oatmeal with milk & berries, egg, croissant & coffee

Q. I’ve been taking levothyroxine for more than a dozen years. I just recently learned I’ve been taking it at the wrong time. I was taking it along with breakfast and coffee, not to mention vitamins, minerals, probiotics, Citrucel and other medications. I am totally confused about how to take it properly.

A. Taking your thyroid medicine with coffee, mineral supplements (especially iron or calcium) or fiber such as bran cereal or Citrucel can interfere with its absorption (Thyroid, March, 2008).  Using a calcium-fortified fruit juice to take the medication could severely limit how much gets into your bloodstream. So could a high-calcium food like Greek yogurt. Other foods that may cut absorption of levothyroxine include grapes, soybeans and papaya (European Review for Medical and Pharmacological Sciences, 2014).

Watch Out for Drugs

There are several medications, especially those intended to moderate stomach acid, that can also interfere with proper absorptions. Proton pump inhibitors (esomeprazole, omeprazole, etc.) at high doses may affect absorption. So do antacids taken at the same time as the thyroid pill.

One supplement that you might want to include with your thyroid is vitamin C. In one randomized controlled study, swallowing the pill with water containing 500 mg ascorbic acid dissolved in it improved absorption as determined by lower TSH and higher levels of T4 and T3 (Journal of Clinical Endocrinology and Metabolism, June, 2014).

Switch to Bedtime

Why not take your levothyroxine at bedtime? A small study showed that the drug is absorbed better in the evening (Clinical Endocrinology, Jan., 2007). As long as you don’t eat within two or three hours of retiring, your thyroid medication should work fine and nothing else will interfere with it.

An alternative to that would be Tirosint. This liquid formulation is designed to be absorbed much better, without interference from breakfast beverages such as coffee or a latte (Pharmaceutics, Dec., 2013). You can learn more about thyroid treatment in our Guide to Thyroid Hormones.

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  1. Beatrice
    United States

    I am going through bouts of high blood pressure and thyroid medication problems. I feel like I will never overcome how I feel and have not been myself for months. My doctor increased my blood pressure meds and lowered my thyroid medication and it’s been a week and I still feel awful. How long does it take to regulate the medication before I feel better, I have no idea, but I have such low energy and overall ‘not feeling like myself’ syndrome. It is so not me and I am tired of people asking me how I feel and me having to say ‘not feeling better yet’. Is this common for one who has never had thyroid med problems before?

    • Gloria
      St Louis Mo

      You hired her so fire her. I was on Levo for 7 months gained 20 pounds lost hair had heart palps, asked my dr for Armour he said no so I called left message I stopped taking the Levo as it was going do kill me. He did give me Armour 1 week ago and I have no more palps more energy and I am glad I quit Levo as it did not work for me.Target sold me 30 pills for $16 and it was worth it. I should have done this months ago. Also the pharmacist told me that the heart palps are a very common complaint with a lot of folks who have also switched. My concern was that when the heart stops it can throw a clot and where would I be then?

  2. Vickie K.
    Johnson City Tennessee 37601

    I take Levothyroxine and wellbutrin

  3. BF

    I take 120mg of Armour Thyroid in the morning and another 120mg in the afternoon. If I wanted to start taking it at night would I take all 240mg or still spilt it up somehow?

  4. LM

    Well, I’m back to report how liberated I am now, since I’ve begun taking my Levo at night…my days are normal again as far as eating and taking my vitamins and supplements. I just make sure I don’t eat anything at least 2 hours before taking my Levo before bed.
    Since I’m taking my vitamins and tea earlier, I’m not having trouble sleeping anymore and I don’t wake up feeling like I never slept. My energy is back…amazing what a little change can do. So looks like I won’t be needing ZzzQuil anymore.
    It might not work for everyone at night, but it works for me. Thanks again for the tips.

  5. LM

    Thanks so much for this forum…glad I found it. Lots and lots of good info. I’ve been on Levothyroxin for around 5 years and have felt crappy ever since starting it. I felt better at the 75 mcg dose but doctors insist I need 100 mcg. At one time they had me on 125 mcg during the early years. Anyway, thanks for all the comments. I’m going to try taking mine before bedtime, which always is well after midnight. I usually wake up around noon, take the Levo, wait an hour to eat, wait 4 more to take vitamins and supplements (and walnuts!), which causes any like B12 to make it hard for me to sleep. The only time I can really sleep well is when I take about 2 or 3 teaspoons of ZzzQuil, but I don’t like taking it too often.
    I really want this change of taking my Levo at bedtime to work, so I can start having coffee or tea again when I first wake up instead of a Levo. And I like to drink milk before the coffee or tea. Oh, life will be good again (I hope).
    2 questions:
    – If I do have problems sleeping after a night dose, will ZzzQuil interfere? I take about 1/4 of an inch in the little cup that comes with it.
    – I have heard green tea is bad when on thyroid meds. Has anyone heard this and if so, do I have to completely eliminate it from my diet or just drink several hours apart from levo? I like to have it around 5 in the afternoon.
    P.S. I asked my doc if I could have Armour…she said no, she doesnt’t prescribe it. I asked if I could try Synthroid instead of Levo. She said Levo’s cheaper and there’s no difference. I don’t believe her but she didn’t seem to want to give me a chance to try the Synthroid. Wonder why? Anyway, maybe taking my Levo at night will make me feel normal again instead of like death warmed over. I just want my energy back. I’ll be skipping my noon dose today and will start tonight and will post again on how it’s working out.
    I was shocked reading that some were in hospitals that served up thyroid meds along with all the vitamins and supplements. Maybe they should ask the patients first if their dose is based on them taking with or without supplements (if they know)….but I know the norm is to take them apart.

  6. CN

    I have been taking Synthroid since 1988 after having half of my Thyroid removed due to 3 nodules on it. I was first on .25 then .50 then .75 now I am on .88. I always took it at 5:AM with 16 oz water and by the time I got my shower and got ready for work I could eat breakfast, then I retired. I did not know that I was not supposed to lie down after taking it so I have been getting up taking my Synthroid and going back to bed. A friend mentioned that she had read not to lay down after taking it so here I am looking up the info. It is so strange when I was in the hospital that the nurses did not know that you are suppose to take Synthroid on an empty stomach and alone with plenty of water! The Nurse brought all my vitamins and other meds all together and I told him that I could not take them all together —he had to look up the info–said well I was right.. Well after 26 years I will be staying up when I take my Synthroid. One question —-why do I get sleepy when I take it?

    • Gloria
      St louis

      Hi, well I was on Levo for 7 months started at 25 went up to 75mcg and gained 20 pounds had hair loss as well as my eyebrows not to mention my energy level was gone and this is not me as I work in yard clean house do everything as I am a widow. The worst symptom was was irregular heart beats. I did some research and found way too many had same symptoms. Levo is just T4 which needs to be converted to T3 and to me Armour was the answer as it is T4 T3 T2 T1/ I like you approached my doc twice to go on armour and he aid no insurance would not cover. Last week after dealing with the heart issue I quit taking the levo as I felt I would soon have some heart damage, called the office relayed this to nurse and told her it was going to kill me and will not take it again. They sent script got Armour over and after 1 week of no Levo I feel like myself and the heart palps are gone. Will get blood work up in 6 weeks and I bet my T3 and T4 or up. Want a difference, also United Health care did not cover and I paid 16 for 30 pills at Target UHC must be in bed with the Big Pharma. If you do not feel right get a new doctor, you have one body and one life you hired her so fire her. Good Luck.

  7. Dianne M.

    I’ve been taking Armour Thyroid for two years and I hear conflicting advice on the best time to take it. I do split my dosage in half and take half in the morning and half in the evening. Should I take it an hour or two before eating breakfast and dinner, or 10 to 20 minutes after those meals? I’ve heard both. I had been doing one hour before meals, but then I read 10 to 20 minutes after meals is better. So I’ve recently tried that, but I’ve had trouble sleeping well at night lately and wonder if it’s related. Three months ago I increased my dosage from 60 to 90. The six-week lab results came back in range, but I’m wondering if I should go back to the 60mg dosage.

    • Gloria
      St Louis Mo

      I was on Levo and now on Armour thank goodness, all research I have done and what my doctor and pharmacist stated was to take it on an empty stomach with a full glass of water. Reason being levo could not make it to stomach without the fluid. Relative to empty stomach and no other fluids or solids for an hour after is because your body needs to absorb only it so no tea, coffee or food for at least one hour.

  8. Crystal

    I have been on 50mcg of levothyroxine for 14 months. I have always taken it in the morning. Never a particular time, just when I wake up.. and then I will wait for an hour before I eat. Which I hate! Because if I want to go walk when I wake up, I go on an empty stomach.
    Anyhow, I saw my doctor two days ago, and asked him if I could switch to night, so that I can have what I want in the mornings. He said, of course. I took my first pm dose last night, and woke up with some serious questions. How long should I wait after dinner, before taking my medicine? Also, if I wanted to have alcohol, how much time should be before and after?
    I’m not a drinker normally, but will be going to a concert in September, and was thinking about how I’ll drink there. And if I do drink, how will I go about taking the medicine around 9-10 ? Should I just stick to mornings if I’m worried about it?

  9. debbie h.

    Taking Synthroid 88 mcg for a few years now. For the past year taking Cytomel 5mcg twice a day. Not good at remembering to take the 2nd dose around 3 pm everyday…I get busy and forget most of the time. Feel as though I’m in a slump and a nap would be great.
    I recently ordered Triple Action Cruciferous Vegetable Extract (I’m not good at eating my veggies), Virgin Coconut Oil, and Thyroid Energy (from the makers of NOW – this is thyroid support).
    What are your thoughts on taking these? More than anything – I’m wondering what will happen to me if I take the Thyroid Energy capsules and I’m taking the Synthroid 88 mcg and Cytomel 5 mcg…thoughts please!

    • Mel

      Cruciferous plants in excess have been proven to negatively affect the thyroid. I was juicing heavily with kale as a base (among other fruits and vegetables) and it was during this time I developed my thyroid issue. I still juice, but use kale on occasion. You should do some research on cruciferous plants, especially before taking a supplement that specifically is made from those type of plants.

    • Gloria
      St Louis Mo

      Relative to the Thyroid Energy, you need to check and see if there is iodine in it if so do not take it as there is probably iodine in yours thyroid med. When I have researched it what I found was to do brussel spouts and kale now and then but they have to be cooked. Chemical breakdown in them can increase chances of goiter.

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