#644 Defining Thyroid: Proper Dosing

Scott and Jenny Smith define thyroid terms.

In this Defining Thyroid episode, Scott and Jenny explain how to take your thyroid meds.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends, and welcome to episode 644 of the Juicebox Podcast.

Before I start the last episode of the defining thyroid series, like to take a moment to thank you for your support of the podcast makes these little side endeavors possible. What I mean by that is that I couldn't do 123456789 episode series about thyroid. If you guys weren't going to support it, by downloading it and listening to it, it would be hard for me to tell the advertisers I'm going to put a bunch of content in nobody's going to listen to it. So I appreciate you guys clicking and downloading and subscribing, you allow me to do things like this defining thyroid series. Today is the last episode in this series so far unless I think of something in the future. But today's topic is about how to take the medication. And it's a bit of a wrap up too. But taking your thyroid medication is not as easy as just popping it in your mouth. There are some things you need to know. If you take these medications incorrectly, they don't work. So settle in. Listen to Jenny and I go over how to take your thyroid meds, and the reasons why I think you'll find them interesting. Speaking of great sponsors of the podcast, this episode of The Juicebox Podcast is sponsored by the Dexcom, G six, continuous glucose monitor, head over to dexcom.com Ford slash juice box and say hello to Dexcom. Alright, Jenny, we've learned that we have hyper or hypothyroidism, and we're going to start taking medication. Somehow we've gotten lucky and found a doctor who understands it. Thank goodness, we're on our way. But it's not that easy. It is a little tiny pill, you have to take it once a day. But there are a lot of things you can't take the pill with. And there are timing issues about how to take it. So how would you? How would you describe to somebody to take their thyroid medication?

Jennifer Smith, CDE 2:27
It would be good. A good long discussion in terms of I would first ask how are you taking it? And what are you aware of in terms of your intake around that medication? Timing and everything. And a lot of people like I said before, a lot of people are probably doing the really like the very basic that their doctor has said which is don't take it with other pills or supplements. Take it first thing in the morning and take it at least an hour before you eat anything else. That's that's like the general idea of taking your taking your thyroid medications, specifically like the level thyroxin or Synthroid or the the typical names that are what most people are using. Yeah,

Scott Benner 3:14
same time of day every day. I guess most people say the morning because their stomachs empty. Right? Right, Arden takes hers at the end of the day, like before.

Jennifer Smith, CDE 3:26
And if she's not taking any other supplements at the end of the day, and it's well past her dinner time, then for some people, that is another really good time of day to take it. Because they don't have time to wait in the morning time. They don't have that like either they're not going to get up in enough time before they have to leave or go to school or whatever is on their docket for the day. But yes, same time of day is really, really important. And then the other things that, you know, we'll talk about as, as we discussed, will give you a good idea that the time taking it is probably not the it's not the best idea at all. So same time of day. Definitely. I think another one is and this would come from your doctor if you found the type or meaning like the brand that works for you. Make sure that your doctor is always writing on your prescription no substitutions. Yeah. Because I know myself like I've been changed from my typical like, human log branded insulin to the generic human log, which is made by the same company it's just not called human log on the label any longer. Right. And that was my insurances, you know, decision to go to the generic. Um, I have found no issue with that at all. It works exactly the same as my name branded homolog worked so fine and dandy, but for something like thyroid medication it's a really it's something I've heard many people say I tried This substitution it did not work for me. So just have your doctor write no substitutions on the prescription Yeah,

Scott Benner 5:07
the compounding of the medication especially when you're taking Levo thyroxin which is the which is the medication name, but you'll see it as brand names like Synthroid Yuna, thyroid, Tierra sin levoxyl. So those compounds things are really specific, like, correct. I've I saw, my wife was just cruising along on Synthroid, and the same thing happened that you're saying, like, one day, it just got substituted for the generic. And yeah, no one noticed, you know, like, no one noticed. And then suddenly, weeks later, my wife was like having problems. And then you don't, you don't mean like you don't, it takes a long time to figure out again, now you figured out this issue for yourself, you're cruising along, and then someone just doesn't write no substitutions. And just like that, you're having a problem you can't even figure out. So Synthroid is taken by my wife Arden used to take Synthroid, but in the, you know, we were trying to find reasons why she might be having other problems and, you know, we're down to like maybe she's having a drug interaction, which it wasn't but she's switched to tears. And at that point tears since actually, it's not a pill like, like Synthroid to drive like compounded pill. It's here since a liquid inside of gel cap. Oh, interesting. Yeah. And because she had good success on it when my son started something they just gave him to listen to because it worked for her and that was the idea. Other medications that you might be taking, if you have hypothyroidism is a word I can't say low thyroid mean, it doesn't matter. It's cite a military sentence A T three mm in synthetic form. My wife had a ton of success with cider mill until it started giving her palpitations. Like one night, I swear one night we were sitting in bed and she's like, I'm having a heart attack. Something's going I remember

Jennifer Smith, CDE 7:08
you telling me I think we talked like the next day or something. You mentioned that she's like,

Scott Benner 7:13
she grabbed a there's an Apple Watch in the house that basically nobody uses it's mine. But my eyes went I can't see it anymore. I don't like just looking at my wrist going. I wish I could see this. So we it was charged up we put it on her and used it for it has like a little EKG thing on it and everything. Sure she was actually in. Oh, gosh. So I think so whatever that thing measures? I'll find out. I'll put it in here. But we were like, like, are we going to the hospital kind of thing. Like it was like right along there. You're very worried. And then she removed the cider mill. And it just went away. Interesting. You told her endo and and then there's like, take this item away. Now the problem was she was getting a lot of benefit from the side of metal. So you know, there was something to do there my son takes. So my son sees Dr. Benito. And she's a little more of a integrative doctor, I guess. I don't know what

Jennifer Smith, CDE 8:15
he looks at everything. And she pays attention to everything that might impact. Yeah,

Scott Benner 8:19
yes. So my son actually takes a mix of terrassen and armor thyroid. So then the third kind of thyroid medication you might see is a more natural version. Armor I think is made from glands of a pig, right? Dry thyroid glands have a pig. And I think there's another brand name, nature thyroid to or nature throw, I forget how they say it. Okay, it might be the generic of it. So my son takes up blending of terrassen. And a very small amount of armor seems to be working really well for him. But

Jennifer Smith, CDE 8:52
and again, what you're emphasizing is just really making sure that you know, how you've been doing on what you've been using, and continue to use it and make sure that it even if you change doctors, which does happen, right plans change things change doctors leave practices, that you really just have them have a definite list of this is what I was using, and even like symptoms and things like your wife, I can't use this, I had to switch to this because these were the problems that I experienced. So keeping some really good notes about what is working, what doesn't work, what you've tried. And kind of even the doses that you know, you find that definitely work for you. And then you know in terms of medications, especially around taking, you know, just the first step is the timing of when you take your thyroid medications. I mean, talking just about medications, you have to also really be good about knowing which other meds you're taking, that might interact with the thyroid medication in a way that you don't want and And there are, I mean, there are a host of other meds that can change the way that your thyroid med gets absorbed. And then your thyroid meds because you're taking these other medications may need specific adjustments based on how these other meds are helping you as well. So it becomes really important to pay attention. I mean, the the list is extensive i There's antidepressants, and there are the blood thinners and some of the statins, even some of the birth control pills, some of them oral medications for diabetes, reflux, anti acid types of medication, I mean, again, yeah, many that you need to pay attention

Scott Benner 10:44
to, like you said things that you might be taking already, because you have type one, like for instance, an iron supplement or a multivitamin with an iron supplement. Same with calcium, calcium supplements or multivitamins, with calcium supplements, if you took those as the same time as your Synthroid or tiersen, it would just block the uptake of it. And now you're going through the effort of taking this pill anyway. And sort of like what we were talking about with my wife when when she got switched to generic and nobody knew you're going to start having problems and you're not going to know why. Because your brains not gonna say to you like, oh, it's the thyroid pill because in your mind, you take that every day you're doing it right, you know, right, right. So, so to me, thyroid is getting it diagnosed. And then finding a doctor who understands it, who will do the right blood work and mess with your levels. Somebody who's going to treat your symptoms and not your lab results, and then direct you properly about how to take the medication because you're going to go through all these steps and then take the meds wrong. And that is such a prevalent complaint online, which it is, which is about my thyroid meds don't work. But yeah, it could be something stupid, like, like, did you know if you take an acid, like even over the counter and acid I'm saying Did you know Jenny's gonna know this, but maybe I don't know. It blocks iron absorption? Oh, yeah, yeah, so people who have low iron but are taking in acid they don't realize that and then you could take your iron supplement at the same time as you take your an acid and then you might as well just flush the iron supplement down the toilet instead.

Jennifer Smith, CDE 12:21
You know, if you think about Summit, some people take some other meds with like their Frappuccino or their iced mocha.

Scott Benner 12:39
I know it's not fair to put the ad here because you're thinking I drink iced mocha, which I MP doing that now. You'll find out in a second when Jenny finishes her thought. But I need you for a moment to focus focus focus on the Dexcom G six continuous glucose monitor. I'm going to tell you a story from this week in our house. Arden had to go on a steroid pack for six days, I believe this steroid pack monkeyed with her blood sugar pretty bad at times are needed. For units of Basal an hour, I was able to use the information that I got back from Ardens Dexcom G six to make quick and accurate adjustments so that she didn't suffer for days upon days. After starting the steroid pack, we were able to get things dialed in about eight hours. And then as the pack tied traits away, she gets fewer steroids as the days go on. The impact on her blood sugar changed, and we were able to change with it. Now tonight as the steroids disappeared from our system. We also had to change a pod and then go right into a meal. Well, we Bolus pretty good. I'd say aggressively for the meal. And about 45 minutes after the Bolus, it was clear that Arden had too much insulin. It was not a problem because of the Dexcom it immediately showed Arden's blood sugar dropping. It showed us the arrows that indicated a fast drop. It made alarms so that we couldn't ignore it. And Arden was able to take in some food without rushing and she avoided a low blood sugar. Her blood sugar kind of stopped right around 69 held held held the food kicked in. And right now she's 111 Without a Dexcom G six continuous glucose monitor. What I'm gonna guess would have happened instead would have been that we would not have had the nerve to be aggressive at dinner. And instead of a drop, Arden probably would have seen a significant rise in her blood sugar based on what she ate. I'm guessing that we would have then fought with for many hours this evening. Because we would just be testing randomly to see where she was. But with the Dexcom you're seeing her blood sugar in real time, now, okay, Fair's fair, we used a little too much insulin. But it was never a problem. Never a panic situation, because Dexcom was right there to say BBB, your blood sugar is getting low. And we were able to react calmly, rationally with a measured amount of carbohydrates and stop her low before it ever happened. kind of magical. Trust me, I raised the child without CGM, and I've raised one with them. I prefer this way. dexcom.com Ford slash juicebox. These are our results. And yours may vary. But there's nothing better than seeing it live. It really gives you a chance. There are links in the show notes of your podcast player to Dexcom. And all the sponsors. There's links at Juicebox Podcast COMM But you can always just go to a browser and type dexcom.com forward slash juicebox This is a piece of technology you want on your side, go check out the website. And when you try to leave it, it's going to give you a little pop up banner that says hello ducks calm, that's your opportunity to maybe get a free 10 day trial, give it a whirl.

Jennifer Smith, CDE 16:35
In the morning time, okay, that might be great and fine for other medications. But for thyroid medications, things like fiber, and caffeine, caffeine and even some of the macro micronutrients, just in food, which is why we recommend not taking it along with food and just with water is because it can really impair the absorption, again, of the dose of thyroid medication that you're supposed to be getting. So don't take it with your caffeine in the morning. Just take a glass of water,

Scott Benner 17:07
plenty of plenty of distance between them. If if you are taking an iron supplement, and thyroid ours, like you're gonna have to make a plan. And then that becomes an issue for people to you know, making a plan.

Jennifer Smith, CDE 17:22
And one interesting thing, especially in terms of diabetes, and a lot of the change that we've seen in just fueling plans, right, I hate the word diet. But the way that people choose to eat with diabetes to manage their blood sugar's better, you might be going from a typical, you know, diet to more high fat, or maybe you're going the complete opposite. And now you're just doing an all vegan, very low fat type of diet. Well, if you had been eating really high fat, and you go to a really low fat eating plan, you may actually need to change your dose of thyroid medication, it the dose might actually be too high. If you had gone from really high fat eating to really low fat eating, you might have to adjust your doses. So I you know, all those kinds of things. These, these are not on the printout list of how to take your thyroid meds when the doctor tells you the the majority of time what I hear. When I ask people how they're taking it is I take it first thing in the morning and then I wait to eat until I get to the office which is like an hour later because that's what the doctor told me to do. Just give it an hour. Well. Another one that often comes up on the list too, if you're really looking how to properly take it is foods that are high in calcium, calcium can impair the absorption of their thyroid meds. And actually the timeframe from calcium intake to taking your thyroid med is much longer than an hour. It's like you're supposed to wait like three to four hours.

Scott Benner 19:03
You know? Because if you're not getting the absorption, then you're not getting the medication and you really do need it. Listen, there's a great example Arden's been applying to colleges, right. She's done now, thank God, like my wife and I got in bed last night. We're like, Oh, like that was something, you know, just Yes. So Arden is applying to fashion schools. So she doesn't just apply. You know, it's not just an application. She's portfolios. Some schools want, like they were samples of things. They were making dresses in my house last week because of that, right? And so it's been a lot. She's got high school on top of this on top of everything else. She's been going to bed exhausted every night. And about, I don't know about four or five days ago. She comes by my office, she's going to bed she goes, Hey, I just realized I ran out a terrassen and I didn't go get it. And I was like when she goes I don't know like five days ago maybe. I was like Great. So. So we did, what we did was we did two terrorists and that night, and then we did two terrorists and the next night, and then we went back to a regular thing, because that is the other thing. If you miss it one night, just take to the next day is definitely that's how it's been explained to us. My doctor even told Arden, if you go away for the weekend and come back and go, Oh, I didn't bring it with me. She's like, just take it all.

Jennifer Smith, CDE 20:26
Oh, interesting. Yeah. And again, that would be something definitely to go over with your doctor of the what if this? What do I do? Because again, Arden's dose may be very specific to that works really well to double up the next day after you missed it the day before for somebody else, that might not be the case,

Scott Benner 20:43
it also brings up the problem is that some people then might think to skip it for seven days and take seven of them, which is not going to work. And I'm not saying that you should make a plan around skipping your medication. But if you do it, there's kind of a way to catch back up again. But the point is, is that yesterday, yesterday, about three days after she told me this happened, and probably about seven days after she stopped taking it. She was exhausted. And she's like, she's like, I can't I'm so tired. And I was like, Yo, you didn't take your thyroid medication for free. It's got to play catch up. And then finally, it caught up to you. And I said, your this is why it's important to know I'm trying to explain to a kid who's been taking thyroid medicine since she was little, she just thinks it's part of her life. She doesn't even I don't even think half the time knows what the hell it's for. You know? Yeah. So yeah, anyway, it's really important. You don't have to live like that. And if you're taking that medication, and it's not helping, there, there should be a mixture of amounts or T three and T four arm or whatever, that a doctor can get you to that will really help you you shouldn't have to struggle with this. So right, you know, exactly. Alright. Well, that's my passion project Jenni, thyroid disorder.

Jennifer Smith, CDE 21:55
Awesome.

Scott Benner 21:56
I think I think we've covered a lot. We I think we're done actually,

Jennifer Smith, CDE 22:00
we done with our thyroid stuff.

Scott Benner 22:01
I think we got through it all. I hope people listen to this, and that they're just like,

Jennifer Smith, CDE 22:06
well actually, I've heard from a couple of people that I work with that they've enjoyed. Although they don't have or they already have and they knew enough but they just like the explanation a little bit better. I've heard a couple of people say that it's nice that we're delving into something related to type one but a side note of how to manage something that could also be impacting your diabetes management if you're not managing your thyroid stuff well to begin with, so

Scott Benner 22:39
I know we've gone over it over and again but let's just leave it here at the end of this episode if your thyroid is mismanaged or are not working properly, and you're not managing it at all that does impact your your insulin 100%

Jennifer Smith, CDE 22:53
Yes, your dose of insulin your glucose control your sensitivity everything is impacted if your thyroid is not well managed.

Scott Benner 23:02
I'll take I'll tell you to the other thing is that you know when you I think that one of the things that might be keeps people away from looking into this stuff is that they don't want there to be another thing wrong with them. Like I say it's psychological sometimes like they just like we just found out we have type one I don't want to find out about this next thing

Jennifer Smith, CDE 23:21
well you know, the funny thing about it is I mean I keep really good I feel like visual on all of my health parameters right? When I get things tested, my lab results come back. Even if the note to me is like all parameters are in Target. I look at all the parameters I don't just go by that note that says everything looks good. I look at each of them. Well, since we started like doing this thyroid stuff. I actually went back like I think it was like six years just to see what have my like thyroid checks look like over the past six years. How have they flocked How have they changed and quite honestly, I'm very thankful and I should knock on some piece of wood somewhere. I mean, they don't mind don't really change. But everybody is doing right Yay, it's doing thyroid right

Scott Benner 24:12
just keep doing it that's all like I do think there's a spot like with diabetes that you do get into you know, he just get into a rhythm you take the pill at the right time your your life kind of goes like that. Like I want people to understand like if you're you know if you're doing this well over and over again and one night you take your multivitamin and your thyroid medication at the same time. Like don't beat yourself up just go DX day, but you're doing it every day at the same time. You could you could be completely crap. Yeah, just just making the thyroid medication. Again, it might as well you might as well not even be taking it because you're blocking its absorption.

Jennifer Smith, CDE 24:50
The other one that comes to mind just briefly, because of everything we've had going on in the past couple of years. People have really tried to get enough Back stash of products and even medications. Make sure your thyroid medication is not expired. Make sure it's not expired, don't take expired, get new.

Scott Benner 25:19
We you needed to work like you need to do what it's supposed to do. I think we Yes, Jenny, I'm, I think it's cool. We're done. Yay for us. Yay for us. For us, like I, you know, I'm gonna tell you that I think we're gonna be doing this more with other things like I want to, I do want to talk about just iron specifically, you know, people's iron levels are generally not high enough. Vitamin D, maybe we're going to go down a little supplement trail at some point,

Jennifer Smith, CDE 25:48
what I think kind of a piece of that, as we've kind of already gotten into even with some of the thyroid discussion is really gut level absorption. And really, maybe doings I know people like more like, link to this, like research. Why is this the information that you're kind of, you know, telling us, there's a lot of good information about gut health, specific to autoimmune disorder, and very specific to type one. That leads to the reason that your daughter's doctor is like, hey, get rid of those oral supplements for vitamin D, you need to be taken it under your tongue, so it gets absorbed through your oral mucosa. It doesn't get absorbed. For many people with type one through the gut, it just doesn't

Scott Benner 26:38
know. So I'm looking into the right people to talk to about some of this stuff. I there's one doctor I'm considering I'm actually also considering contacting the company that we sent the gut testing off to, like maybe they've got a medical who did you because I

Jennifer Smith, CDE 26:53
did that to Cat it was probably four years ago. Because I think Conan was like, a year or so old. Maybe he was like 18 months, so it was probably about four ish years ago that I did it. I'm curious what company you guys used

Scott Benner 27:07
to have the information downstairs? I don't have it here at my desk. Okay, I'm not sure. But I that's what I'm trying to figure out. Like, who do you get, they can really talk about this stuff, right down deep.

Jennifer Smith, CDE 27:19
And isn't just like a fufu kind of like, Oh, we're doing this fancy. Like, send us your poop and like, give you you know, you shouldn't be eating broccoli anymore. And you know, I was, you know, how did you nail it down to broccoli? I didn't even have broccoli for the past week, so it wouldn't have been in my poop Where are you getting that

Scott Benner 27:43
from? I'd like to know I definitely do and understand it better as well. So okay, yeah. All right. Cool. Thank you. Awesome. Yeah

how about that Jenny Smith huh? Round of applause. I'm not gonna clap because it mess up your audio. But I mean, like, she's terrific. Jenny's for hire if you're interested, she works at integrated diabetes.com. I'd like to thank Dexcom very much for being a longtime sponsor of the Juicebox Podcast and remind you that you may be eligible for a free 10 day trial of the Dexcom G six, head over to dexcom.com Ford slash juice box and say hello Dexcom Thanks again for listening to my defining thyroid series. I hope you found it valuable. Please don't forget I ran right in that music there. owe me a drink. Please don't forget there's a fantastic episode at episode 413. It's called thyroid disease explained is with myself and Dr. Addy, Benito. She's terrific. And if you really really want to dig down deep and understand thyroid, it's a great place to to keep going. All right. You guys good? Did you like this episode 616 Defining thyroid hypothyroidism and Hashimotos thyroiditis episode 619. Defining thyroid pituitary and thyroid glands 624 TSH testing 628 T four and T three 632 auto immune 636 goitre 640 thyroiditis 641 Graves disease and of course this the last episode 644 I think I'm going to call this one I don't know I didn't really think about it till now. And I got me on the spot. I mean, defining thyroid Alright, let's think about the other defining thyroid taking your medicine know how to take the meds, how to take the meds. proper dosing. We got that I got it Defining thyroid proper dosing, Episode 644. I hope you've enjoyed it. Hope you've gotten something out of it. I've enjoyed bringing it to you. I'll be back very soon with another episode of The Juicebox Podcast. If you're enjoying the show, please share it with someone else who you think may enjoy it. And my goodness, if you're not already subscribed, subscribe. Subscribe in your favorite audio app, Apple podcasts, Spotify. I don't care which app you use, hit subscribe please helps the show immensely.

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