coffee in a cup, cocoa in your coffee

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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  1. Deepthi Sreeramoju

    Taking levothyroxine in the morning for me causes a lot of starvation, what should I do? Iam also a psychiatry patient, being hungry all the time even though I feel full initially has been hurting me psychologically. My meds have been a mandatory thing from any doctor I try to deal with along with my family. Family says try to lessen the meds, but I feel helpless sometimes. Just don’t know who to follow…

  2. DAVID

    Better to be safe than sorry. My doc says after taking Levothyroxine wait one hour before eating of before drinking coffee,tea, any juices. So it’s simple. I take the med at 5 a.m. and eat breakfast anywhere between 6 and 7 a.m.

    Life by the inch is a cinch. Life by the yard is hard. Remember that, and it will serve you well. Listen to your doctor.

  3. Carolyn

    Have taken Levothyroxine for 30 yrs. and no doctor has ever told me all this stuff about not taking with food and coffee. I have heard this from friends so did start at one point taking with a full glass of water and waiting about 15 min. – 1/2 hour before my coffee and eating my small breakfast. 5 yrs. ago I found I have A-fib after having a stroke. I do remember when I was in the hospital, the nurse brought my Levo and other meds and vitamins to take with my breakfast and stood and waited while I took them w/my breakfast and coffee in front of me. I did think that a bit odd because it seems like a hospital would know these things about waiting, etc.

    Oh well.

  4. Lisa

    Adding this, in the event that someone is searching for answers. For the 4 years I’ve been on generic levothytozin, Synthroid and Tirosint, I’ve had morning diarrhea. When I had a colonoscopy about 3 years ago they found inflammation around the illium and then we followed up with all kinds of tests for Crohn’s, gluten, elimination diets for dairy, sweeteners, lettuces, and nothing made a difference until I asked to go off the Synthroid. Day 1 had no problem. As soon as I went back on it a month later, the diarrhea started back up. I was drinking coffee in the morning the whole time. So, natually I assumed it was the meds and I’ll have to live with it.

    Then one morning, recently, I didn’t have coffee and I didn’t have any tummy issues. So, for me, the levothyroxin is fine, and coffee is fine, but the two together makes me miserable for a few hours in the morning. (I was waiting 30 – 60 minutes at least, after taking my pill before drinking coffee.) Tea causes no complaints.

  5. Su

    IMO, Levothyroxine is a health hazard. Putting patients in hypothyroidism has increased heart disease, obesity and diabetes. More physicians need to look into porcine thyroid meds for patients rather than synthetic. We’d be a healthier nation.

  6. flax

    Just read this article…………the statement ” 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? ”

    If the person’s thyroid level has remained the same since taking the medication something is not working….it may be the coffee.

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