Question re: taking meds together:

[RB10]

Question re: taking meds together:

Hello,
Thanks for all your posts and advice; this is a helpful forum!
I understand that the recommendation is to take your T4 (Levo, etc.) on an empty stomach to maximize absorption.
Can you also take your dose of T3 and hydrocortisone with your T4?
What if those are slow release T3 and HC, does that make a difference either way?
Looking to simplify taking meds so that they're not forgotten or delayed.
Thanks, RB.

[member_41389]

Hi, caution I'm not a doctor!
Thyroxine, T4, is not the main active hormone so taking it before or after Hydrocortisone is likely to have little impact on the effect of the HC. The concern is that absorption of Thyroxine might be reduced. However T4 costs pennies and if they find you're a bit low at your next review a small increase to compensate costs nothing. T4 is converted to T3 mainly by your liver (and kidneys to a degree).
Triiodothyronine, T3, is the active hormone and appears to down-regulate the action of CYP3A4, the pathway by which cortisol is metabolised, and so it could have the effect of increasing your exposure to cortisol. In consequence you should discuss the timing of doses with your endocrinologist.
The question of delayed release T3/T4 is unlikely to change this substantially but delayed release hydrocortisone is known to have less effect. For example, a 20mg tablet of Plenadren is reckoned to have the same effect as about 15mg of normal release. This is apparently due to the acidity of the intesine changing the further along absorption takes place. However absorption is very individual and it's difficult to predict your personal response so testing would be necessary to quantify what's going on.
Hope this makes sense
Tim

[RB10]

Thanks Tim, good info.
I'm a liltle confused about the risk of cortisol hanging around a little longer if you're already adrenal insufficient, is that bad? Generally, hydrocortisone clears too fast and it's time to take another dose already.
Good to know about how Plenadren (or SR HC here in the US) is actually a lower dose in reality. I hadn't heard that before, thx.
R

[Mgh]

Hi RB10
Tim, thank you again for more valuable info. RB, I hope you don't mind me asking what route led to you being prescribed T3 and what difference do you think it makes. I have only been able to read about the research. So far I have been unable to discuss with a real person who takes it!
Please don't worry if for any reason you don't wish to discuss but if you can I would love to learn more.
Maria

[member_41389]

Hi R
The issue with slowed metabolism of the hydrocortisone is that it increases the risk of Cushingoid effects, that is that you suffer the effects of chronic over exposure to cortisol. There's a lot of pressure on endocrinologists to lower the doses of steroid replacement because of this perceived risk. I confess that I'm not agnostic over this and as a steroid dependent person prefer to feel human part of the time rather than worry about a possible side-effect which might crop up as a problem in a few years time.
My current regime is 25mg of hydrocortisone a day and I don't feel over-replaced at all. My endocrinologist has maintained this dose because I have active acromegaly, that is known to increase the rate at which the body converts cortisol to cortisone (the inactive form). I have, in the past, been able to reduce my dose to 20mg a day when feeling well. Unfortunately since last April when I had a dose of sepsis and emergency hospitalisation I have not been able to do anything to keep my dose down.
Keep on taking the tablets
Tim

[KitKat]

Hi RB,
As Tim says, T4 tablets cost around 2p each, so if you aren't absorbing it as efficiently as you might, it's easier to just notch the dose up a bit than to faff around trying to take it separately from everything else on an empty stomach. In real money terms, if you lose 25% of the theoretical dose potential by swallowing a 100mcg T4 tablet with milky tea in the morning, you would be costing costing the taxpayer an extra 2p a day in a 25mcg top-up on your daily dose. Whereas if you try and remember to take it separately on an empty stomach, you are more likely to forget it altogether and lose stamina and concentration by being subtly undermedicated.
Hydrocortisone is a lot cheaper than it was a year ago but still around 90p for a 10mg tablet. Grapefruit juice also slows the metabolism of hydrocortisone down a bit (without increasing the initial serum peak). So if you were keen to stretch a dose out and make it last longer, you could try washing it down with grapefruit juice every morning. On the other hand, a lot of people don't much like the taste of grapefruit.
The important thing is to find a routine that works for you, so that taking your medication becomes an everyday part of your lifestyle rather than something that takes up a lot of your thoughts.
Best
KitKat

[RB10]

Thank you both Tim and KitKat, very helpful!