Q. I was alarmed to hear about the interaction of coffee and levothyroxine. I take this medication daily “upon rising” as my doctor instructed me.
I usually have a cup of coffee after 30 or 45 minutes. Does this mean I have been undoing the benefits of my medicine all this time? The only warnings I was given are to: take levothyroxine on an empty stomach and not to take it with magnesium or aluminum.
I drink three or four cups of coffee a day. My doctor checks my blood every six months and tells me to continue the medication at the same dosage because there has been no change in the level.
A. The Italian researchers who uncovered this interaction found that after an hour there was no problem (Thyroid, March 2008), but when coffee is drunk right around the same time that levothyroxine is taken, it can reduce the absorption of this thyroid hormone.
The most important point when it comes to taking thyroid medication is to be consistent, however, and you are doing that admirably. That is why your doctor has not found variations in your blood level of TSH (thyroid stimulating hormone), the indicator used to assess thyroid function. Our advice: keep doing what you are doing.
You may want to know more about other foods that could interfere with levothyroxine absorption, however. In addition to antacids containing magnesium or aluminum, people should avoid bran at the same time they take this thyroid medicine. Bran muffins or bran cereal could block absorption even more than coffee.
Taking minerals such as calcium, iron or zinc around the same time as levothyroxine can also interfere with proper absorption of the hormone (Thyroid, May, 2011). Chromium picolinate, which is sometimes used as weight loss supplement, also reduces levothyroxine absorption (Thyroid, Aug., 2007) One way to avoid such conflicts would be to take levothyroxine at bedtime (Archives of Internal Medicine, Dec. 13, 2010).
If you would like more information about this topic, you may be interested in our Guide to Thyroid Hormones. Please feel free to comment on your own experience.

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  1. Lori
    Reply

    I have been experiencing tremors in side my body. I’m taking synthroid. Would the symptoms be a glucose problem? Labs show my thyroid is normal

  2. D R Drum
    Reply

    Hi, your post gave some good info. I’m going to the store and get the ingredients for your”treat” today. You didn’t mention chocolate in your recipe ingredients. Do you use chocolate? If you do, how much?

  3. Mary
    Reply

    I prefer to eat and drink coffee first thing in the morning upon awakening. I take Armour at mid morning. How long after my last cup of coffee do I need to wait before taking Armour?

  4. fbl
    Reply

    Gia, I think some of the pharmaceutical companies are slacking on their quality control.
    I’d been on NatureThyroid for years with no problem then all of sudden my “plug” got pulled and I had no energy. I called the pharmacy to see if they would replace what I had left and they were really nasty about it. I called my Dr. and he immediately sent a new prescription for Armour and I’ve done fine since.
    You might contact your Dr. to see if you can get a new script and see if the new bottle is better. I’d go to a different pharmacy to make sure that the new ones don’t come from the same production batch.

  5. fbl
    Reply

    Gia, you may want to try iodine as I mentioned in a post above and also one of the natural thyroid meds such as Armour or NatureThyroid.
    For dry skin and hair, yes, proper thyroid levels help but they aren’t the whole answer. Your body is telling you that you need some good fats! Yup, get rid of the unnatural oils such as safflower, corn and soy. Instead, use real organic butter, coconut oil, olive oil and palm oil. It makes a huge difference!
    Yes, it will take some time to see the differences in you skin and hair but it will happen. I make a hot chocolate afternoon “treat” for myself using a rounded two TB spoon of unprocessed coconut oil, cinnamon, a fat pinch of Celtic Sea Salt, boiling water and heavy cream. Yes, heavy cream and no, my cholesterol is too low not too high.
    Since starting my afternoon “treat” I’ve lost 100 pounds as well. My skin is really good, especially for a 68 year old broad!
    Word of warning: Start slowly with the coconut oil as it goes directly to the liver and cleans it out. You will be shocked by what your bowels eliminate.

    • Jennifer
      Reply

      I like your recipe for the hot chocolate but I am wondering where the hot chocolate ingredient is and how much you use?

  6. Gia
    Reply

    I am on Armour and have been for many years. I had a total thyroidectomy from cancer in 2002 and was initially given various synthetic thyroid medications (synthroid, etc.). They all worked the first week and then I literally became immune to them. I have had no problems on Armour since 2006 or so but I noticed that lately, I’m sluggish, puffy and my hair and skin are very dry. I will be going to the doctor in a few weeks for blood work but I know when my levels are off. I am going to increase my armour a bit in the afternoons for now. I am currently on 90 grains twice a day. I can’t understand why all of a sudden it doesn’t seem to be absorbing. I haven’t changed my diet or anything- Any ideas? (I am 45 btw).

  7. RC
    Reply

    I am 19 yrs old (girl). My thyroid has been removed (total thyroidectomy) due to cancer 3 yrs ago. I am prescribed to intake 100 mcg of levothyroxine in the morning, 30 mins (empty stomach) before eating meal. Then after 30 mins of intake of levothyroxine, I eat meal plus a cup of coffee. Is coffee good for my health? Can it affect my health in the future? Should I stop drinking it?

  8. fbl
    Reply

    jf, you may want to try a natural thyroid med like NatureThyroid or Armour. Believe me it makes a BIG difference. I’ve been through the medication mill and natural is better.
    You may also want to try a natural iodine such as Iodoral. It has made a huge difference for me. My family Dr. is the one that first put me on iodine after we tried many thyroid meds and finally found ones my body liked. The iodine was the “cherry on top”. My energy stays level.
    My Dr. has me take the natural thyroid in the morning and then the Cytomel at night. Apparently my body doesn’t convert enough T3 to T4… or is it vice versa? At any rate it took years for us to figure out the right path.
    Talk to your Dr. and if he is not willing to work with you, find one who will. I’ve had my family Dr. for over 20 years.

  9. jf
    Reply

    I was prescribed 25mcg of levothyroxine due to the tsh results. I followed directions exactly. After a few weeks, I began to not feel right – chest pain, neck pain, angina, breathing fast, exhaustion, dizzy, not relaxed, increase in appetite, craving sugar & salt, ulcer acting up, mentally confused. After two months, I dropped the pill completely, as I was terrified to take another pill or to even cut back on the dosage. Today is about 10 days since I stopped the pill, and my thyroid gland is painful and I still feel dizzy. I am an elderly 78-yr. old woman.
    My morning temp about 97.3 to 97.5, pulse in the 60s. I read between 97.8 and 98.2 should be normal morning temp. I have all the physical symptoms of low thyroid. Looking back, I think the dosage should have been 1/4 of 25mcg as my body is extra sensitive to drugs, and I am an elderly woman. I will resort to a cup of coffee or tea to physically move my body. After that experience, I’m terrified to ingest any thyroid hormone.

  10. amy n.
    Reply

    Hi, it would be very helpful if u can let me know if having instant (nescafe) black coffee without sugar after 30 mins of intake of thyronorm 75mcg would affect my health in long run. I have started having instant black coffee regularly on empty stomach and have directly lunch and I have been doing this for a week now, as I heard black coffee helps in weight reduction. Am I on right track?
    People’s Pharmacy response: We don’t know if the black coffee will actually help with weight control. It’s quite possible the instant coffee would not be a problem, especially if you could stretch that 30 minutes to 45.

  11. KR
    Reply

    Just wanted to say that I have tried all different ways to take it…The ONLY way that works for me is to take levothyroxine upon rising…wait 2 hours for coffee and/or breakfast. I was waiting the 1 hour for coffee and it was not working. I would feel horrible all day long. Some days I could hardly put one foot in front of the other. Just thinking that some people might take longer to get the medicine into their system, so waiting a bit longer is a great option.

  12. fbl
    Reply

    Sk, I wouldn’t think so. Do you get a rash from sunlight? You might try changing brands as all vitamins are compounded differently with different fillers etc.

  13. Sk
    Reply

    Does Vitamin D3 cause hives?

  14. fbl
    Reply

    The lab tests were not an indicator for me at all. My Dr. knew there was something wrong so he had me take my temperature before getting out of bed in the morning. It was way below the bottom black line, so probably was 92 or 93.
    We had to play around with the types of medication and the amounts and wound up with NatureThyroid and Cytomel. My energy is usually good, the blood tests are normal and my body temperature stays about 98 to 98.4.
    I am blessed that my Dr. does more than read tests and is patient.

  15. DH
    Reply

    My doctor has increased my levothyroxine dosage over the last couple of years from 150 mcg. that I started with after having my thyroid removed because of cancer 15 years ago to 188 mcg. about a year ago. Over the last couple of months I have noticed heart palpitations and skipping the odd beat during the palpitations more frequently. I am wondering if my medication dosage is to high and if it is how you can tell from the blood tests, ie. that the tsh levels would be to low or by some other sign. Because my thyroid was removed because of cancer I was told that my tsh needed to be kept as low as possible, .01-.1.
    My concern is that there is a slow build up of to high a dosage if that is possible that is causing the palpitations. I have also started limiting my intake of caffeine to see if that helps. Any thoughts on this would be appreciated.

  16. SP
    Reply

    I was told to take levothyroxine on an empty stomach with 8 ounces of water and not to eat or take any other medication for an hour. I keep the bottle along with a glass of water on my nightstand and take it as soon as I wake up in the morning. By the time I have read the paper I can eat and take the rest of my medication. I’m surprised no one has mentioned the delay in eating or drinking coffee after taking the medication.

  17. SS
    Reply

    My pharmacist advised me NOT to take thyroid medication in the evening or in the middle of the night. He said it is needed during the day and should be taken in the morning on an empty stomach.

  18. Donnie
    Reply

    My TSH is lower when tested in the afternoon, then when tested in the early morning. My doctor uses a common sense approach to that problem. We test my Free T4 and Free T3, and use them to set my dosage. Along, with how I feel, and whether or not I have symptoms. Since I’m the one who lives with Hashimoto’s hypothyroid disease, I am in a much better position to know what is working, or not. Most doctors test only the TSH, and if it is in the so-called normal range, that is good enough. That may not be what is normal for the hapless patient, though.
    The Free T4 and Free T3 tests are a better indication on what is actually happening with the thyroid. The TSH is the lazy approach to thyroid treatment, and leaves many people suffering needlessly, in my opinion. I had to switch doctors to get decent treatment. I was having many hypo symptoms, for several years, from too low a dosage. After the dose was doubled by the new doctor, I felt so much better.

  19. Donnie
    Reply

    Soy is a goitrogen, and should be avoided by people with thyroid disease. It interferes with the thyroid, and with thyroid medication.
    PEOPLE’S PHARMACY RESPONSE: That is true for raw soy, but soy in foods like tofu or tempeh could be consumed in moderation–not every day–by most people on levothyroxine.

  20. JG
    Reply

    I think not , as I’ve taken Armour Thyroid for years and my t3 t4 tsh are all within normal limits. I take it when I get up with coffee and Mag. and my other vits.

  21. Don
    Reply

    I am taking 75MCG of Levothyroxin as prescribed by my Endocrinologist for about 2 years. The dose was adjusted once and I now see her once a year. I am blessed (?) with frequent opportunities to take the medication during the early morning hours. The label does quote “Morning” and “on an empty stomach”. The accompanying material suggests that the medication be taken 1/2 to one hour before food. Coffee is not mentioned. Seems to be working for me.

  22. barbara
    Reply

    I wake up in the middle of the night every night, so I take my thyroid med. then. That way I can be sure that no meds taken before bed or in the morning will interfere with absorption.

  23. abigail
    Reply

    I have been taking Armour thyroid at night because I had such good results when I forgot my morning dose and took the Armour thyroid that night. I do have to be careful not to drink or eat anything caffeinated after 4 PM, (no chocolate !) but I sleep through the night and have good energy the next day. I have been waiting 2 1/2 hours after dinner to take it. Question: How long should we wait after eating before we take thyroid medication at night?
    Not all of us can get to a lab for fasting test scores. My naturopathic physician says there is new research that indicates TSH levels are lower when blood testing is done in the afternoon. Peoples Pharmacy has mentioned that T3 and T4 levels should be tested also. This seems like a good idea.
    PEOPLE’S PHARMACY RESPONSE: Two hours plus should be long enough.
    Endocrinologists do not all agree that T3 and T4 levels should be tested. We were taken to task for suggesting that in a case where TSH was not tracking with clinical symptoms. We do feel that symptoms are important and should not be ignored even if the lab value doesn’t indicate a serious problem.

  24. fbl
    Reply

    Is taking magnesium and calcium a problem for those taking natural thyroid medications like NatureThyroid or Armour Thyroid at the same time?
    PEOPLE’S PHARMACY RESPONSE: Great question to which we do not have an answer. We haven’t seen any research on this.

  25. Toni
    Reply

    I have wondered the same, but also have had little change in dosage until very recently when hospitalized with heart/lung complications from SLE Lupus and severe immunodepression.
    I have considered taking this at bedtime rather than 6:00 am as well. I do take Lisinopril for blood pressure near bedtime. Would this pose a conflict at all?
    I take Prednisone at 7:00 am and Plaquenil and Methotrexate (but only once a week for this one) at 10:00 am.
    I take iron at lunchtime and calcium/vitamin D with dinner.
    PEOPLE’S PHARMACY RESPONSE: There shouldn’t be an interaction with lisinopril.

  26. Debi S
    Reply

    I take levothyroxine and coffee has not affected the absorption of mine that we can tell. If I take 50 mg it runs low and if I take 75 mg it runs high, so I’m going to go to a specialist in March. I will post the findings then…

  27. MMH
    Reply

    For “full disclosure” it should be said that I take Armour thyroid rather than levothyroxine, and that might affect this discussion.
    I was having trouble sleeping and attended a lecture on sleep disorders. The doctor said the biggest problems were caused by medications. At the top of his list was thyroid taken at night. He commented that it was not good to take a medication to wake up your body when you wanted to sleep. I switched to taking it “upon rising” and my sleep problems have almost disappeared. Unfortunately your article about coffee really hits home because my habit is to have a cup of coffee before doing chores, and then to fix breakfast about an hour later. Is it likely that I’m sleeping better because I’m absorbing less thyroid overall?
    In the interest of testing this theory, could you tell me if tea affects absorption? It would be hard to give up that first cup of coffee, but a tea substitute would make it easier.
    PEOPLE’S PHARMACY RESPONSE: We haven’t seen this addressed in a study. If it were green tea, though, rat research suggests potential anti-thyroid activity: http://www.ncbi.nlm.nih.gov/pubmed/20561943
    That is different from simply interfering with absorption.

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