Thyroid problems are extremely common, with about 12 percent of the American population affected by one at some point during their lives (American Thyroid Association). Since an underactive thyroid gland is by far the most prevalent of the problems that afflict the thyroid, it is little wonder that millions of people are taking levothyroxine (Levothroid, Levoxyl, Synthroid), a thyroid hormone intended to supplement or replace the inadequate production of the thyroid gland. But there is plenty of confusion about how to take this medication. It has a number of possible interactions that can make it tricky to find the best time to take Synthroid.
The Best Time to Take Synthroid:
Q. I’ve been told to take my Synthroid first thing in the morning, but I’ve read that coffee interferes with its absorption. I hate waiting an hour after I get up before I have my coffee or breakfast. Is this really necessary?
A. Levothyroxine is better absorbed when you have not eaten (Journal of Clinical Endocrinology and Metabolism, Oct., 2009). That is probably the basis for the usual admonition to take this pill first thing in the morning. But that is not always the best time to take Synthroid. Food, dietary supplements and coffee can interfere with its absorption (Thyroid, March, 2008). As a result, the most conscientious patients may end up like you, rising an hour before breakfast time and stumbling through that hour before enjoying the first sip of steaming coffee.
Try Another Time:
Taking your Synthroid at bedtime is effective and you don’t need to worry about coffee (Archives of Internal Medicine, Dec. 13/27, 2010). Of course, you’ll want to make sure you haven’t eaten for at least an hour or preferably longer. Since that is beneficial for lowering the likelihood of nighttime reflux, you’d want to do that anyway.
Researchers Say You Can Pick the Best Time:
The dilemma described above inspired scientists to test whether taking thyroid at different times changes the results (Endocrine, Nov. 2018). They used randomization to assign approximately 90 hypothyroid patients into three different groups. (84 people finished the trial.) The first group took levothyroxine half an hour before breakfast, as is usually recommended. Another took the pill an hour before the main meal of the day. The last group took their medicine at bedtime, at least two hours after the evening meal. The investigators measured TSH, free T3 and free T4 at the beginning and end of the two-month trial period. There were no significant differences among thyroid function markers regardless of when people took their pills.
As the researchers concluded,
“The three investigated timing regimens of LT4 administration were equally efficient and offer additional options regarding the treatment individualization.”
Other readers have found it helpful to switch to taking Synthroid at bedtime.
One person wrote:
“I’ve been taking levothyroxine for years and have felt crappy the whole time. I could barely drag myself out of bed. Trying to take my thyroid medicine on an empty stomach and wait an hour before eating or drinking was really inconvenient.
“After reading on your website that thyroid could be taken at night I feel liberated. My days are normal again. Since I’m taking my vitamins, minerals and tea earlier, I’m not having trouble sleeping anymore and I don’t wake up feeling exhausted. My energy is back.”
Be Consistent When Taking Thyroid:
The most important thing to remember about taking Synthroid or any other thyroid hormone is to be consistent. Even taking your pill with breakfast can work, so long as you do it every day and your breakfast time doesn’t vary too much. If you are consistent, your doctor will adjust the dose so that it is appropriate for your usual regimen.
It is better to avoid taking Synthroid at the same time as some supplements you might be swallowing with your morning juice. Specifically, both iron and calcium can reduce the absorption of the hormone. Vitamin C, on the other hand, can increase absorption (Clinical Therapeutics, Feb. 2017). Soybeans, like coffee, interfere with good absorption, so you might want to skip the soy sausage if you take your levothyroxine at breakfast time. We don’t know exactly how fiber affects levothyroxine, so to be prudent, don’t indulge in bran muffins or bran flakes cereal.
Liberated from the Morning Routine:
Q. I’ve been taking levothyroxine for years and have felt crappy the whole time. I could barely drag myself out of bed. Trying to take my thyroid medicine on an empty stomach and wait an hour before eating or drinking was really inconvenient. After reading on your website that thyroid could be taken at night I feel liberated. My days are normal again. Since I’m taking my vitamins, minerals and tea earlier, I’m not having trouble sleeping anymore and I don’t wake up feeling exhausted. My energy is back.
A. Research has shown that levothyroxine to treat a sluggish thyroid works just as well if not better when taken in the evening instead of the taking thyroid medication in the morning (Journal of Thyroid Research online Jul 14, 2011; Archives of Internal Medicine, Dec. 13, 2010).
No matter when it is taken, it is important to know what foods, beverages and drugs may interact badly with levothyroxine (Synthroid). For example, preliminary research indicates that PPI acid-suppressing drugs such as omeprazole might reduce levothyroxine absorption (Journal of General Internal Medicine, June 2021).
A different formulation may solve the problem as well. Italian researchers report that liquid thyroxine taken with breakfast does not appear to interact with coffee or food (Cappelli et al, Thyroid, Feb. 2016).
Learn More About Taking Thyroid:
You’ll learn about taking thyroid medication, along with the symptoms of thyroid disorders and innovative approaches to managing them, in our Guide to Thyroid Hormones.
