Should you take your thyroid medication at night, in the middle of the night, or the morning? Find out my answer to this common question.
Readers frequently write in with thyroid-related questions. Here's a very common one, asking about when to take thyroid hormone replacement medication, along with some of my thoughts on the subject.
"Is it okay to take the thyroid medication the doctor has prescribed at bedtime, 2 hours after dinner, or even when I wake up in the middle of the night, around 3 to 4 am? I'm always in a rush when I get up in the morning..." -- L.R.
Dear L.R.,
You should first ask the doctor what she/he thinks about when to take your medication. But keep in mind that the studies have shown that the key with thyroid medication is taking it consistently -- taking it around the same time each day -- and in the same way (without food, or several hours apart from eating, etc.)
Research reported in the journal, Clinical Endocrinology, did find that taking the same dose of levothyroxine (i.e., Synthroid) at bedtime, as compared to first thing in the morning, might be better. (Read Should You Take Your Thyroid Medication at Night?) A small pilot study was prompted by observation that some patients had improved thyroid hormone profiles after they switched from taking their levothyroxine in the morning, to bedtime. The purpose was to look at the impact on thyroid hormone profiles by changing the time levothyroxine was taken from early morning to bedtime. They also evaluated the impact of this change on the circadian rhythm of TSH and thyroid hormones and thyroid hormone metabolism.
The study, while small (12 subjects), was fairly conclusive in its findings, which the researchers said were "striking" and which have "important consequences for the millions of patients who take l-thyroxine daily."
Researchers reported that taking medication at bedtime, rather than the morning, results in "higher thyroid hormone concentrations and lower TSH concentrations." TSH decreased and Free T4 levels rose in all patients by changing thyroxine ingestion from early morning to bedtime and T3 levels rose in all but one subject. And TSH decreased irrespective of the starting TSH levels, suggesting better absorption of the thyroid medication when taken in the evening. Interestingly, the researchers found that the circadian TSH rhythm -- the typical daily fluctuations of TSH that occur during a 24-hour period -- does not vary.
The researchers suggested several explanations for the results:
- Even when waiting at least 30 minutes to eat, breakfast may be interfering with the intestinal absorption of thyroid medication
- "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.
Taking medication at bedtime instead of in the morning could have major implications for many thyroid patients.
- First, it's easier, as you don't have to worry about when to eat breakfast.
- Second, it's easier to avoid medications, supplements and foods, like calcium, iron, and high-fiber foods that can interfere with thyroid medication absorption.
- Third, it might offer some improvement in symptoms to people who are just not getting optimal absorption by taking thyroid medication during the day.
You may want to talk to your practitioner about changing the time you take your medication to bedtime, versus morning. And if you decide to change to taking your thyroid medication in the evening, be sure to have your thyroid levels evaluated -- six to eight weeks is a reasonable timeframe -- after you've made the switch. The blood test results, along with any improvements or worsening of symptoms, will help you and your doctor to determine if you need to adjust the dosage or timing of your medication.
Note, however, that this study was conducted with levothyroxine -- a synthetic form of the long acting T4/thyroxine thyroid hormone. This form of the hormone must first be converted in the body to the active form (T3) and this can take days. Thyroid drugs that contain T3 -- Cytomel, Thyrolar, and the natural desiccated thyroid drugs like Armour can by used directly by the body within hours. These drugs were not evaluated in the study.
Anecdotally, some thyroid patients have reported improvement in symptoms when taking their T3-based thyroid hormone replacement medications in the evening. But some thyroid patients also find that if they take a medication with T3 later in the day or in the evening, the slight stimulatory effect of the T3 medication can make it difficult to sleep.
So keep in mind that while it's very possible that if a similar study were conducted with T3 drugs, the results would be similar, there is some chance that it would impact sleep quality. Only make such a change after discussing it with your doctor.
Optimally, some doctors have suggested that patients who take medications with T3 split their doses to take them throughout the day, leaving a dose for bedtime. This approach seems to minimize sleep interference.
Again, if you do make a change to how you take your T3 thyroid medication, you'll want to have a reevaluation of blood levels and symptoms after several weeks, to determine if you need to adjust the dosage or timing of your medication.
Ultimately, consistency is the key.
Live well,
--Mary
Source:
Bolk, Nienke et. al. "Effects of evening vs morning thyroxine ingestion on serum thyroid hormone profiles in hypothyroid patients." Clinical Endocrinology 66 (1), 43–48
Photo: clipart.com
It would be great if you would address HYPERthroid treatment in your articles,as well. Thanks.
By taking my Levoxyl at night, I actually ended up losing about 10 pounds! Knowing I could not eat any closer than two hours before bedtime helped curb that evening snacking that had been getting me into trouble!
I’ve been taking my med. in the morning and waiting up to two hours to eat a small taste of food. After reading your article I would like to try this bedtime routine on myself! It makes perfect sense. The most important part of the article was about the absorbing rate into your system. Now write and article about your personal trials with your med. I bought your book. thanks for the research. I used your resources to find a doctor 45 minutes away that is a ear nose and throat guy who gave me the med., when no one else would, and that’s because like you said they still read the old bell scale. and no the over all picture. Why are doctors so hard on treating woman with this problem. They want to toss prozac or some other reasonable crazy thought from there side and no even listen to what you are telling them your symtoms are. What do you do about the side effect like dry skin and hair and missing half your eyebrows., trouble sleeping and never feeling well rested.?
It is better to say that time of taking thyroid hormones might be different for different patiences, because some work too late and have to eat more before bed
and some are not, morning for me is the best time since I can wait 30 minutes and don’t eat very simple. And in this case, your stomic has no food , for sure!
If possible, take your thyroid sublingually. It doesn’t interact with ANY food or digestive processes, and is more usable this way. I take Armour and it’s actually sweet, so there’s no qualm about letting it dissolve under my tongue.
I too take dissolve my Armour in my mouth instead of swallowing it. Synthetics did not work at all for me since they needed to be swallowed. I have approx. 35% malabsorbtion in the small intestine. I switched to Armour and at first was taking 60mg at bedtime.
Once my thyroid was removed the dose was increased to 60 in the morning, a 60 at 2pm and a 30 at bedtime. The first week on Armour I thought I was put on another thyroid medication that wasn’t going to work. Then I read on one of the sites that some do better if it is dissolved in the mouth. Worked perfect for me. Within a week of taking it sublingually my hypo symptoms started to resolve and within two weeks I started to loose weight and in fact needed to increase my calorie intake to keep from loosing more. I not only feel nearly 100% back to normal…. I’m in “hog heaven” now that I can finally eat more than 800 calories a day without gaining.
Hello. I actually questioned my Dr. about when I should take my synthetic tyroid medicine—specifically questioning whether it would interfer with my “birth control”, since they are both hormome related. My Dr. told me that I should probably take them at different times. I have always taken my birth control at night, so I have been taking my thyroid medicine in the morning. In light of this article, I will readdress the question to my Drs.
Hi everyone –
The first time I read this article a few months ago, I decided to try switching from am to evening since it would be so much easier for me to eat when I get up rather than waiting. Since I don’t usually eat for a few hours before bed anyway, I thought that would work out fine.
It did interfere less with my daily schedule to take it at night (I’m on Synthroid), but after a few days or a week (I don’t remember know how long it took), I started to feel hypothyroid again – and that lasted another week or two before I decided it just wasn’t working for me to take it in the evening. I went back to taking it in the morning and started to feel fine again.
So perhaps it does depend on the person.
(I use how I feel as my main guide to what is and isn’t working, and have had an endocrinologist who is willing to work with that as long as the tests support it – so that’s how I assessed whether or not taking it in the evening was working for me – based on how I felt. If I had felt good, I suspect the tests would have supported that, or we would have worked together to finetune….)
Best wishes – Ariel
I’d like to take levothoxine at night, as you suggested. I also take a mild sleep aid at night (trazodone, 50mg). Is there any problem taking the two together?
I take trazodone at night too and I was told I have to take it with food. So I would suspect that you probably shouldn’t take your levo at the same time.
I am curious… when would it be more beneficial to take Armour as opposed to levothyroxine? I am hypo… and I have read that there are variations to being hypothyroid as far as the T3 and T4 goes… but I am not sure about how synthetic and herbal treatments affect those variations.
If anyone knows the difference… please share.
I would also like to say that I have a very supportive group of CNP’s and physicians who believe in their patients and work with me and my thyroid issues. (And after reading your comments, I am sure I will ask them my question next time I take my test as well.)
I feel so bad for those of you who must struggle to convince your doctor that it is more than “simply” depression. I would like to encourage you to seek out professionals who will listen and work with you… it makes the process less stressful (and with irritability a strong symptom for me, less stress is necessary!).
Have a great 2008 =)
and God Bless!
I’m with Linda. I’m hyperthyroid and take PTU. It only stays in your blood for 12 hours, so I must take it twice a day. I enjoy the site but wish more was geared towards hyperthyroid patients with Graves’ Disease, like me. Thanks!
I’m Hyperthyroid and take Tapozol. Does the same info hold true for this?
Regarding natural thyroid medications which Mary said were not studied: after reading this article I experimented for one week and took my Naturethroid at night–I FELT TERRIBLE! I agree that the immediate bioavailability of natural thyroid products precludes taking them before bedtime. What I find works is a sublingual split dose, 1/2 upon waking and 1/2 about half-way through my day.
hello,
I have hypothyroidism and I’ve just read that it may be better to take my synthroid meds at night rather than A.M.
I also take paxil at night. Does anyone know if the meds may interfere with one another?
Please let me know, thank you.
email me: deni_luv@yahoo.com
Thank you again,
hi
I have been having problems with Euthyrox dose as it fluctuates between 0.75 and 100 mcg. I find taking a small dose of euthyrox at night has helped me stabilise. Taking high dose of 100mcg is toxic if taken daily.
My doctor agrees to taking small dose at nigh.t I have to say shifting full dose to evening can cause sleep problems.If some one has problems with fluctuating doses and you know the information to help please do so.Thanks for useful comments.
Hi all. I was diagnosed with Graves disease about 4 years ago. I took the radioactive iodine and am now hypothyroid. I have been on Levothyroxine since then. I have gone back and forth with my doctors about my medication because I still have many of the symptoms that I had prior to my diagnosis. I recently got my new doctor to lower my dosage and I haven’t noticed any difference since then except for the fact that I am more tired during the day. I decided that I would take my medication at night. This worked better for me as I slept better because it put me to sleep. I am going back to my doctor to discuss other possible medications. Thanks for the information though.
Cindy
In the beginning i tried to take Synthroid before bed but found myself to be restless and unable to sleep over 5 hours. My weight continued to go up. I switched to taking Synthroid in the morning on a empty stomach with a tall glass of water (1st count of water requirement for the day). I am energized. My body processes quickly by time i sit to have breakfast which is around 1-2 hours later.
i tried taking my synthroid at night and ended up feeling worse and my tsh went up. i was diligent about not eating at least 3 hours before, so my guess is that, like everything else thyroid related, everyone is different.
I couldn’t figure out why I was having major insomnia for about a month. My husband suggested I switch taking my pill at bed time to the morning or afternoon. AHA! I have slept so so much better since.I know for some people taking it gives a boost of energy, be it a little. I will not be taking it at night again!
I was wondering I have been taking levothyroxine in the morning for about 6 months and gain about 15 pounds can the medication be a reason for weight gain
I seldom see responses on this site but I would really appreciate comments. I have just switched to Armour after 30+ years on synthroid. I think I’ve felt poorly most of that time without ever equating my depression, etc. to my thyroid. Anyway, when should Armour be taken? Morning/night? I wake up hungry every day and can’t really imagine waiting to hours to eat if meds are taken first thing. Help, please with information.
I have taken Armour for over 30 years and done quite well until they changed the formula a few years ago. I gained almost 90# in almost no time eating from 900 to 1200 calories a day. I have been taking my med’s between 3:30 & 4:00 in the a.m. I am feeling better but not losing any weight no matter how little or how much I eat. I’m not gainning again but l’m losing either. I think I will try the under the tongue method and split the dose.
I have been on armour for about a year..it isn’t really working for me so they’re switching me to synthroid..but from what I’ve read armour has a short 1/2life, so if you take a split dosage it will probably help. I took 1/2 in the morning and 1/2 in the evening. I was interested in taking the synthroid at night as that would be easier..but I’m concerned about the birthcontrol…maybe I can switch the time I take that..since I only take it for regulation reasons.
Try ERFA Thyroid, desiccated thyroid available in Canada, and made without the micro crystalline celullose that makes Armour Thyroid unable for some people to absorb properly. It’s changed my life after 7 long, unproductive years on Synthroid.
WILL TAKING LEVOTHYROXIN AT NIGHT INTERFERE WITH THE SLEEPING AID I HAVE TO TAKE.?
Thankyou for all the help you are giving me, I thought I was going nuts but I just had an under active
thyroid.
If you are unable to get the answer from your Dr regarding medication interactions, then perhaps you can ask your pharmacist. Mine actually recommended taking it at night before bedtime, but it usually makes me HUNGRY and want to whiz soon after (therefore not easy to sleep). I personally wake up between 5 and 6 am (cat, or birds singing, or need to pee…and take it, then go back to sleep, exercise, or get ready for the day, and THEN eat…about 1-2 hours later. Works well for me…and consistency is key!
Call me crazy but I get the best results by taking my natural dessicated thyroid WITH breakfast. For some reason, food seems to help get it into my system.
Sally- I take my Armour with food also. I do not get the t3 rush all at once then. Am not sure if this will help as I just started but I feel better. Not so crabby or snappy!
i have a big stomach troubles since i ve started euthyrox with empty stomach and now i m taking this pill WITH breakfast!it works!
Is it okay to dissolve levothyroxine under the tongue?
Would it be safe to take t5’s with lethathyroxin.
Just started taking tirosint at 4am, going back to sleep for a few hours and then eat breakfast. So far, not interfering with sleep. How long does it take to start working? Anyone else take tirosint?
Keep reading where you should take thyroid replacement therapy at least an hour or two before eating, but then I’ve been instructed to take 1/2 in morn with breakfast and 1/2 with dinner! Wonderful results from this taking WITH food have been posted on other sites. It is natural desiccated thyroid that has done the numerous small studies and getting fantastic results. Taken synthroid for 2 yrs with no difference except at last dose increase I gained 15 lbs in 2 1/2 weeks. Next dr visit – she asked if I gained weight and was irritable as my levels were way too high. Ok. I give up. Buying and taking on my own. Will adjust as necessary.
When is the best time to take Birth Control with your medication. I have had my tyroid removed 4 years ago and my levels are currently good but now I want to start on birth control. I have heard that it affects absorption. Do you have any recommendations on minimising effect
I’ve been taking my levothyroxine @ bedtime for years. Seems to work well for me. Can’t remember when I started doing that, but maybe there is a connection to this and the fact that I was able to loose 30 lbs 6 years ago, and have been able to keep most of it off since then.
My wife asked her GP (General Practitioner) about taking Levothyroxine in the evening. He didn’t really have a view – I suspect he, like many GPs, is clueless. What are the particular issues he should be considering?
I switched to taking my Nature-Throid in the evening several years ago and found I felt better. Checked it out a month ago by switching to the morning. I would take it at 7 when I woke up and didn’t have breakfast for at least 2 hours. Didn’t last a week, did not do well, off center during the day and didn’t sleep well at night. switched back and right away slept better at night and felt better during the day. Doctor didn’t seem pleased when she asked me when I took my thyroid but didn’t suggest I change. Arlene
I have learned from my daughter’s doctor in Idaho that thyriod should always be taken sublingual. After taking desicated thyroid for 6 years with poor energy etc results I found an overnite difference when I took it S/L. I have lost 6 lbs eat more and can get up early in the morning and be off to the gym. I feel like a normal human again.
Wouldn’t taking your thyroid medicine at night interfere with your sleep? One day I accidentally took double dose thyroid medicine in the morning and had trouble sleeping that night. Taking it before you sleep would seem counter productive imo.
I take Levothyroxine in the am, on an empty stomach, and I think I’m going to try it with food. If that doesn’t help, I’m going to try at night, or splitting the dose between morning and evening (with and without food).
I think studies can be biased to show whatever the researchers want them to show. Everyone’s body is different. I get extremely irritated with any doctor who tells me I should do something just because the majority of study results showed this or that. Why do I have to fit into that majority? What about all the results that weren’t in the majority? How about the anomalies? Tell me about ALL the results so I can make a decision.
OK, 100% of people die when held underwater for 2 hours with no oxygen. That’s a statistic I can live with. But just because X% of people had Y result in a study doesn’t mean I’m going to.
It’s MY body, unless you tell me I’m specifically going to die, or do myself harm, by doing something, then let me try what works for me.
Niektorzy rozpatruja, ze istnienie mlodzianem istnieje takie proste. Nagminnie zliczyc mrowie wlasciwych tresci, jednakze przekazuje sie nie pamietac psycholog. slipi, zgadzam sie, ze nasze istnienie jest latwiejsze anizeli doroslych, tymczasem potem nie istnieje wlasciwie linie, podczas gdy wielu rzeczy.
potrzebowalbym napomknac nieco niesprawiedliwych ustepow bedac nastolatkiem. Matki rodzicielce az do publikacji psycholog bo stanowimy sposrod rodzicielami, jacy placa za budynkiem, dla niekrajowej nauki a wielu roznych sprawy. Zapewniaja nam ogonkowe i zdolamy z przedtem zdzialac co pozadamy. Nastepujacym operandem jest to, ze nastolatki sa w wlasciwym zdrowiu tudziez psychologia obszerne swady. Gros nastolatkow otrzyma jasne intelekty oraz nauczac sie szybko. Jednakowoz najistotniejsze jest to, iz istniejemy mlodŸ, czas wolny, miec wielu przyjaciol i no multum potencjal. Z pozostalej strony, bytuja jakies wady, rowniez. Stoimy w postaniu stresu, wzglednie w szkole czy tez w klanu, co przypuszczalnie prowadzic do ponurosci. Znosimy sily kiedy kazdy pragnie egzystowac maksymalny. Obca kwestia istnieje owo, ze niektorzy wzrosliby psychiczne przestrzegaja nas, jak my istniejemy 18 lat, oraz dotyczyc jak przychowek.
W najwiekszym stopniu okrutne zwierzeta stanowia w Afryce i Ameryce. W Afryce sa slonie, slonie natomiast lwy, toz na dniach prawdopodobnie wyginac za ¬ byc przyczyna, ze ludzie zarzynaja wsuwa w celu swoich zebow, ktore sa bardzo wazne. To tymiz sposrod nosorozca – jego kant jest drogie, too. W Afryce skorce uprzedni dodatkowo bez liku modeli kolorowych papug. Obecnie jest ich coraz to mniej sposrod nich. Natury w terenie Amazonii istnieje w niebezpieczenstwie, poniewaz rece do pracy rzeŸbienie lasow, legendarnego w charakterze “plucami ziemio”. Owo nie przeciwnie pustoszy siedliska zwierzat, mimo to plus psycholog wplywa na atmosfera na swiecie. Wypalanie ogromnego regiony lasow byc moze wywolac niezamiennego Klapy zas dziko zyjacych, gdy posiadaloby to miejsce w pozogach w Malezji w 1997 roku. Tam jest mniej polozenia gwoli nieuprawianych zwierzat na Glebie, bo rece do pracy wykoszone lasy, budowac miasta, iw ow tryb powiazac wariacyj otoczenia typowego. Parki nieetnicznego sa kreowane w przedmiotu troski nieokielznanych zwierzat. Internacjonalnego przepisy chwycily wkomponowane, azeby zapisac zwierzeta od czasu gosciach ¬ drapieznych natomiast ich zakatrupic. Niektore z tych zwierzat postraszonych wyginieciem sa brane az do ogrodow zoologicznych w obcych krajach, jakiego maja byc plodzone natomiast nastepnie sa one zezwolic bezsensownie w ich realnym otoczeniu znow. Jednak ail to nie dosyc tego: Coraz wiecej typow zwierzat sa zagrozone wyginieciem. Niepolskim obowiazkiem istnieje bronic szamie tudziez zdzialac calosc, azeby dac mozliwosc psychiatra zbawienie.
Czestokroc mysle o mojej przyszlosci. Nurtujze istnieje gdy to bedzie miec wyglad.
Obecnie przechodze do szkoly tudziez jestem w czwartej jakosci. Tym samym istnieje publiczne, ze pozadalbym pokonac badanie konsekutywne – poswiadczenia oswiatowego. Pracuje rowniez. Moja utwor ma sens i przyjemne, tymczasem na nieszczescie to nie istnieje apetycznego platnej monografii. Mam otuche, ze zapracuje nieco wiecej, jeslibym przekazal sprawdzianu. Prosze nie rozmyslac, iz istnieje owo faktycznie grunt dla mnie. Obecnie najwyzszego jest moje wychowanie. Jesliby absolwent grupy wezme na test inauguracyjny do szkoly polowicznej. Jednakze nie istnieje jeszcze niejaki, co bede badac. Uwazalam o marketingu i kierowania – to jest byt, co mnie frapuje a byloby akcesoryjne w mojej posadzie. Reflektowalbym powiadac po angielsku pod kazdym wzgledem. W mojej profesji ogromnie grunt jest, aby posiadac dziedzina kolezenstwo biezacego jezyka. Wyjawszy tym zawsze bylo moim rojeniem psycholog.
Nie wiem, gdzie bede mieszkac w przyszlosci. Potrzebowalbym dysponowac mieszkanie w Warszawie na lokalna rasie. W tym momencie istnieje owo tylko marzenie, przeciez prawdopodobnie kiedys. Matki podobnie jakies porzadki nalezacego mojej linii. ORAZ czuc, ze jeden dwadziescia cztery godziny bede wywiac rota zas byc wyposazonym dziatwa. Sa owo wprawdzie poŸniejsze uklady. Aktualnie staram sie skoncentrowac na mojej oswiacie natomiast kariery zawodowej. Nie zapomnielismy dodatkowo o dobra gre. W moim zyciu ocene bez zabawie nie jest uwienczony powodzeniem.
Rozmyslalabym o znajomosci. Raz za razem poetyzowal na eskapade wokol ziemio. Bylem w tym momencie w wielu polozeniach. Na ilustracja bylem we Francji tudziez Anglii. Pozadalbym odwiedzac Azje, Ameryke Poludniowa a Australie. Nie bylem w owa strone coraz.
Nasze spoleczenstwo istnieje zawarty na zrealizowanie tryumfow. Od szczeniactwa jestesmy nauczeni, ze grunt istnieje, azeby rezultacie potezna kwota mlodych goscmi staja sie zestresowane. Zle przeczucie przypuszczalnie biec az do bogatych umyslowego poczatku unsex smierci.
Sprawnego fortel niebiezacego szkopulu jest kuracja ze zwierzetami. Podejscie Pracownik naukowy wykazalby, ze dotyk ze zwierzeciem pomaga obnizyc napiecie. Zalozenie niniejsza uzna zjawisko, iz zasoby sily roboczej, ktorzy zbieraja krocie czasu ze zwierzetami spekulowac sie szczesliwsi tudziez wiele pewnosci se.
Nowa psychologow impuls istnieje wynaleŸc godziwy sposob relaksu. Po tygodniu nazartym stresu jest w sam raz inicjatywa, izby pokonac sposrod prawym kamratem az do kina czy tez osoby.
Rozmyslam, iz w przyszlosci bede dysponowac profesje scementowana sposrod pecetami. Uwazam, iz istnieje owo niezwykle wabiaca utwor, i ego aktualnie rozmawialem z kilkoma ludŸmi, ktorzy pracuja jako koneserzy komputerowych. Chce pracowac w instytucji telekomunikacyjnej wiekszosci. Dumam, ze programisty otwiera nadzwyczaj ekspresowo konaru edukacji. Pragne posiadac moc odmian w mojej monografii pelny chronos. Sadze, ze to nieslychanie ambitne misja. Zupelnie nie reflektowalbym wykonywac prace w charakterze pracownik fizyczny – Rozumuje, iz ta robota jest nagminnie skutkuje punkty pomagajacego. Olsniewajaca praca winnyscie oddac mi poczucie poczta oraz satysfakcji.,
Rodzicielek psychologa/ otuche, ze bedzie pomyslny homo sapiens z wieloma mozliwosciami, z dobrze platnej wytworczosci w piastowaniu pozycji. Imponujaca praca przystoi mi robocie, ethusiasm i kategorycznosci, tak aby przydac sie do tryumfow instytucji.