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Thyroid problems are extremely common, with about 12 percent of the American population affected by one at some point during their lives (American Thyroid Association). 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 (Levothroid, Levoxyl, Synthroid), 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.
The Best Time to Take Synthroid:
Q. I’ve been told to take my Synthroid first thing in the morning, but I’ve read that coffee interferes with its absorption. I hate waiting an hour after I get up before I have my coffee or breakfast. Is this really necessary?
A. Levothyroxine is better absorbed when you have not eaten (Journal of Clinical Endocrinology and Metabolism, Oct., 2009). That is probably the basis for the usual admonition to take this pill first thing in the morning. But that is not always the best time to take Synthroid. Food, dietary supplements and coffee can interfere with its absorption (Thyroid, March, 2008). As a result, the most conscientious patients may end up like you, rising an hour before breakfast time and stumbling through that hour before enjoying the first sip of steaming coffee.
Try Another Time:
Taking your Synthroid at bedtime is effective and you don’t need to worry about coffee (Archives of Internal Medicine, Dec. 13/27, 2010). Of course, you’ll want to make sure you haven’t eaten for at least an hour, or preferably longer, but that is beneficial for lowering the likelihood of nighttime reflux so you’d want to do that anyway.
Other readers have found it helpful to switch to taking Synthroid at bedtime. One person wrote:
“I’ve been taking levothyroxine for years and have felt crappy the whole time. I could barely drag myself out of bed. Trying to take my thyroid medicine on an empty stomach and wait an hour before eating or drinking was really inconvenient.
“After reading on your website that thyroid could be taken at night I feel liberated. My days are normal again. Since I’m taking my vitamins, minerals and tea earlier, I’m not having trouble sleeping anymore and I don’t wake up feeling exhausted. My energy is back.”
Be Consistent:
The most important thing to remember about taking Synthroid or any other thyroid hormone is to be consistent. Even taking your pill with breakfast can work, so long as you do it every day and your breakfast time doesn’t vary too much. If you are consistent, your doctor will adjust the dose so that it is appropriate for your usual regimen.
It is better to avoid taking Synthroid at the same time as some supplements you might be swallowing with your morning juice: both iron and calcium can reduce the absorption of the hormone. It is also better not to take Synthroid or other versions of levothyroxine with a high-fiber breakfast such as bran muffins or bran flakes cereal.
You can learn more about optimizing your treatment for hypothyroidism in our downloadable 25-page Guide to Thyroid Hormones.
12/11/17 redirected to: https://www.peoplespharmacy.com/articles/taking-thyroid-medicine-at-bedtime-fights-off-fatigue/
Mimi
WV
I have been on Levothyroxine since July 2017 .25 mcg. I love coffee in the morning. I stop eating at 7 p.m. and take my Levothyroxine between 1-2 a.m. when I get up in the middle of the night to use bathroom. (an every night occurance) This works perfectly for me. My Dr. just increased my dosage to 50 mcg. I feel better than I have in YEARS… Stick with it if you can. I was discouraged at first, low energy, no sleep, lethargic… but all that has changed. I am thankful for this medication!
Jacquie
Ct
After reading these comments I’m going to try taking my Syntroid in the middle of the night. My MD increased my dosage starting at 25 then to 50 and now 75. 25 wasn’t enough med for me but I could sleep at least. Now I can’t but maybe I should give it time? The increase to 75 is only 8 days.
Christina
TN
http://www.thyroid.org/patient-thyroid-information/ct-for-patients/vol-4-issue-5/vol-4-issue-5-p-7/
I read this article and I have decided to stick with taking it before bed!
Mary
Florida
I guess everyones body is different so if it works for you how you take it then fantastic! I tend to listen to my body and how it reacts so therefore I will stick to my routine which is taking it early in the morning everyday with water and wait at least an hour to eat breakfast. My Endo told me to take my supplements after lunch so that it doesn’t interfere with Synthroid.
Darren
Colorado Springs
Just starting reading articles on taking synthroid at night so I asked my provider about this. They consulted with the pharmacist who relayed pretty much everything that was outlined here. Taking it at night might also curb those unnecessary late night food binges. I’m going to start doing mine like this very soon.
melissa
ct.
Well, I am happy to read these comments, but have come to the conclusion that it works differently for different people.
At 77, I have terrible insomnia, and I finally decided not to take my synthroid upon going to bed. Well, we shall see. Last nite was the first nite I did not take it at nite and slept much more soundly than I have in a year. I have been on this pill for twenty years.
One thing to let people know, and something my Dr. did not know, is if your thyroid medicine is too high a dosage, it can cause heart palpitations and irregular heartbeat. My Dr. kept telling me I had an irregular heartbeat, but not to worry. Well, I did worry, and finally Googled it, and found out that an overdose can cause an irregular heartbeat. I called my pharmacist, and he said that was correct. I printed out the side effects and insisted my Dr, lower my dosage. Once it was lowered, I never had to have an ekg again for irregular heartbeat. Drs cannot possibly know all the side effects of drugs, so one must be a self-advocate.
My friend had the same problem, and when I mentioned my story to her, she also had hers lowered and no longer has the problem. Just hope this helps anyone who has an irregular heartbeat while on synthroid.
Kathy
Maine
After a thyroidectomy 1 year ago I have battled with my meds. My TSH levels are not consistent and my t_3 was really low. My doc added 5 mcg of T3 ( liothronine) which I split in half and take am and pm. Currently I am on that as well as 125 mcg Synthroid. I have been and continue to be so fatigued, moody, miserable and sleepless. At the moment my TSH is way too low .014. Every 6-8 weeks I get my blood tested and every time I have to get my meds adjusted.
Frustrated with the whole thing. I am usually an athletic person but I feel so lousy that I don’t care anymore. My weight is fine as I do try to be careful with my diet. I even stopped drinking white wine on the weekends to see if that would help me feel better. No difference.
I do drink coffee as soon as I get up…almost the same time that I take my Thyroid meds. Maybe that’s my issue?
Any ideas/ thoughts are welcome!
I am going to try taking my meds in the middle of the night.
Zennie
Illinois
I switched to taking my Synthroid at 11:00 pm. about 2 weeks ago. I stop eating for the day around 7:00 pm, and fast until about 10:00 am. I find that I feel hyper/anxious now. I had been taking it for 12 years upon waking. Even thought the eating situation is more convenient taking it at night, I don’t like feeling jittery. I’m going to switch back to the mornings, starting tomorrow.
Anon
You may be absorbing your Synthroid better now and may be on too high of a dose if you feel hyper instead hypo. Get blood work done and maybe you’ll be able to reduce your dose by taking it at night – that would be a great improvement in my opinion.
Anne
Compounded sustained-release Levothyroxine, taken at bedtime, has worked wonders for me. (I sure wish I’d known about this option decades ago!) Everyone is different; here’s my story:
After (finally) being diagnosed with hypothyroidism, I took Synthroid brand for 5 years, taken before breakfast (50mcg initially, increased to 75mcg). Due to mood swings, anxiety, and afternoon sluggishness, my doctor said I could split the pills and take 1/2 before breakfast and 1/2 at bedtime. After that change, I felt much better, and I also slept better (including fewer leg cramps). I still experienced some periods of anxiety and other thyroid-related symptoms.
I’m very sensitive to most medications, so I prefer sustained-release oral meds or patches. (I take compounded sustained-release progesterone and I use an estradiol patch. Both are low-dose and are “bioidentical” hormones. I don’t take any other medications.) So, my doctor prescribed compounded sustained-release levothyroxine. (Levothyroxine is the active ingredient in Synthroid, but Synthroid tablets have been tested in the past to be more consistent than at least two generic versions.) I experienced a VERY difficult adjustment period of several weeks: the first two weeks weren’t too bad, but in the third week, I felt greatly increased anxiety, and the last 2 days I felt REALLY bad, with anxiety/panic attacks alternating with a feeling of euphoria. But, after that, I started feeling really good! It was as if I had gone through a “detox” to reset my endocrine system to function more as nature intended (without “shocking” it with either a single or a twice-daily dump of Synthroid). During the daytime, I had so much energy (too much!) that my doctor reduced my 75mcg capsule to 50mcg. For the three months since that change, I fall asleep quickly at bedtime, sleep well through the night, and have only had a couple of leg cramps (which had plagued me almost nightly since childhood, no matter how I changed my diet or supplements).
To summarize, within a few weeks of starting the compounded sustained-release capsules, I was sleeping like a rock for the first time in my life and feeling better overall than I have in decades (I’m in my early 60’s). I now wake up before the alarm goes off, and I don’t need any caffeine beverages (before the compounded levothyroxine, I had to drink coffee to wake up, drink tea at lunch, and then drink more tea in the afternoon). Since I was a child, my circadian rhythm has been mixed up; I’ve always been more awake at night and sleepy during the day. Maybe that’s why my current regimen works for me. BTW, I’ve experimented with taking the capsule only before breakfast, but I didn’t sleep as well, and I had more anxiety in the morning, so I resumed taking my capsule at bedtime.
The compounded version ($90 for 90 days) is much more expensive than my Synthroid (which was only $6 for 90 days through my mail-order drug plan), but for me, it’s worth it! Best wishes to all!
Angel G
Hialeah Fla
I haven’t taken Synthroid in 4 days how do I start again? At Night or in the morning or How?
Ruth
Vancouver B.C.
Just wondering if you take magnesium as my sister has restless legs and she finds it helps her a lot. I take it twice a day as it’s diminished my anxieties greatly. I just started taking levothyroxine and am scrolling the info for ideas in time.
Connie
You are not supposed to stop synthroid cold although the medication does have a half life that remains in your system for about a week. I had stopped cold because I was so sick from it, felt great for six days and then crashed! Total exhaustion. I contacted my endo who put me on 25 mcg and then increased it to 50 and now 75, but she made it clear never to stop completely but rather contact her right away if a problem arises. So… contact your md ASAP and ask what to do now.
Annie
CA
I have been taking synthroid for over 20 yrs first thing in the morning (5-6am) and have not had any problems. I was just prescribed Lisinopril for hypergension, and in my readings have seen that many are now taking their synthroid at night or in the early morning hours.
Just wondering if there are any other synthroid and Lisinopril users out there and would be willing to share the time of day you are taking these meds?
Linda
Portland, Me
I only wait 1/2 hour after taking levothyroxine before eating breakfast, can anyone weigh in on that? Also if I take atenolol and magnesium at night, could I still take the levothyroxine then as suggested?
Donna
I have tried to take Synthroid in the morning and at night. I take other vitamins and medications at those times as well, so I started taking my synthroid mid-afternoon, between 3 and 4. By then, it’s been at least two hours since lunch and it’s at least 2 hours before supper. I find that has worked for me.
Rebecca
Chicago IL
I have used Kathy’s method of taking my thyroid pill in the middle of the night for several years also! I just set it on top of the pill bottle while I am brushing my teeth at night before bed. If it’s gone in the morning – I know that I took it. If It’s still there I take it right away and bless my lucky stars for sleeping through the night! Win- Win no matter which way it works out!
R
For those who have GERD or LPR (reflux) we are usually told to eat our last meal 3-4 or more hours before bedtime. We are also told to avoid further liquids after dinner. I have done this for years and have good control of my problem without PPI’s. The problem with taking a pill with a big glass of water even an hour before bedtime as you suggest is that this is not good for people who reflux. I too get up in the early morning to use the bathroom but again taking the pill with water and then lying down is not allowed.
There is no good time to take this medicine that really works should I need this medication (right now just being followed) except to take it with breakfast (without the hour wait) and just not worry about it. Unfortunately I do eat dry cereal with fiber (shredded wheat etc) and I do have a cup of coffee first thing but it is extremely difficult to do everything that this medicine requires: Including avoiding certain supplements and foods for several hours around taking it, waiting 3 hours after eating any food to take the thyroid med and an hour before eating any food.
Really a nuisance drug in my opinion, especially when a person takes supplements, eats food dietary calcium, and has no time in the morning to wait around for an hour before starting your day. Also problematic for those like me who can’t take a medicine at night. I do take a probiotic and one of my magnesium supplement doses with breakfast which I suppose I could take later in the day. Frankly I would prefer to just take synthroid consistently when convenient and let my doc make adjustments in the dose.
Rosemary
Florida
My endocrinologist told me that his wife takes her Synthroid in the middle of the night. He said night time is the best time to take it, but don’t take it with other medications. Since I take Gabapentin and Crestor at bedtime. I put the pill in my pill cup and take it when I get up in the middle of the night to use the bathroom.
Cat
Waynesville, NC
If you have thyroid disease/symptoms believe me, this med is not a nuisance but a life saver and you do what it takes for optimum results. I have adjusted other meds/vitamins around my Synthroid. You only need to wait an hour after/before meals even thou more time is optimal. You can take Synthroid several hours after breakfast, take vitamins another time. Sounds like you must not need it at this time or you would make the time.
Kat
oklahoma
Amen to that. I take 12 different Rx, and 10 supplements, along with 5 PRN meds. Each have ‘optimal’ times to take. Some are simply when needed, or work BEST-NOW. I was lucky enough to have the Rocket Science Type Pharm Type help, work out a system /chart along with adjustments. And a # to call and ask HELP. But if it seems like to much of a hassle to fell and be your best—-you don’t need it. Or need to want a life. my Thyroid med IS the one I have the most problems w. I take 11 other meds with food in AM and COFFEE, : } IS FIRST. Best of luck and joy. kat
Shirley
NYC
I used to take my thyroid meds at 3 or 4a.m. My pharmacist told me to take it upon rising. He said I need it during the day not at night and not at the time I was taking it.
Madelyn
Bradenton,FL
Does the same rule apply to Armour Thyroid? My husband has been taking it all his life and never has been told to take it on an empty stomach. Just recently a home health nurse told him to take it o an empty stomach and wait before eating. He also takes omeprazole on an empty stomach. How do we do both?
Rosie
Buffalo, NY
I thought that I once heard that you should have a time gap between taking “Synthroid” and any cholesterol drug. Is this true?
Donald
Ohio
My Doctor told me to take it in the morning either 1 hour before or 1 hour after breakfast. I did that for a number of years until I read an article about taking the medication in the early morning hours. So I started taking it at 2am. After my next TSH test, the Doctor had to lower my dosage from 137 to 125 mcg. And it’s also more convenient for me because I don’t have to worry about interaction with foods.
thorgersen
Seattle
I also take my thyroid med in the middle of the night, when I wake up to go to the bathroom, usually around 3:30am. I get up around 8:30 and don’t have to worry about when I eat breakfast or what I eat or drink for breakfast.
Barbara
Florida
Just like with Kathy, I have gotten improved results by taking my Synthroid when I wake to urinate in the middle of the night/morning. I tried taking it at nighttime but for whatever reason, it kept me awake. Taking it first thing in the morning was not helping my energy level or weight issues. It has only been a couple of months, but taking Synthroid in the middle of the night has given me energy back and hopefully will allow me to loss some of the weight. I think my metabolism is slower than normal and taking the pill in the middle of the night gives it a chance to ‘do its thing’ before I rise to start my day.
Lee
NY
I agree with the previous comment. My Doctor asked if I got up to go to the bathroom in the middle of the night and at age 76, I do. So she said, take the thyroid medication then. I have always taken in the middle of the night and have had no problems with the medication. The only problem I had was that the generic didn’t work for me and I had to take the synthyroid instead.
Aya
I agree to take Synthroid in the wee hours of the morning — that’s when I also take mine.
Arlie
Virginia
Do the same cautions apply to Armour Thyroid? After years of taking Synthroid I switched to Armour, and I’m not sure if it too must be taken on an empty stomach several hours away from taking mineral supplements, so I still do that to be on the safe side, but I’d like to know if it’s necessary.
Kathy
Vernon, CT
I have been taking Levothyroxin for several years now. As an older person (73), I wake up usually around 4 in the morning to go to the bathroom.
Before I go to bed at night, I put my pill in a little cup on the sink and when I get up to use the toilet, I take my pill. This has worked great for me and I don’t have to wait to eat breakfast or have a cup of Joe.
PP
Florida
Kathy, that’s the way my Primary Care Nurse Practitioner told me to take it. Only I find if I take it too early (like 4 am) I can’t get back to sleep, so I wait until I have to get up again after 5 to take the pill. (By then the news is on, so it puts me back to sleep. :-)