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How Bad Is Coffee with Levothyroxine?

Should you avoid drinking coffee with levothyroxine? Coffee reduces absorption of this hormone, but it is most important to always take it the same way.

Levothyroxine (Levoxyl, Synthroid) was prescribed more than any other medication in the US last year. Wouldn’t you think people would be eager to learn the best way to take it? Yet there is surprising controversy over one simple problem: just how bad is it to drink coffee with levothyroxine? One reader took issue with our advice to wait.

How Should You Take Your Levothyroxine?

Q. I read on your website that you should not drink coffee within one hour of taking a thyroid pill. My endocrinologist disagrees with you. He said I can have coffee with levothyroxine, though I still should wait 45 minutes before eating breakfast.

Since I started taking this medication, 15 months ago, my thyroid level has remained the same even though I drink coffee right after taking my pill. Am I just lucky, or is the warning wrong?

The Trouble with Drinking Coffee with Levothyroxine:

A. Years ago, Italian researchers demonstrated that coffee interferes with the absorption of levothyroxine pills such as Synthroid (Benvenga et al Thyroid, March 2008). They also pointed out that bran and other dietary fibers block levothyroxine absorption more completely. So do antacids containing aluminum hydroxide or sucralfate. Calcium carbonate antacids, proton pump inhibitors such as omeprazole (Prilosec) or esomeprazole (Nexium), as well as the osteoporosis drugs raloxifene (Evista) all interfere significantly with levothyroxine absorption (Liwanpo & Hershman, Best Practice & Research. Clinical Endocrinology & Metabolism, Dec. 2009).

If You Insist on Drinking Coffee with Levothyroxine:

A different formulation, Tirosint, isn’t affected by coffee, although it is pricey (Vita et al, Expert Opinion on Drug Delivery, July 2014). A recent review recommends either this soft-gel formulation or an oral liquid levothyroxine for people troubled by malabsorption due to digestive disorders, bariatric surgery or incompatible medications (Fallahi et al, Expert Opinion on Drug Delivery, May 2017).

While it makes sense to avoid foods, drinks and medicines that interfere with levothyroxine absorption, the most important principle for taking this drug is consistency. Taking it exactly the same way every day allows the physician to adjust your dose to your needs.

Learn More:

We discuss exactly how to take your levothyroxine and how to interpret the blood tests that track your treatment progress in our Guide to Thyroid Hormones. Click on the link to purchase it online; it is too long to send in the mail.

You might also wish to listen to our interview with top scientist Dr. Antonio Bianco and patient advocate Mary Shomon. It was Show 1015: Thyroid Mysteries, Controversies and the Latest Research.

If you have found a “best way” to take levothyroxine, let us know about your experience. Share your thoughts below.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
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