The People's Perspective on Medicine

Taking Synthroid in the Middle of the Night

One reader takes thyroid medicine in the middle of the night. That avoids any problem of potential interactions with coffee or breakfast foods.

An underactive thyroid gland is a surprisingly common condition, affecting up to 5 percent of adult Americans. More people experience subclinical hypothyroidism than overt hypothyroidism. Nonetheless, plenty of folks suffer with troublesome symptoms such as fatigue, cold intolerance, puffiness around the eyes, constipation, dry skin, hair loss, muscle or joint pain and depressed mood. Although doctors usually consider hypothyroidism to be simple to diagnose and treat, our readers often report that their experience differs. Delays in diagnosis and difficulty finding the correct dose or the best treatment can be frustrating. Which medication is best? Then there are conflicting instructions about when to take the medication: first thing in the morning, but not with coffee or breakfast. What about taking Synthroid in the middle of the night? That is one reader’s solution.

Taking Synthroid in the Middle of the Night:

Q. I read that you should wait at least an hour after taking Synthroid before you drink coffee or eat breakfast. To get around this restriction, I take my Synthroid when I get up in the middle of the night to go to the bathroom.

A. Your solution is sensible for those who consistently rise at that time. Some people take their levothyroxine before bed to accomplish the same goal. That way they don’t have to get up in the middle of the night to take it.

Armour vs. Synthroid for Underactive Thyroid:

Q. My thyroid was removed 38 years ago. I did very well on Armour thyroid replacement all of those years. Recently, my endocrinologist insisted that I take Synthroid instead. It made me feel awful.

Finally he put me back on Armour, but kept reducing the dosage. He insisted that the blood work showed that I was getting too much.

I reached a point where I was so fatigued that I could do nothing. When I saw another specialist, she said that my thyroid dosage was too low. In three weeks on the higher dose she prescribed, I have begun to feel better. Quality of life is important!

Which Thyroid Medicine Will Work for You?

A. For many people, levothyroxine (Levoxyl, Synthroid, TirosintUnithroid) is an effective treatment to replace missing thyroid hormone. However, up to 15 percent of those with an underactive thyroid may have a genetic variation that makes them less efficient at converting levothyroxine (T4) to the active form, triiodothyronine (T3).

Many of these individuals feel better taking a desiccated thyroid preparation such as Armour, Nature-Throid or Westhroid. This is not appropriate for everyone, as these products are derived from pig thyroid gland. As a result, they are not desirable for vegetarians or people following Muslim or Jewish dietary laws. Doctors may worry that these natural products are more variable in dose than synthetic levothyroxine, though we have not seen head-to-head studies confirming this problem.

Helen reported:

“It is very difficult to find an allopathic physician who is willing to prescribe anything but synthroid and its generics. I have one; however, any endo I have seen wants me to drop the Naturethroid and go back to a synthetic. While I have not experienced any of the wonders others have by switching, I am not interested in switching once again. As I have had thyroid cancer, it is important to my health to take enough to suppress my TSH score. Except now that I am 78, two endos have told me I no longer need concern myself about this. The same endos who said tight control of diabetes is no longer necessary. Well, I could live to 105 and be sorry I did not take care of these things when I could; so I didn’t listen. One of the endos was at Stanford, so they are just as rigid in standard of care there as anywhere in the boonies.”

Rebecca wrote:

“Hashimoto’s Thyroiditis has been a nemesis of mine for almost 30 years. That being said, I’ve been on a narrowly varying dose of levothyroxine (between 150 and 175 mcg daily) during that time.

“However: *three* friends of mine (none of whom know each other, or live in the same city) had terrible effects from Armour thyroid. One, a nurse, had cardiac arrhythmia from pills well in excess of the dosage they were supposed to have, sending her to the emergency room. One had a 30 lb. weight gain and brain fog, which resolved quickly after Armour was replaced with generic levothyroxine. The other had neurological problems and tremors, again, resolving after Armour was removed from the equation and replaced with synthetic hormone.

“I have no love for levothyroxine. My friends know me as an earth mother type. But alas, sometimes “natural” isn’t always better.”

Marla said:

“I have suffered with hypothyroid for years. Started with Synthroid with no noticeable results. Switched to Armour thyroid which worked great until my insurance company removed it from their formulary. My doctor had to petition to get my prescription covered again and switch me to Nature-thyroid which has been a miracle drug.

“I STRONGLY recommend that anyone with thyroid issues (and any doctors treating people with thyroid issues) read Root Cause by Izabella Wentz, which my doctor recommended to me.”

Learn More:

We agree that quality of life is an important consideration. You can learn much more about levothyroxine, treatment with T3, desiccated thyroid and getting the best treatment for your thyroid condition in our Guide to Thyroid Hormones. You may also wish to listen to our interview with Mary Shomon and Dr. Antonio Bianco. It is Show 1096: What You Need to Know About Treating Thyroid Disease.

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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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I have read that walnuts have a negative affect on thyroid medication. I have avoided them for years. Although my thyroid numbers are in the normal range, I do feel cold most of the time.
Any knowledge about eating walnuts would be appreciated,

We do spend four months in a warmer climate.

I have Graves disease and had my thyroid radiated-Radiation killed the thyroid years ago. I was started on Levothyroxine and had poor results. I read about Armour thyroid and asked to be put on that drug. The endo refused, so I found a doctor that would prescribe it. I finally had more energy! I have been on Armour thyroid for years and found a doctor who was willing to tweak the medication until it worked for me. I take 75mg. daily, except on weekends, I take 60mg. Unfortunately, the pill does not come in a 75 mg. tablet, so I have to take 60 and 15mg pills. I have never heard of nature thyroid. Since I still am tired a lot, I will ask my doctor about the nature thyroid.

I am allergic to the binders used in most pills. I started taking Tirosint. It is a gel cap without colorants. It has been working well for me for the past few years.

I have been on natural thyroid for fourteen years, sometimes different brands, but always natural. When I couldn`t get nature-throid, I researched and found NP thyroid. I do great on this. It is made by Acella in Georgia.

I’ve always taken my thyroid medicine at 2:30a.m., about the time I awaken each morning. Works great for me.

Oh, for years, I have daily bouts of diarrhea so I include an Imodium. Not recommended for all, but it sure helps.

So, a lot of this addresses Synthroid and coffee timing. Does the desicated Naturthroid share the same concern? Are the coffee warnings pertinent to the dessicated? I ‘m not sure I have ever seen that addressed. (I think I must be part of the 15% since I never did well on synthroid, not even with T3 added—- but am great with the desiccated).

I also take my Synthroid in middle of the night. I sleep until 8 am usually and then would have to wait until 9 am for breakfast. Buy it from a government authorized pharmacy in Canada. (I like The Canadian Pharmacy in Winnipeg). For $45 you can get a 3-month supply–this includes $15 S & H.
I will never take the generic Synthroid again. I tried it for two weeks and felt terrible. Also the pills dissolved before I could finished swallowing. The drug company told me to use more water. That was no help.

Taking thyroid meds in the middle of the night, with water, is the best way to assure there is no interaction with food. Instead of setting a clock, I drink about 12 ounces of water just before bedtime, which guarantees I’ll wake up around 3 or 4 AM for a pit stop and thyroid medication.

My journey to getting my thyroid hormone regulated has been long. First, hypothyroidism is rampant in my family: mother, siblings, nieces and nephews, and my daughter. In my 40’s I was finally diagnosed as hypothyroid. That was decades ago, and I was never satisfied with the results of taking just T4 because the classic symptoms lingered (even with a TSH around 1).

Animal-source thyroid seemed a poor option to my present MD because of efficacy and supply issues so a few years ago I talked him into letting me try compounded, sustained-release T3, reducing my daily dose of T4. Once as high as 175mcg T4, we’ve settled on 100mcg, with a 5mcg T3 SR2 cap twice a day. My basal temp, carefully tracked for a month before and after the initial addition of T3, rose over a degree and both my energy and mood were dramatically elevated.

The generic for Synthroid has issues because the multiple brands used by pharmacies are not always equivalent. So a major chain pharmacy has decided to have a single source and is now in the process of dropping 4 or 5 suppliers of generic T4. Unfortunately, there is presently no “authorized generic” for Synthroid but you can always ask your Pharmacist to dispense only a particular brand for you, the source they believe most likely to be consistent, and available.

Be proactive!! Find a physician with an open mind about treating hypothyroidism, one willing to at least try a combination therapy, who focuses on how you feel and what your levels of free T3 and free T4 are, instead of TSH. And do your part by taking meds properly, by being acutely aware of the symptoms associated with low or high thyroid hormone, and by communicating with your physician about any relevant change you perceive.

Is Nature-Throid back on the market? If so, where do you get it? I have been on both Armour & Nature-Throid for years. I don’t have a thyroid. Im 75. I prefer Nature-Throid.

I take my Synthroid as soon as I get up in the morning but go for a walk right away so have well over an hour before I get to breakfast. When I was working (now retired) I took it during the night, too. Worked for me. My blood tests do not reflect how I feel, and after nearly 30 years and good luck with 2 endocrinologists, I have about given up feeling well again. One end retired, and one moved. Very discouraging. Most worrying is my decreasing heart rate. I asked the current endo what his goal for me was. He did a double-take (surprise!), then said to have my blood test numbers be normal. Odd and discouraging how so many people have hypothyroid AND have so much trouble feeling well on the prescriptions provided.

My OD added cytomel — first time I’ve felt like thyroid meds are working consistently. She also warned me about coffee, so I take it in the middle of the night, too.

I had my thyroid removed in 1995 and was prescribed Synthroid. I experienced fatigue that raising the dose did not resolve. Then I read one of your articles in the L.A. Times recommending adding Cytomel. When I first mentioned it to my Internist he dismissed it and I continue to suffer…..six months later I went back in and he had read in a “journal” that a small amount of Cytomel combined with Synthroid helps some patients!!! I have been on this combination ever since and while I still experience occasional fatigue this combination works for me!
I have since learned that when a physician dismisses my suggestion…..usually because it didn’t come from them….I either continue to discuss it or find a doctor who will accept me as a partner in my own health!

My Dr says that there are too many variations in the amount of actual medication in generic Levothyroxine so he will only prescribe Synthroid. It costs $45 a month. All those copays add up, but I’m glad it’s not more expensive.

My insurance luckily will give me my Synthroid at around $30, which I consider a bargain compared to pre-approved Synthroid!

I have taken various thyroid medications in varying dosages for 40 years since being diagnosed with Hashimoto’s Thyroiditis. I have always taken it 1st AM and at first, did not get the message that no food for 30 min. Later was told 30-60 min. Then told as long as I was consistent in what I did following taking Rx, it was OK. I rarely need dosage tweaked. I don’t get up in middle of the night so that would not work for me. Taking the might before would BUT, isn’t the objective to take on an empty stomach? How many hours before bedtime should one fast? Can it be taken with other PM meds like a statin?

I want to get off the pharmaceuticals, I’m finally on Armour. But, I’m worried. Anybody make the switch? To Nature-thyroid. Thanks

I’ve been on thyroid medication for almost 40 years. I did well on levothyroxin until about 5 years ago. My primary care physician suggested that I try Armour Thyroid, but could never get the dosage right. She switched me to Nature-Throid (81.25mg) and I started feeling better than I have in years. Also, my labs were perfect.

Then, about 6 month after I started taking it the manufacturer quit distributing the dosage. That’s been well over a year ago, and I’m back to the constantly fluctuating doses of Armour. I feel so much better on the desiccated thyroid products (even though they aren’t covered by my insurance) but it would be great if I was able to get the one that works best.

Of the desiccated thyroid meds, which is the best? I have read that Nature-thyroid is only manufactured in the U.S. with no imported “ingredients” for purposes of quality. I can find no info about Armour, which has had many recalls, as to whether they import frm China their ” ingredient”. Nature-thyroid has never had a recall. ( I am on Armour currently).

We haven’t seen a comparison, so we can’t offer an opinion on the best.

After a total thyroidectomy, I was put on 125 mcg of Synthroid. I was exhausted all the time. Eventually a new endo , saying she could be blackballed for prescribing T3 , added it to my daily meds. The result was almost instantaneous and very gratifying. When I told his story to my open-minded PCP, he said he had always been taught not to prescribe T3, but after hearing my story he would try it with several of his patients

In 1983 I had a thyroidectomy and was told to take synthroyd on an empty stomach during the night – didn’t have to be the same time each night. So that’s what I do. When the generic came out years later my doctor told me to stick with the brand name. So I take it about 3 or 4 hours after I’ve eaten, and then I can eat again 1 hour after I take it. That’s what I do, and my numbers come out good. I’m shocked to hear that there’s a discrepancy about all this. Even when I’ve been in the hospital, they wake me at about 3 or 4 or 5 a.m. to give me a pill, and I always bring my own in because not every hospital has the brand name. So, I don’t get it if I don’t bring my own.

My endo does by blood work and does not go by how a person feels. my T3 is in the lowest level of normal. I had anxiety, hair falling out, and a bruise. Sometimes I get lots of bruises. Yet if the reading is even the slightest in the norm she refuses to adjust my meds. I originally was taking 4, T3 tablets per day; now I am on 2. I tried 3 tablets on my own, and I felt so much better, but will have to find a new dr to test me and prescribe it. Since it fluctuates, she refused to give me extra med so I could adjust it when I needed to. The anxiety was obvious when I was in her office, as was my swollen stomach, and all the other side effects that I told her about. I also had a lack of energy, and for several years chronic constipation, which the dr. continued to ignore. Stomach swells until I look like I am pregnant.

I am considering using my family dr for thyroid problems. The endocrinologist where I live (as I am also diabetic) is not a very good doctor, so I drive a long way to see the specialist. Am thinking I need a new one – as an endocrinologist is required for insulin pump. It’s not so easy finding the right doctor, as I drive 3 hr round trip now, so I am glad others seek to find the dr that “gets” them. I may be looking for another doctor who listens to symptoms instead of looking only at a blood test, which should have indicated that meds needed to be adjusted.

Just keep on changing doctors until you find the right one for you. That is what I do, and it looks like I will be finding a new endo in the future.

My granddaughter was diagnosed with Hashimoto’s when she was 9 y/o. Her medication had to constantly be tweaked. By adulthood she was at 200 mcg. All but stopped growing. Pediatric Endo keep watch on her but missed her growth spurt at around 12 so they could sadly not intervene. She stopped growing at 4’9. She hates it! She has a new endo now who changed her medication to synthroid, and she only needs 50mcg to get results and keep her levels up. New doctor says brand name in this medication is better.

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