabo, da imaš vrtoglavice, aritmije, boleče sklepe, mišice, glavobole....pa nisi depresiven....ti se vendar po mnenju zdravnikov "moraš" počutiti vredu.
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Sabrina
Pridružen/-a: 22.05. 2006, 16:46
Prispevkov: 975
Kraj: Postojna
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| Objavljeno: 03 Maj 2007 20:14 Naslov sporočila: |
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Ja. Tole zadnje sama ves čas pravim!
_________________
sABrINA |
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n.sostaric
Gost
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| Objavljeno: 03 Maj 2007 20:38 Naslov sporočila: |
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| Športnica1 je napisal/a: | Tudi sama sem se po prebiranju članka odločila začeti jemati odmerek Eltroxina zvečer (ne terapiji sem po 8-ih letih spregledane bolezni sedaj leto in pol).
Rekla sem si, da slabše kot se počutim sedaj se že ne morem in bom pač preizkusila to varianto jemanja zdravil na sebi.
Po treh tednih jemanja lahko rečem, da se mi je počutje izboljšalo. Zjutraj lažje vstanem, nisem več omotična oz. vtroglava, tudi jutranji glavoboli in težka glava so izginili...vsaj zaenkrat....Prej sem poleg slabega jutranjega počutja ugotavljala, da sem okrog 13 ure v službi postala neznasko zaspana (bi se lahko kar dol poknila in zaspala), pa možgane sem imela nekako plavajoče, tako da sem bila dobesedno "počasna"-možgani niso in niso hoteli delati. Potem je bilo kakšne dve uri takšno stanje in do treh se je nekako umirilo. Doma sem potem morala obvezno počivati pol ure, da sem prišla malo k sebi in proti večeru je bilo že vredu in tudi energije je bilo takrat več oz. vsi simptomi so nekako poniknili neznano kam-kot bi bila zdrava.
Zdaj nekako z več energije in moči preživim delovni čas, ampak ugotavljam, da sem pa okrog 17 ure bolj omotična....
Sem že razmišljala, da bi jemala zdravila 2x na dan.
No, skratka....zdaj bom stestirala na sebi najprej večerno jemanje zdravil (bom šla tudi na odvzem krvi, da vidim še vrednosti hormonov)....bom še poročala. Če pa ne bo bolje pa bom začela jemati zdravila2 x na dan.
Zgleda, da se nam, ki nam je ščitnica odmirala več let to zelo pozna na zeloo slabem počutju (kot bi bil v začaranem krogu nihanja počutja) in bi mogoče res morali tudi zdravila jemati drugače...ne vem no, moje razmišljanje pač.
Mogoče se pa tudi stroka kaj nauči od nas....samo prisluhniti nam bo morala in ne goniti samo eno in isto.... : "Pri normalnem TSH in ustezni terapiji mora biti počutje vredu"...Pa ni in težko je nekomu dopovedat, da životarimo iz dneva v dan in čakamo na to, da nam zdravila "primejo"....a kaj, ko se s počutjem ne spravimo na zeleno vejo (kljub jemanju zdravil, zdravemu prehranjevanju in športanju). Ja, to je hudo nekomu razložiti in ga prepričati v to, da ti je slabo, da imaš vrtoglavice, aritmije, boleče sklepe, mišice, glavobole....pa nisi depresiven....ti se vendar po mnenju zdravnikov "moraš" počutiti vredu.
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Čestitam Športnica,
čestitam za pogum, da si napisala to kar si. Tako kot se počutiš ti, se počutim tudi jaz. Jaz jemljem še zaenkrat Levaxin, ki pa ga bom prenehala jemati 10. maja, ko grem na kontrolo k onkologu. Levaxin je registrian samo na Švedskem. Nobena evropska država ga ni sprejela. Kako in na kakšen način se je znašel v Slov. ne vem, vem pa naslednje. Odgovornost za jemanje neregistriranega zdravila nosiš sam, čeprav ti ga je predpisal onkolog. Takšnih igric pa se jaz ne grem. Da naj jemljem celotno količino dnevne terapije že na tešče, mi je predpisal onkolog. Torokalni kirurg, ki ga slučajno poznam, pa mi je svetoval, da je bolje, če si dozo porazdelim čez celi dan. Kljub takšnemju nači8nu, se počitum mizerno. Tudi aritmije težko prenašam. Enkrat imam občutek, da mi bo srce skočilo iz telesa, drugič, da mi bo prenehalo biti. Tudi utrip je silno različen od 100 do 45. Z onkologom nameravam razčistiti, vsaj upam, da bom, če se ne bova skregala, marsikatero stvar. Bom poročala na forumu.
Pred tednom sem si tudi jaz predpisala popoldansko dozo ob 17. uri in zadnjo dozo ob 22. uri. Bom videla kakšen bo učinek. Na žalost eksperimentiramo same na sebi. Kar je silno žalostno. Zdravniki pa imamo vsi podobne izkušnje. Sedaj morate biti v redu. Pa nismo in nihče nam tega nme verjame. Treba jim je trobiti in trobiti, da bodo začeli slišati. Če ima katera kakšen recept kako prepričati zdravnika, da je počutje takšno kot je, prosim povejte m i ga.
Še več poguma od drugih, tebi pa, še enkrat čestitke.
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