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Drinking Coffee with Synthroid Means the Morning Dose Is No Good

Drinking coffee with Synthroid leads to lower absorption of this thyroid hormone. Fiber and cow's milk also interfere. What's for breakfast?

How do you take your Synthroid, the levothyroxine medication used to treat an underactive thyroid gland? Usually, people are urged to take it first thing in the morning. Ideally, it is taken at least half an hour to an hour before eating or drinking anything else. That’s because quite a few things interfere with Synthroid absorption. But not everyone is willing to give up morning coffee with Synthroid. What else can you do?

What Is the Problem of Coffee with Synthroid?

Q. I take levothyroxine for hypothyroidism and have done so for 20 years. Usually I take it with my morning coffee.

I started on 75 mcg, but the dose has gradually been increased over the years. It’s gone from 75 to 100, 150 and now 175 mcg. That dose seems high to me. Could I be having trouble absorbing this thyroid hormone?

A. Coffee can interfere with the absorption of levothyroxine such as Synthroid (Thyroid, March 2008).  Coffee is not the only thing that could cause trouble for thyroid absorption. So can tea (Frontiers of Endocrinology, Sep. 12, 2022).

Taking Levothyroxine at Breakfast:

Taking levothyroxine with a healthy high-fiber breakfast such as oatmeal or a bran muffin could also limit absorption. So could antacids, acid-suppressing drugs or mineral supplements such as iron, calcium or magnesium. Even a simple multivitamin could interfere with your thyroid medication. You can learn more about the best ways to take your thyroid medicine from our eGuide to Thyroid Hormones.

We agree that 175 mcg might be a high dose. Too much thyroid hormone can weaken bones and affect cardiovascular health. It might also lead to diarrhea, insomnia, anxiety or tremor. If you experience any of these symptoms, you may wish to discuss this with your healthcare provider.

Is It Essential to Take Synthroid in the Morning?

Q. I was told to take my Synthroid before breakfast. Some of my favorite healthy breakfast choices have a lot of fiber, like oatmeal and granola and walnuts. I read that fiber can interfere with Synthroid absorption.

When I discovered coffee also was prohibited for at least an hour after taking the pill, that did it! No more morning Synthroid for me. Why don’t doctors know these things?

Alternate Dosing Avoids Coffee with Synthroid:

A. That is a good question. The FDA includes a warning about fiber reducing levothyroxine (Synthroid) absorption in its prescribing information available to every doctor.

Quite a few foods can affect Synthroid absorption. Coffee and soybeans can significantly reduce the amount of levothyroxine that is absorbed, while vitamin C increases absorption (Skelin et al, Clinical Therapeutics, Feb. 2017). If you like a latte, or put milk on your bran flakes, the plot thickens. Cow’s milk also interferes with optimal levothyroxine absorption (Chon, Endocrine Society, April 1, 2017).

Taking Synthroid at Bedtime:

Many people have concluded, just as you did, that no coffee in the morning is a non-starter. Instead, they take their Synthroid in the evening. That eliminates the problem of coffee with Synthroid and works just as well, if not better (Bolk et al, Archives of Internal Medicine, Dec. 13, 2010). A randomized controlled trial concluded that bedtime administration also works equally well for older adults (Frontiers in Medicine, June 23, 2022). The advantage is they don’t have to worry about coffee with Synthroid.

You can learn more about the pros and cons of levothyroxine and the best ways to take it from our Guide to Thyroid Hormones. 

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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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  • Benvenga S et al, "Altered intestinal absorption of L-thyroxine caused by coffee." Thyroid, March 2008. DOI: 10.1089/thy.2007.0222
  • Lai Y-W & Huang S-M, "Tea consumption affects the absorption of levothyroxine." Frontiers of Endocrinology, Sep. 12, 2022. DOI: 10.3389/fendo.2022.943775
  • Skelin M et al, "Factors affecting gastrointestinal absorption of levothyroxine: A review." Clinical Therapeutics, Feb. 2017. DOI: 10.1016/j.clinthera.2017.01.005
  • Bolk N et al, "Effects of evening vs morning levothyroxine intake: a randomized double-blind crossover trial." Archives of Internal Medicine, Dec. 13, 2010. DOI: 10.1001/archinternmed.2010.436
  • Bandeira de Mello R et al, "Evaluation of bedtime vs. morning levothyroxine intake to control hypothyroidism in older patients: A pragmatic crossover randomized clinical trial." Frontiers in Medicine, June 23, 2022. DOI: 10.3389/fmed.2022.828762
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