Exogenous testosterone replacement therapy has been associated with the development of venous emboli through directly induced polycythemia, hypertension, and hyperlipidemia but a causation for cardiovascular events has not been established [ 5 ].
Hyperthyroidism has been associated with a higher incidence of coronary artery disease and acute cardiovascular events [ 6 ]. Increased levels of free thyroxine hormone lead to increased concentrations of clotting factors and fibrinogen with a decrease in tissue plasminogen activator leading to a hypercoagulable, hypofibrinolytic environment [ 1 ]. Levothyroxine supplementation in hypothyroidism has not been associated with an increased risk of acute cardiovascular events [ 2 ].
Testosterone affects thyroid hormone carrier proteins causing a decrease in thyroxine-binding globulin, thyroid stimulating hormone, and total T4 but an increase in free T4 and T3 [ 7 ]. The patient demonstrated a similar pattern for his thyroid hormone tests.
Armour Thyroid is a porcine desiccated thyroid-derived supplement that was being used by the patient for weight loss. Due to the lack of standardization, there might have been significant batch-to-batch variation in the number of active ingredients being consumed by the patient.
The co-self-administration of Armour Thyroid and testosterone in this patient possibly led to the development of a hypercoagulable, hypofibrinolytic milieu with alterations in the clotting factors and polycythemia. This would have accelerated the development of a thrombus in his LAD in the absence of underlying atherosclerosis in his coronary arteries. Coadministration of Armour Thyroid and testosterone may cause thromboembolic events.
Physicians prescribing testosterone and thyroid hormone supplementation should consider the potential for drug interaction of these medications and adjust the levothyroxine dose based on frequent serum thyroid hormone level monitoring. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional.
Do not disregard or avoid professional medical advice due to content published within Cureus. The authors have declared that no competing interests exist. Consent was obtained by all participants in this study. National Center for Biotechnology Information , U. Journal List Cureus v. Published online Apr Joshua Coutinho 1 Internal Medicine, St.
Author information Article notes Copyright and License information Disclaimer. Corresponding author. Anupam A. However, our study also indicated that patients may have more adverse effects on Armour Thyroid when compared to levothyroxine and further studies are needed comparing the two medications.
Limitations of our study include the retrospective nature of the study and the sample size. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. For many people, taking their thyroid medication in the morning is what they have always done. In this instance, switching to nighttime levothyroxine does not really make sense, unless your healthcare provider is worried about medication absorption or interactions, which would be detected in your periodic thyroid-stimulating-hormone TSH blood test.
Similar to the morning levothyroxine guidelines, experts recommend waiting up to four hours after your last meal or snack before taking your nighttime thyroid medication. Here are some potential pros to taking nighttime levothyroxine:. One study, reported in the Journal of Clinical Endocrinology and Metabolism in , examined the impact on thyroid hormone blood tests after changing the timing of when levothyroxine was taken from early morning to bedtime.
In all the patients, TSH decreased and free thyroxine T4 levels rose by changing thyroxine ingestion from early morning to bedtime. Triiodothyronine T3 levels rose in all but one subject.
Interestingly, TSH decreased irrespective of the starting TSH levels, suggesting better absorption of the thyroid medication when taken in the evening. Taking your thyroid medication at nighttime may be challenging for the following reasons:.
If you do take a T3 drug, your healthcare provider may recommend a time-released or sustained release formulation, or splitting your dose and taking your medication several times throughout the day.
These approaches may minimize any sleep interference. In the end, the key to optimizing your thyroid health is to maintain consistency, taking your thyroid pill around the same time and in the same way each day. Your body won't able to absorb enough medication.
Your symptoms—fatigue, constipation, dry skin, brittle nails, and so forth—should diminish within a few days. However, it will take from four to eight weeks for your TSH blood levels to reflect the effectiveness of your medication. Your endocrinologist likely will test your blood six to eight weeks after you start treatment or begin taking a different dose. Dairy products and coffee both have been found to prevent adequate absorption of levothyroxine.
Other foods that may interfere with the drug include soybeans, walnuts, and foods that are high in fiber. Grapefruit and grapefruit also may be problematic. How should I take it? Alternatives to Armour Thyroid. The takeaway. Read this next. The Effects of Hypothyroidism on the Body. Medically reviewed by Jason C. Baker, MD. Medically reviewed by Kelly Wood, MD. Recognizing the Symptoms of Myxedema.
Medically reviewed by Marina Basina, M. Medically reviewed by Deborah Weatherspoon, Ph.
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