How Should I Take Thyroid Hormone (L-thyroxine)?

What is the best way to take thyroid hormone?

The maintenance of steady and predictable thyroid hormone levels in the blood is essential to health (see normal thyroid hormone levels).  Patients with hypothyroidism need to take thyroid hormone by mouth as a medication each day.  Dietary habits can influence how the body absorbs thyroid hormone.

Thyroid medication should be taken on an empty stomach, around the same time each day. Afterwards, we recommend avoiding eating or drinking for 30-60 minutes. Most of our patients take thyroid hormone in the morning upon waking. Breakfast, including any coffee or milk, can be eaten 30-60 minutes later.  The second most popular method is to take thyroid hormone in the evening, at least 3-4 hours after any food intake. You should try to establish a routine that allows you to be consistent each day. 

Certain medications and supplements decrease absorption of thyroid hormone and should be taken 3-4 hours after taking thyroid hormone. These include fiber supplements, calcium and iron supplements, proton pump inhibitors (omeprazole/Prilosec and lansoprazole/Prevacid), soy products, and multivitamins with minerals.

Are certain foods okay? Can I drink coffee with thyroid hormone?

Unfortunately, even coffee can interfere with how you absorb thyroid hormone. We recommend waiting 60 minutes after you take thyroid hormone to drink coffee. If you are having trouble maintaining an empty stomach in the morning, please discuss this issue with your physician.

What happens if I eat or take medication too soon?

If you occasionally do not wait the full recommended time before eating or drinking, do not worry. This is not dangerous. Just do your best the next day.

The recommendations provided here help your doctors to dose your thyroid medication more accurately and decrease the need for frequent blood tests. If you are having trouble taking your thyroid hormone consistently, please speak with your doctor.

Do I have to take my thyroid hormone in the morning? Can I take my thyroid hormone at night?

Taking your thyroid hormone at night is a fine option, but remember that it should be taken on an empty stomach and at least 3-4 hours after eating. 

What happens if I miss a dose?

Missing a single dose of thyroid hormone is not dangerous, so please don’t panic! Please ask your doctor what they would like you to do if you miss a dose of thyroid hormone. In many cases, your doctor may ask you to take two doses the next day. In some instances, skipping a dose is okay.

I take biotin as a dietary supplement. May I continue taking it?

Biotin has no effect on the thyroid, but it does interfere with thyroid lab tests. If you are going to have blood tests to check your thyroid function, please stop taking your biotin three days beforehand to have an accurate result.

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Further reading & references

1. “Normal Thyroid Hormone Levels.” UCLA Health. https://www.uclahealth.org/endocrine-center/normal-thyroid-hormone-levels
2. “Thyroid Hormone Treatment” Patient Brochure from American Thyroid Association. https://www.thyroid.org/thyroid-hormone-treatment/
3. “Levothyroxine.” National Health Service. https://www.nhs.uk/medicines/levothyroxine/
4. “Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association.” Garber, Jeffery et al. (2012). https://www.liebertpub.com/doi/full/10.1089/thy.2012.0205
5. “Effects of Evening vs Morning Levothyroxine Intake, A Randomized Double-blind Crossover Trial.” Bolk, Nienke et al. Archives of Internal Medicine. (2010). https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/776486
6. “Altered Intestinal Absorption of L-Thyroxine Caused by Coffee.” Benvenga, Salvatore et al. Thyroid. (2008). https://www.liebertpub.com/doi/abs/10.1089/thy.2007.0222
7. “Concurrent Milk Ingestion Decreases Absorption of Levothyroxine.” Chon, Deborah et al. Thyroid. (2018). https://www.liebertpub.com/doi/full/10.1089/thy.2017.0428
8. “Serum Thyrotropin Levels Following Levothyroxine Administration at Breastfast.” Siilva Perez, Camila Luhm et al. (2013). https://www.liebertpub.com/doi/full/10.1089/thy.2012.0435
9. “Treatment of Hypothyroidism with Once Weekly Thyroxine.” Grebe, Stefan et al. (1997). https://doi.org/10.1210/jcem.82.3.3830
10. “Metformin does not suppress serum thyrotropin by increasing levothyroxine absorption.” Al-Alusi, Mostafa et al. (2015). https://www.liebertpub.com/doi/full/10.1089/thy.2015.0211