Do you also feel tired all day long, just feel like you have no energy, are gaining weight, or are you more cold than others? These could be symptoms of an underactive thyroid gland, a condition doctors call ``Hypothyroidism''. So your doctor may have told you to use Levothyroxine solution for this condition. Today, we will talk about this medicine, how to use it, and what you need to be careful about, in a very simple and friendly way.
Simply put, what is Levothyroxine?
Think of our body as a car. The engine of this car controls the speed and helps everything run smoothly and on time, and that's the thyroid hormone, which is produced by the thyroid gland in our neck. This hormone controls many things in our body, such as our metabolism, heart rate, and body temperature.
Sometimes, due to various reasons, our thyroid gland is unable to produce the required amount of this hormone. That is what we call `(Hypothyroidism)` or thyroid hormone deficiency.
Levothyroxine is a synthetic hormone that is completely identical to the thyroid hormone that our body produces naturally. Simply put, this medicine replaces the hormone that the body needs but cannot produce itself. Since it comes in a liquid form, it is very easy to use for people who have difficulty swallowing pills and for young children. `(Ermeza)`, `(Thyquidity)`, `(TIROSINT-SOL)` are some of the names available in the market for this medicine.
Things you need to tell your doctor before starting this medication
Before your doctor prescribes this medicine, he or she will need to have a complete picture of your health condition. This will help them determine the most appropriate dose for you. Therefore, if you have any of the conditions listed below, be sure to tell your doctor.
| Your condition or habit | Why should you inform the doctor? |
|---|---|
| Addison's disease or adrenal gland problems | Changes in thyroid hormone levels can affect the functioning of these glands, so those conditions should be controlled first. |
| Diabetes | Levothyroxine can affect blood sugar levels, so you may need to adjust the dose of your diabetes medication. |
| Heart disease, chest pain | This medication may have a slight effect on your heart rate when you first start taking it, so your doctor will start you on a very low dose and gradually increase it. |
| Bone problems (e.g. osteoporosis) | Taking too much levothyroxine over a long period of time can cause thinning of the bones. |
| If you are taking medication to prevent blood clots (e.g. `Warfarin`) | Levothyroxine may increase the effectiveness of those medications, so the dosage of those medications may need to be adjusted. |
| If you are pregnant or trying to get pregnant | Thyroid hormone requirements change during pregnancy, so your doctor may need to adjust your medication dosage. |
| If the baby is breastfed | Since small amounts of medication can pass to the baby through breast milk, it is important to inform the doctor about this. |
| If you have allergies to other medicines, foods, or dyes | This is important to confirm whether you are allergic to any other ingredients in the medicine. |
The correct way to use the medicine
To get the most out of this medicine, it is very important to know exactly how to use it.
- Most importantly: This medicine should be taken every morning, on an empty stomach . That means at least 30 minutes before breakfast, and preferably an hour before. This is because the absorption of this medicine into the body is reduced when food is present in the stomach.
- At the same time every day: As much as possible, get into the habit of taking your medicine at the same time every day. It's a good habit to take your medicine as soon as you wake up in the morning.
- Interactions with other medications: Some medications and vitamins can interfere with the absorption of this medicine, especially antacids, calcium, and iron tablets.
Remember: If you are taking an antacid containing calcium, iron, or aluminum/magnesium, you should take Levothyroxine 4 hours before or 4 hours after taking it. This means that there should be a 4-hour gap between the two medications.
How to use different types
The method of use may vary slightly depending on the type your doctor has prescribed for you.
- For Tirosint-SOL: This liquid can be taken directly into the mouth. Or, it can be diluted in 1-2 teaspoons (5-10 ml) of water. Never mix it with any liquid other than water (milk, fruit juice).
- For Thyquidity: This type should be taken directly into the mouth. Do not mix with water.
If you give it to children...
This medicine is even given to newborns for some conditions. But it is done under the close supervision of a doctor. Follow the doctor's instructions regarding the dosage and method of administration to the child.
What to do if you take too much medicine?
If you think you have taken more than the prescribed dose, immediately call the National Poisons Information Centre at the Colombo National Hospital. Or go to the Emergency Department (ETU) of the nearest hospital.
Important: This medicine has been prescribed for you only. Never share this medicine with anyone else, even if their symptoms are similar to yours.
What to do if you miss a dose of medication?
If you forget to take a dose, take it as soon as you remember. However, if it is almost time for your next dose (e.g., it is only a few hours away), skip the missed dose and take your next dose at the scheduled time. Do not take a double dose to make up for a forgotten dose.
Other medications that may interact with Levothyroxine
Other medications you take can affect the way Levothyroxine works, and Levothyroxine can change the way other medications work. Therefore, it is very important to tell your doctor about all the medications you are taking (including vitamins and herbal remedies) .
| Drug/substance category | Examples |
|---|---|
| Stomach pain medication, vitamins, and minerals | Antacids, products containing calcium, iron, magnesium |
| Cholesterol-lowering medications | ``Cholestyramine'', ``Colesevelam'', ``Colestipol'' |
| Diabetes medication | Insulin or diabetes pills |
| Medications for depression and epilepsy | `Carbamazepine`, `Phenytoin`, `Phenobarbital` |
| Types of hormones | Estrogen, Testosterone, Birth Control Pills, Steroids |
| Medicines for heart disease | `Amiodarone`, `Digoxin` |
| Other | Warfarin (used to thin the blood), Rifampin (used to treat tuberculosis), some weight loss medications, products containing soy |
This list is not complete, so tell your doctor about any medications you are taking.
Things to be careful about when taking medicine
- Regular check-ups: After starting this medication, you should visit your doctor at regular intervals as directed. You may need to have blood tests (`Thyroid Function Tests`) to find the right dosage for your body.
- Be patient: You won't feel a big difference right away when you start taking the medication. It may take a few weeks for the fatigue and lethargy to subside and you to feel better. So don't panic.
- Don't switch brands: Don't switch from one brand to another without your doctor's advice, as different brands can be absorbed slightly differently by the body, which can affect your hormone levels.
- Be careful with Biotin: If you are taking a vitamin containing `Biotin (Vitamin B7)` for beauty, hair, or skin, stop taking it at least two days before a thyroid blood test. Biotin can cause false results in the blood test.
Side effects that may occur due to medication
Generally, when taken at the correct dosage, serious side effects from this medication are rare. Most often, side effects occur if the dosage of the medication is higher than the amount needed by the body. That is, if a condition such as hyperthyroidism occurs instead of a deficiency of thyroid hormone (hypothyroidism).
| Side effect | Description |
|---|---|
| Side effects that you should report to your doctor immediately | |
| Changes in heart rate | Heart palpitations, a pounding sound in the chest, difficulty breathing, chest pain. |
| Severe restlessness and insomnia | Constantly feeling anxious, irritable, feeling like your body is shaking, and not being able to sleep at night. |
| Excessive sweating | Feeling hot and sweating profusely even in normal environments. |
| Severe diarrhea | Uncontrollable diarrhea. |
| Allergic reactions | Skin rash, itching, swelling of the face, lips or tongue. |
| Changes in the menstrual cycle in women | Irregular menstrual cycle or intermittent bleeding. |
| Side effects that are usually not serious, but should be reported to the doctor if they persist | |
| Headache | You may experience a slight headache when you first start taking the medication. |
| Temporary hair loss | There may be some hair loss during the first few months, but it will return to normal once the body gets used to the medication. |
| Changes in appetite | You may experience an increase or decrease in appetite. |
How do you store medicine properly?
To maintain the quality of the medicine, it must be stored correctly.
- Keep away from children and pets.
- Tirosint-SOL: Store this at normal room temperature (25 degrees Celsius). Discard any remaining medicine within 15 days of opening the packet.
- Thyquidity: Store this at room temperature (20-25 degrees Celsius). Discard any remaining medicine within 8 weeks of opening the bottle.
Safely dispose of expired or unused medication.
Take-Home Message
- Levothyroxine is a medication that replaces the thyroid hormone that is lacking in your body. You may need to take it for the rest of your life.
- Take this medicine every morning, on an empty stomach, 30-60 minutes before meals.
- If you are taking iron, calcium, or stomach pain medications, keep a 4-hour gap between taking Levothyroxine.
- Do not stop taking the medication, change the dosage, or change the brand without your doctor's advice.
- If you experience symptoms such as a fast heartbeat, tremors, or excessive sweating, this could be a sign of an overdose. Tell your doctor immediately.
- It is very important to have blood tests done on time, see your doctor, and maintain the correct dosage of medication.
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