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Timing and sublingual

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Kat,

You wrote:

>

> How long before taking thyroxine should I last eat?...

The best guidelines call for a minimum of two hours after and one hour

before eating, and that includes beverages. On an empty stomach we only

absorb about 80% of T4 anyway. With anything other than water, that can

drop to 40% or less if they are together. It will be somewhere in

between, the longer the wait, although I am sure the change is not

linear (proportional to time).

I am also skeptical of the practice of sublingual administration

immediately followed by a meal.

First, the main cause of the 20% that isn't absorbed under the best

conditions is that globulin and albumin, the same proteins that bind T4

in the blood, diffuse into the saliva and gastric juices to bind T4 on

the wrong side of the barrier. I have no idea whether that is better or

worse in the thin tissue under the tongue or in the capillaries around

the intestine.

More importantly, I doubt that most of the medication is actually

absorbed under the tongue. Your gums do not form a hermetic seal, so a

good portion diffuses into your mouth to be swallowed and end up in the

intestine anyway. You may not need to wait the whole hour, but I would

suggest waiting at least a little while, just to be safe.

I still haven't found any studies that address this question.

Chuck

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