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Why Take Thyroid On An Empty Stomach

Plus How To Get The Absolute Most Out Of Your Thyroid Meds

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The time of day you take your thyroid meds, and how you store them, can make or break your thyroid disease management.

Levothyroxine is the name of all synthetic forms of the thyroid hormone T4. This manufactured hormone mimics the natural hormone produced by your thyroid and is prescribed as the primary treatment for hypothyroidism, or an underactive thyroid.;

Levothyroxine dosage is highly individualized, and your dosage may change as you and your doctor work to find what works best for you. See our levothyroxine dosage chart below to get an idea of where your treatment might begin and when to expect your doctor to check for adjustments.;Starting dosages are often calculated based on your weight, but because in some cases your thyroid still makes its own T4, some doctors will start you with a lower dosage to avoid over-treatment symptoms that mimic hyperthyroidism . They also may start you on a lower dose if your body might need extra time to adjust to the effects of hormone replacement.;Your doctor will then check your thyroid stimulating hormone levels over the first few months to see if your dosage needs any adjustment. Hormone replacement therapy is usually a lifelong treatment, so you should get your TSH levels checked every year to ensure youre still taking the right dose.;

Infographic by Lauren Hunter

You can find more information about levothyroxine, including dosage,;here.

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What Should I Expect With Hypothyroidism Treatment

Your primary care doctor may help you manage your hypothyroidism, or you may see an endocrinologist a doctor who specializes in the bodys hormones.;

At your doctors visits, you can expect to have your thyroid-stimulating hormone levels checked. TSH is a hormone that tells your thyroid to make more thyroid hormones and send them into your blood.;

Your healthcare provider will likely want your TSH level to be between 0.5 and 2.5 micrograms per liter. If your TSH is high, it means your body doesnt have enough thyroid hormone, so your doctor may increase your dose of thyroid medication. If your TSH is low, the opposite is true your body might have too much thyroid hormone, so your doctor may decrease your dose. Its a good habit to write your current dose down since it may change a few times until you find the sweet spot.;;

You can expect a TSH check once or twice a year if your levothyroxine dose doesnt change. If there are dose changes, you might have another TSH check 6 to 8 weeks after the change.;

What Other Drugs Will Affect Synthroid

Many other medicines can be affected by your thyroid hormone levels. Certain other medicines may also increase or decrease the effects of Synthroid.

Certain medicines can make levothyroxine less effective if taken at the same time. If you use any of the following drugs, avoid taking them within 4 hours before or 4 hours after you take Synthroid:

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Not All Desiccated Thyroid Is Created Equal

You might think that all desiccated thyroid is essentially the same.

Or, that you should be able to change brands, sources, etc. and still experience the same therapeutic effect.

Unfortunately, thats just not the case.

Long ago there was a study that looked at various brands of desiccated thyroid that were being sold in pharmacies.

Out of the ten products analyzed, only two contained the amount of thyroid hormone they claimed to have, while many contained little to no thyroid hormone at all.

One of the problem faced is that desiccated thyroid is not a pure chemical substance.

This makes it much more difficult to achieve the same amount of T3 and T4 from batch to batch.

While today, there is more of an effort to standardize desiccated thyroid and improve the consistency, its still difficult to achieve.

Some manufacturers of desiccated thyroid today use only a single source and single process to help minimize the differences from batch to batch.

While for many other manufacturers, there can still be quite a lot of variation and oftentimes their products still provide little to no usable thyroid hormone at all.

This is a common problem among compounding pharmacies, which is one reason that compounded thyroid is not ideal.

Taking Your Thyroid Supplements For Maximum Benefit

Levothyroxine or T4 Pills Require Stomach or Gastric Acid ...

If you are taking thyroid supplements then you are already ahead of the curve.;

But are you taking your thyroid supplements correctly?

It may seem obvious to you how you should be taking your supplements but many aspects of thyroid disease are anything but obvious.;

I find that many patients accidentally or unknowingly take their supplements incorrectly even though they are on the RIGHT supplements.;

But taking the right supplements the wrong way can render their effectiveness moot and is obviously something that you want to avoid.;

And that is exactly what we are talking about today:

How and when to take your thyroid supplements for maximum benefit.;

In this article you will learn:

  • The best supplements for managing your thyroid and how to make sure you are on the right one.;
  • How to take your supplements in relation to your thyroid medication.;
  • The best time of day to take your thyroid supplements for maximum benefit.;
  • Whether or not you should take your thyroid supplements on an empty stomach.;
  • And the two vitamins/nutrients which can block thyroid medication absorption.

With that in mind, let’s jump right in…

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Some Individuals May Benefit From Taking Their Medication At Bedtime

Two important studies a 2007 study published in the journal Clinical Endocrinology, and a follow-up larger randomized trial reported in the December 2010 issue of the Archives of Internal Medicine have found that taking the same dose of levothyroxine at bedtime, as compared to first thing in the morning, may be better. These are some of the reasons:

  • Even when waiting at least 30-60 minutes to eat, your breakfast may be interfering with the intestinal absorption of levothyroxine.
  • Bowel motility is slower at night, which means that it takes longer for the levothyroxine tablet to transit through the intestinal system, resulting in longer exposure to the intestinal wall, and therefore, better uptake of the medication.
  • The conversion process of T4 to T3 may be more effective in the evening.

Please talk to your doctor before switching the timing of your medication and please also note that the studies were only done with levothyroxine.

As always, do not make any changes to your thyroid;medication;dosing/timing without the direction of your physician.

About the Author

Medical Conditions That Affect Absorption

There are a number of medical conditions that may affect the absorption of thyroid medications, and, hence, the effectiveness of a particular dose. Some of these include:

  • Lactose intolerance
  • Pancreatic diseases
  • Liver disease

Gene differences may also result in decreased effectiveness in some people, such as those who have polymorphisms in iodothyronine deiodinase 2.

For people with health conditions that affect digestion such as inflammatory bowel disease , or celiac disease, the Tirosint brand of levothyroxine with fewer ingredients that may be better tolerated. In addition, the liquid or gel cap form of levothyroxine may be better absorbed than levothyroxine pills.

If you have any of these conditions, it will be important to have your thyroid tested regularly.

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What If I Have Other Medical Conditions

Hypothyroidism can have profound effects on the rest of your body, so many people with low thyroid levels might have other conditions.

For example, people with low thyroid hormone are more likely to have depression. If you have depression, thyroid replacement therapy may help improve your symptoms.;

Low levels of thyroid hormone can also increase your risk of developing type 2 diabetes. Thats because thyroid hormone helps your body manage its insulin and blood sugar levels. By getting your thyroid hormone levels back to normal, you can improve the way your body processes insulin and blood sugar.

What Medications Treat Hypothyroid

When is the best time to take Thyroid Medication? | PRICELINE PHARMACY WEST BRUNSWICK

Levothyroxine is the most common prescription used to treat hypothyroidism. This medication is also known by several brand names, including:

Whether your healthcare provider prescribes the generic or brand name, these medications help to replace the thyroid hormone your body isnt naturally producing in your blood.;

It may take some time to find the right medication, or dosage that works for youand once youve figured out your treatment plan, certain things can mess with how the prescription works for you.

RELATED: Levothyroxine details | Levoxyl details | Synthroid details | Tirosint details | Unithroid details

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Taking Too Much Thyroid Hormone And Thinking Its Harmless

The synthetic thyroid hormone T4 is relatively safe, and you shouldn’t worry if you accidentally take an extra dose, Bianco says. But taking an excessive amount could have side effects it can make you feel tired, affect your sleep and concentration, lead to bone loss, or cause irregular heartbeats, according to the Cleveland Clinic. If you take combination therapy, which contains both T4 and T3, the medication needs to be taken precisely as prescribed, as taking too much can be dangerous. The ATA notes that potential side effects of taking too much combination therapy include a racing pulse, anxiety, trouble sleeping, and problems with your heart and bones. Contact your healthcare provider immediately if you accidentally take more than prescribed.

Gel And Liquid Formulations

Tirosint is a soft gel form of L-T4, and Tirosint-Sol is the liquid form. These medications are absorbed more rapidly into the body than the standard formulations. The gel and liquid forms of L-T4 were developed primarily for people who have digestive and absorptive problems or allergy issues.

Studies have also shown that you can take Tirosint and Tirosint-Sol at the same time as your coffee, with no negative impact on absorption or thyroid hormone levels.

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About Dr Kent Holtorf

Kent Holtorf, M.D. is the medical director of the Holtorf Medical Group with locations in Los Angeles, Foster City, Atlanta, and Philadelphia. He is also founder and director of the non-profit National Academy of Hypothyroidism , which is dedicated to dissemination of new information to doctors and patients on the diagnosis and treatment of hypothyroidism.

Dr. Holtorf has personally trained numerous physicians across the country in the use of bioidentical hormones, hypothyroidism, complex endocrine dysfunction, and innovative treatments of chronic fatigue syndrome, weight loss, fibromyalgia, and chronic infectious diseases, including Lyme disease.

He has been a featured guest on numerous TV shows including CNBC, ABC News, CNN, EXTRA TV, Discovery Health, The Learning Channel, The Today Show, The Doctors, Dr. Dean Edell, Glenn Beck, Nancy Grace, Fox Business, ESPN, Rush Limbaugh, CBS Sunday Morning, Sean Hannity, So Cal News, and quoted in numerous print media including the Wall Street Journal, Los Angeles Times, US New and World Report, San Francisco Chronicle, WebMD, Health, Elle, Better Homes and Garden, US Weekly, Forbes, Cosmopolitan, New York Daily News, Self magazine, among many others.


  • Benvenga, S., et al. Altered Intestinal Absorption of L-Thyroxine Caused by Coffee. Thyroid. 2008; 18:293-301.
  • Mazzaferri, E. Thyroid Hormone Therapy. Clinical Thyroidology for Patients: Summaries for Patients from Clinical Thyroidology. 2008; Vol 1, Iss 1.
  • What Supplements Should You Avoid With Levothyroxine


    Some over-the-counter dietary supplements can interact with levothyroxine, including :

    • Ferrous sulfate or iron supplement: Dont take within four hours of thyroid hormone medications as it can prevent normal absorption of levothyroxine.
    • Calcium supplements: These can interfere with the absorption of levothyroxine; dont take within four hours of thyroid medications.;;

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    How Soon After Taking Thyroid Medication Can I Eat

    Levothyroxine, also called T4 or thyroid hormone, is a commonly used thyroid medication.Brand names for this drug include Synthroid, Levothroid, Levoxyl, Tirosint and Unithroid 1. Doctors prescribe levothyroxine for any patient who is hypothyroid, either because his thyroid does not produce enough thyroid hormone naturally, or because disease or cancer has necessitated surgical removal of the thyroid. This medication is usually required for life. Your doctor will most likely recommend that you take levothyroxine first thing in the morning and that you wait for a specified period of time, usually 30 to 60 minutes, before eating or drinking anything other than water. A person taking levothyroxine should follow the same daily medication regimen to ensure a steady level of thyroid hormone in the body.

    Important Points To Note

    Dont get tempted to take a supplement that claims to support thyroid health without checking with your doctor. Some of these supplements may contain thyroid hormones not listed on the label. Adding them to your medication may cause an overdose. Some supplements, including types containing a seaweed called kelp, may contain very high levels of iodine.

    Adding T3 to your T4 may help some, but not all people with hypothyroidism. T3 is the bodys active form of the thyroid hormone. Most people convert levothyroxine to sufficient T3. Check with your doctor if your hypothyroidism symptoms persist despite normal TSH levels. S/he may want you to try adding triiodothyronine to your levothyroxine therapy. It could work, but research suggests it doesnt help everyone.

    At Community Clinical Pharmacy, we carry commercially available T4 and T3 as well as compounded forms of thyroid medication that are prescribed by your provider, based on your individual needs.

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    Scheduling Timing For Multiple Medications To Avoid Interactions

    Another point in planning for bedtime dosing of your levothyroxine is other medications. Ideally, levothyroxine should be the only medication taken at bedtime. Just as with morning dosing, it is best to avoid co-administration with other medications such as statins, blood pressure drugs, and metformin.

    If you must take other medications that must be taken in the evening, consider adjusting the timing of these medications so you take them with dinner, leaving four hours afterward so you can take the levothyroxine at bedtime.

    Close monitoring of your thyroid levels and any symptoms you notice will help assure that your thyroid labs remain within acceptable reference ranges.

    How Thyroid Medication Works For Patients

    Thyroid Medication Tips

    About 12 million Americans have an underactive thyroid gland. The condition is called hypothyroidism. Conventional treatment with the synthetic thyroid hormone levothyroxine works very well for most of these patients.;

    However, for about one in seven of these individuals, levothyroxine just isnt enough. In certain cases, the person may benefit from adding a second thyroid hormone called liothyronine .

    But before you assume that lack of T3 is the problem, it is a good idea to keep the following in mind:

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    Why Take Thyroid Medication On Empty Stomach

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    Taking Thyroid Medicine At Bedtime Fights Off Fatigue

    Thyroid problems are extremely common, with about 12 percent of the American population affected by one at some point during their lives . Since an underactive thyroid gland is by far the most prevalent of the problems that afflict the thyroid, it is little wonder that millions of people are taking levothyroxine , a thyroid hormone intended to supplement or replace the inadequate production of the thyroid gland. But there is plenty of confusion about how to take this medication.;It has a number of possible interactions that can make it tricky to find the best time to take Synthroid.

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    Foods Or Medications That Can Affect Levothyroxine

    Certain foods may cause your body to absorb less of this medication, according to the website. These include high-fiber foods: walnuts, cotton seed meal and soybean flour. Speak to your doctor if any of these foods are a regular part of your diet. Some medications or vitamins can also make thyroid medication less effective, including antacids, cholesterol-lowering drugs and calcium and iron supplements.These should be taken either four hours before or after taking levothyroxine.

    • Certain foods may cause your body to absorb less of this medication, according to the website.
    • Some medications or vitamins can also make thyroid medication less effective, including antacids, cholesterol-lowering drugs and calcium and iron supplements.

    Before Taking This Medicine

    Make Every Thyroid Pill Count!

    Synthroid should not be used to treat obesity or weight problems. Dangerous side effects or death can occur from the misuse of levothyroxine, especially if you are taking any other weight-loss medications or appetite suppressants.

    Since thyroid hormone occurs naturally in the body, almost anyone can take levothyroxine. However, you may not be able to take this medicine if you have certain medical conditions. Tell your doctor if you have:

    • an untreated or uncontrolled adrenal gland disorder;

    • a thyroid disorder called thyrotoxicosis; or

    • symptoms of a heart attack .

    To make sure Synthroid is safe for you, tell your doctor if you have ever had:

    • a thyroid nodule;

    • heart disease, a blood clot, or a blood-clotting disorder;

    • diabetes ;

    • kidney disease;

    • anemia ;

    • osteoporosis, or low bone mineral density;

    • problems with your pituitary gland; or

    • any food or drug allergies.

    Tell your doctor if you have recently received radiation therapy with iodine .

    If you become pregnant while taking Synthroid, do not stop taking the medicine without your doctor’s advice. Having low thyroid hormone levels during pregnancy could harm both mother and baby. Your dose needs may be different during pregnancy.

    Tell your doctor if you are breast-feeding. Your dose needs may be different while you are nursing.

    Do not give this medicine to a child without medical advice.

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