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Medication-lab testing question

Hi eveyone,  

I've been reading alot about NOT taking your thyroid meds 24 hours before doing your blood test, My question is if I have NO Thyroid would it be safe to go the entire day without my meds or would I have some sort of set back?

I'm on 2 grain Armour Thyroid I take 1st pill early morning and 2nd pill late morning early afternoon...... Thanks
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Avatar universal
It does not have to be 24 hours.  For you I would just defer your morning dose until after the blood draw.  The intent is to avoid false high results.  T3 in particular reaches full effect of that dose on serum levels in about 3-4 hours, so you can understand the need to defer until after blood draw.
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Hi Gimel
So it would be fine and no bearing on lab test if I take my meds the day before the test?

Thanks, Grace
I'm getting this wait 24 hours from HealthMed
Avatar universal
Hi Grace,
I was reading your question re timing of getting thyroid labs and I had a look back at some of your earlier posts. It really is heart breaking to see that after two years your doctors have not been able to get your thyroid meds sorted out and you are still hypothyroid. So I thought I would send you a couple  of quick comments.

First on the 24 hours business. Most people take Synthroid or other T4, and they usually take one pill in the morning. So they want you to take the pill in the morning and get the labs the next morning before you take the next pill. So in their case it would be about 24 hours. You are doing it differently, so you have to ask what is the principle behind setting the timing. The principle is that you want to take the labs so that they capture the lowest blood thyroid levels that you will have through any day if you follow your particular daily regimen. The lowest level will be at the time which has been the longest time since you took a pill. In your case it will be in the morning just prior to the time you take your morning pill. If you usually take your pill at 6 am, then you might have to wait until 8 am when the lab opens. It good to get into the habit of getting labs at the same time of day.

Now on your labs. It is very obvious from you labs that your T3 is too low and you are having hypo symptoms. You mention palpitations - that is a hypo symptom too. It is easy to find medical research on the web where hypo patients had palpitations and it stopped when they took enough thyroid meds.

Your doctor has seen research reports that show a correlation between hyperthyroidism/low TSH  and  eventual cardiac problems. But those people weren't taking NDT. But your doctor is looking at your very low TSH and hearing that you have palps, is declaring you hyperthyroid. So of course he won't raise your meds, in fact he wants to lower them.  A doctor who prescribes Armour/NDT and does not know it drives TSH to a very low number, and therefore TSH should not be used for gauging adequacy of the meds is not really helping his patients. On 2 grains NDT you are getting 76 mcg T4 and 18 mcg T3. I'd bet that 2.5 grains (95 mcg T4 and 22.5 mcg T3) would make a world of difference for you.
Helpful - 0
Hi Telus2,  
I only started Armour Thyroid in August of this year (2grains) to replace my prescription of Synthyroid (88mg) and Cytomel (15mg) I just never felt good on synthyroid and cytomel, anyway my Endo is worried about my low TSH "not" because I complained about palpitations I never told her.

(Gimel) recommended I split my dose of Armour to get rid of palpitations and breathlessness. I was taking both pills at same time and it (worked) no palps or breathlessness anymore....

Back to TSH being to low for my Endo shes worried about a bone scan from earlier this year that showed me as having mild osteopenia, this is why she's worried about having a too low TSH and keeps TRYING to mess with my meds...I know my tsh has nothing to do with my mild osteopenia since my bone scan in Aug 2010 also revealed mild osteopenia in 2010 I (had a thyroid and was on no medications for thyroid problems) So I did slam her on that (I recently obtained FULL ACCESS to my medical record) she can no longer blame my thyroidectomy and low TSH on my Bone scan in order to keep lowering my dose.....I'm in the military medical system these Doc (use term lightly)are disasterous.... She takes no consideration that I had hysterectomy 15yrs ago and have been a heavy steroid user my entire life because of my autoimmune disease.

Ok...you got my run down...lol.  I was curious if it would matter if I did go the entire day before my blood test WITHOUT my meds or If I should just take as normal the day before test since I take my last Armour @10am.?

I should add the reason im willing to forego one days worth of my thyroid meds....No matter how  much medication my Endo keeps removing from me my TSH,FT4, T3 ....keep bottoming out...she says by lowering my meds it will raise my TSH (for bone health) and the other numbers will follow....total lie as this has never happened and my weight keeps climbing along with my emotions.  

So if I go one day without medication and do blood test next morning....Will this raise my TSH so she leaves me the hell alone...I'm just tired of being harassed and fighting and looking at their stupid faces.  I do have 2 Endo appts in Jan (outside endo) I'm paying out of pocket and appt. With my current clinic blood test after 1st of year and before both endo appts.
649848 tn?1534633700
Hi Grace... I get where you're coming with the low TSH and I understand your question about whether or not if you don't take your medication the day before your blood work, will your TSH come up enough to get the doctor off your back?  Did I get that right?  

I've had the same issues with my doctors for about 10 yrs, because my TSH lives in the gutter
(< 0.01).  They kept telling me the same things - that I was getting osteopenia because of my low TSH, it was causing heart problems, blah, blah, blah... I was able to do the same thing you did and point out that I had osteopenia prior to becoming hypo (no med, no low TSH, etc) and I've been on blood pressure medications since I was in my 40's, but didn't have thyroid issues until I was 58... no correlation there and my new cardiologist finally "got it"...

As to whether not taking your medication for one day will bring your TSH up "enough" to  get the doctor off your back is doubtful... I had to be off my medications for 3 weeks to do a nuclear medicine scan last year and during that 3 weeks, my Free T4 dropped down to 0.6 (0.8-1.8), but my TSH only went up to 4.0.  That's higher than it's been in 10 yrs, but not as high as I though it would have gone in 3 weeks without medication.  Of course, we're all different and yours may go up more quickly than mine did.

And what do you think my endo said when she saw that my TSH had come up to 4.0 in that 3 weeks?  She said that my pituitary gland had "recovered" from being on too high doses of medication for so many years... I mentioned the 0.6 Free T4 and my symptoms of hypothyroidism and she blew them off with a wave of her hand, telling me "those things happen when we get older".  She wanted me to stay off thyroid medication and I said "no", so then she insisted that she would only prescribe a lower dose of T4 and no T3... Of course, as soon as I got back on medication after the nuclear test, my TSH scurried back to its home in the gutter, but my hypo symptoms persisted.

Need I say she's no longer managing my thyroid and  I've since gotten my dosage back up to where it was prior to stopping it for the nuclear scan...

It won't really "hurt" you to be off medication for a day, but since T3 medication is in and out of your system faster than T4 medication is, you'll feel it, not taking desiccated hormones, more so than you would if you were taking a T4 medication...

Good luck with your endo appointments in January.
Helpful - 0
Hi Barb, You get my question. I've had 4 Endos in 2 years and my TSH was originally suppose to be 1 or lower I had thyroid cancer and because of this blasted bone scan diagnosing me with mild osteopenia earlier this year its the only thing they care about...In the meantime my health keeps deteriorating and I'm worried these people are going to cause this life sucking cancer to grow back.  I feel better now then I have since my thyroidectomy but the damage these so called doctors have done is taking it's toll on me.  

Prior to even knowing I had thyroid cancer I was on a biologic drug (stellara) and these doctors removed the biologic from me before surgery they (thought it would cause recovery problems, inability to fight infections) it caused a avalanche of problems (psoriatic arthritis)flare that has left me almost crippled inspite of doing other biologics.....I'm just tired of battling stupidity and as my appts draw near it causes me to stress...and now I'm on Cosentyx biologic and these doctors don't know if this medication affects my labs....
I wonder if my thyroid meds should be a little higher to make up for the medications I'm on.  I take Estridol,Stomach pills and this immunosuppressive therapy treatment (cosyntex )
Okay, so you have other conditions in addition to the thyroid cancer that require other ongoing medications I wasn't aware of.  Of course, that doesn't change the TSH issue, but some of your other medications can cause issues, depending on when/how you take them.

Is Psoriatic Arthritis the only other issue (not that it isn't enough...lol) you have or are there others?  

What type of "stomach pills" do you take and how/when do take all these medications?  Some of them may interfere with absorption of thyroid hormones and there may need to be a separation between them.  Do you also take any vitamins/minerals in addition to the medications? If so, there should also be separations between those and thyroid medications for best absorption.

Of course, none of this is going to change the doctors' attitudes toward your TSH, because that's instilled into them in medical school... I wish I had a magic wand I could pass on to help you deal with that problem... The only way I've been able to deal with it is to keep kicking doctors to the curb until my primary doctor got the message and realized that trying to get "measurable TSH" from my blood tests was like pulling hen's teeth.  He finally decided that he'd let my TSH live happily in the gutter as long as my Free T4 didn't get too high and my cardiologist is happy with my heart function.  Since I kicked my endo to the curb and got my thyroid levels at a "somewhat" happy medium, I've turned around some adverse heart issues (I believe they were caused by faulty/lack of thyroid function), which went a long way toward convincing my pcp that maybe TSH wasn't all it was cracked up to be.  

Anyway, taking meds at the right times, leaving adequate separations, even changing your diet to eliminate the stomach pills (?), might be helpful to balance things out and help you feel better.  

It's customary to keep TSH suppressed in thyroid cancer patients, so I'm somewhat confused by the problem you have with your doctors over low TSH.
Avatar universal
I agree with Barb that 24 hours would have very little impact on your TSH because it is the slowest moving of all the thyroid markers. Also I think it would be better to use your January labs to test at a higher dose - read on.

Since my last comment, I have looked in detail at all your labs and symptoms since inception and I think it is very unfortunate that your doc moved you off the 100 + 15 dose. It looks like you were on 100 + 15 for 5 or 6 months in the first half of 2018.

You have 2 labs on 100+15, March and May 2018:
FT4 - 1.23 and 1.29 midpoint of reference range is 1.3
FT3 - 2.98 and 2.9 midpoint of reference range is 3.2
These labs are very near midpoint and would be like thyroid heaven for a lot of thyroid sufferers. IMHO these are the best of all your labs, and you made several comments about your symptoms diminishing and some gone. The doc should have left you there longer; it takes a long time to get back to normal after all what you have been through.

You have gone from good labs on 100+15, to low T3 on 88+15, to even lower T3 on NDT 76+18. Those are big drops in meds and it is no wonder that your symptoms returned and are getting worse and you are feeling crappy. I know it is not you making these changes, it is your doctors, but any reasonable doctor would see that you are clearly hypothyroid.

It's not my place to tell you what to do, but if I was you I would either go back to 100+15 or go to 2.5 grains NDT which is pretty close (95+22.5). And I would do it ASAP. You do not need to be consigned to hypothyroid hell forever.
Helpful - 0
Telus2, I battle every single time I go to see these people (I'm on my 4th endo) in 2 yrs and now paying to see Endo on the outside...and your correct when I was on 100 synthyroid and 15mcg Cytomel my weight gain finally stopped but, I had bad times with synthyroid colored pills 112mcg particularly.   The ONLY reason for lowering my meds is the bone scan earlier this year without bothering to look at the same bone scan I had in August 2010 (results on both test the same) mild osteopenia.

Mentally I do feel better on Armour Thyroid and will see about upping my dose because I know my numbers will still be bottoming out.
649848 tn?1534633700
I don't agree that TSH is the "slowest moving of all the thyroid markers."  TSH can fluctuate as much as 70% over the course of a single day so it's not necessarily "slow moving".  The reason I don't feel like staying off meds for a day is going to impact it that much is for the very reason that so many other things, besides thyroid med can impact it... it's been a while since I read gimel's entire paper, but I think a lot of this is addressed there.  IMO, because your thyroid levels are already on the low side and your TSH is also low, it's not likely your levels will go low enough to increase your TSH over a 24 hr period.  In addition, you have other conditions and take other medications, so there's a good chance they could be affecting what's going on.

You said that your bone scan is, at least partially, if not, entirely, what's putting your doctors into a tailspin about the TSH issue.  Again, gimel's paper discusses the fact that when on adequate amounts of thyroid hormones TSH is often suppressed.   There's plenty of research that debunks the theory that TSH determines bone loss... Again, I can use myself as an example, because I actually rebuilt bone I'd lost "after" I became hypo and "after" my TSH plummeted into the gutter... I did this via a routine of daily exercise, diet and supplements.  A higher metabolism, in general will cause increased bone loss; it's not the lower TSH.  As I explained to my endos (the first one listened, got the message and didn't worry about it; the second one refused to listen and she's been kicked to the curb) as well as my pcp - all one has to do is look at Free T4 and Free T3 levels, along with weight and other hypo symptoms to know that I, and you, are not hyper, and that we do not have overactive metabolism...  I've since lost some bone due to higher metabolism and not keeping up with my exercise adequately.

I haven't gone back and looked at all your labs and/or posts, so I'm not familiar with where your levels are within the ranges... hopefully, you've kept notes and can determine at which point(s) you felt best and try to keep your levels within a certain range.  

Unfortunately, when doctors are determined to dose our medications by TSH, only, there isn't a lot we can do about it.  Sometimes, the only options we have are to keep trying different doctors until we find one that will listen to us.  It's also important to remember, it's not always an endo that will be our best ally... in my case, it turned out to be my cardiologist who understands that hypothyroidism affects the entire body and is just as bad for the heart as hyperthyroidism.  It was unfortunate my endo refused to listen to him so I could no longer deal with her, but my pcp did listen so I transferred management of my thyroid to him and although it's not "great", we're doing okay.  
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Hi Barb,  I did feel best on 100mcg synthyroid and 15mcg Cytomel but I can not say I felt normal I finally happy to have weight stop and and Endo that listen to me "until" that stupid bone scan.  Prior to thyroidectomy and psoriatic arthritis flare I was super fit and active, now I'm a slug riddled with remorse for doing this surgery. Well I will have to wait until Jan for blood test which I will post and see what happens.

Quick  question: I'm having issues with NOT being hungry....Is this hypothyroidism or Armour Thyroid?
If that's the case and you did feel best on the 100 mcg Synthroid and 15 mcg cytomel, then you should either talk to your endo and try to get back on that + additional T3 to try to feel "normal" again.   Have you taken the bone scan from 2010 in and laid it side by side with the current scan to show your doctor that they're same, even though you didn't have suppressed TSH is 2010?  Sometimes, that visual will do more than all the talking in the world.

I have to do some research on psoriatic arthritis because I'm not familiar with that, but I do know that, by itself it can cause a lot of symptoms and there may be side effects from the medication that could be coming into play as well.  We know you're hypo, but we don't know how much effect your other medications or diet are coming into play.  

"Quick  question: I'm having issues with NOT being hungry....Is this hypothyroidism or Armour Thyroid?"  It's likely neither... One of the side effects of Cosentyx is Inflammatory Bowel Disease (IBD) and one of the common symptoms of IBD is lack of appetite... IMO, not all of your symptoms can necessarily be attributed to thyroid.  

If you have greater mental clarity now on desiccated hormones, than you did on the Synthroid + cytomel, I would fight for an adequate increase in your current medication, as well as think about what your other medications are doing, take a look at your diet... some foods are inflammatory and can cause some conditions to flare.  There may be some foods you need to avoid in order to feel your best.  Is that something you've ever looked into or are willing to look into?  I didn't "want" to consider it, but once I did, I realized what a difference certain foods make in the way I feel.
Hi Barb,  I take Cosentyx for psoriasis and now psoriatic arthritis flare (similar to Rheumatoid arthritis flare) so I'm told.  Diet wise I have not tried anti-inflammation diet although I have eliminated  gluten as much as I can without driving myself nutz and I only did this because only recently did I get full access to my medical records and I had test done few yrs ago and it said I have  mild celiac (I think this is correct name) and was never told by my PCM who had quit over a year ago, I do probiotics,turmeric, Keifer and Vit C and take magnesium with Calcium Vit K and Multi Vit protein powder. Not too sure what else I could do.
Barb, I did make my Endo look up my 8/2010 bone scan which was almost identical in results to the scan earlier this year and the and the only thing she said was "huh, interesting" and I refused her request to reduce my Armour to 1.5 grains.
Grace...I understand what the Cosentyx is for and I know you can't stop it; I'm just saying that your lack of appetite is likely caused by that, since it causes IBD and IBD causes lack of appetite.  

If you have celiac, mild or otherwise, I find it appalling that your doctor didn't tell you give up gluten 100%... celiac isn't just a sensitivity or intolerance; it's an autoimmune condition in which your body can't tolerate any gluten.  Psoriatic arthritis and psoriasis are also autoimmune conditions, which I'm sure you know.  A real quick search turned up a couple of articles which say there's a link between celiac and the various types of psoriasis, including psoriatic arthritis and that going gluten-free is often advised as part of the treatment for any type of psoriasis, even if one doesn't have celiac and for sure if one does have celiac...

It's not easy to go gluten-free; I know because I try, too...gluten is everywhere.  Much to my doctor's disappointment, I'm not 100% gluten-free, but I don't have celiac either.  I do know that the more stuff I eat with gluten, the more inflammation I have and the worse I feel.  Add sugar to that and I have a real recipe for feeling like crap and it can take days to get even a little bit out of my system.

Vitamins/minerals should be taken at least 4 hours away from thyroid medications because they inhibit absorption of the medication. If you take thyroid medication morning and noon, take the vitamins/minerals at dinner and bedtime.  These things will help with absorption.  Selenium can help with conversion of Free T4 to Free T3, etc.
Avatar universal
The following link will give you a lot of good info to review and discuss with your doctor.  

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Avatar universal
Grace - yes, I see that you are in a difficult situation with your doctors. I dunno if you have tried this trick to find a new doctor - go to your pharmacy (or every pharmacy in town) and ask the pharmacist if he/she will give you the names of any doctors in town who prescribe Armour. And also ask the pharmacist which doctor he/she would go see...

WRT your experience on the 112 synthroid - it appears that this was the first T4 that you had. I believe that you were still having lingering effects from your Graves disease and surgery at that time, and if you took 112 now your experience would be different.
Good luck.
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Telus2, Synthyroid 112mcg was the devil.  I broke out in red welts and a super red face and sweat like crazy...1st time and then new endo tried it again...rinse and repeat same symptoms.....I looked up ingredients to that pill it has a tree ingredient and I took allergy injection for 6 yrs because of tree allergies.  
Telus2, I was not diagnoised as having graves or Hashimoto disease one day I just had cancer.  Although looking back past 5 yrs I think I had Hashimoto disease.

Avatar universal
Great advice all! It's been 8 years since I was educated here about all that has been discussed above, yet to this day, I do not let any doctors test my thyroid levels because they'd freak out over my TSH, I CAN'T. How is it that it is still this way? I have been lucky up to this point that my GP just follows an old prescription and I test myself---but for what you are dealing with Grace, I am so sorry. I feel like endos and doctors need to go back to school and go over these things- they are really hurting a lot of people. Good luck to you, I hope you can get back to the level you need!
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