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Mary Shomon

Taking Levothyroxine at Breakfast: An Option for Thyroid Patients?

By July 1, 2013

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Researchers studied whether taking levothyroxine with breakfast, versus on an empty stomach, would allow a patient to maintain targeted thyroid stimulating hormone (TSH) levels. The study had hypothyroid patients taking levothyroxine randomized into two groups. One took their levothyroxine with breakfast, the other group took their medication while fasting.

The study found that the TSH level was for patients taking their medication with breakfast was higher (2.89) vs. those who fasted (1.9). mIU/L, p=0.028). The researchers concluded that taking levothyroxine with food is more likely to cause a variable TSH level, and therefore patients who take their thyroid medication with food need to be followed more closely.

According to the researchers, when patients need to maintain a specific targeted TSH -- for example, in thyroid cancer patients after surgery whose goal is to maintain a suppressed TSH -- taking levothyroxine while fasting is recommended.

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Perez, Camila, et. al. "Serum Thyrotropin Levels Following Levothyroxine Administration at Breakfast," Thyroid, Volume 23, Number 7, 2013

July 1, 2013 at 10:00 pm
(1) Jan Nathan says:

I take compounded porcine thyroid with a little levothyroxine twice a day with food. The effect is very smooth, not unlike timed release meds. My Free T3 and Free T4 levels are consistently where I want them to be and my TSH suppressed for thyroid cancer. I am consistent about how and when I take my thyroid meds. My doc adjusts my meds accordingly. I know I could not tolerate these doses on an empty stomach.

This brings up the fallacy of the above study. The dose needs to be raised when taking meds with food. Duh!

July 1, 2013 at 10:19 pm
(2) amy flett says:

it kind of scares me when i read all this stuff about levels because where i am and i am a thyroid cancer patient and I’ve had a total thyroidectomy but it had also spread to my voice box and i also had my lymps removed BUUT i only have blood work done once in a blue moon and well my doc says if you fall somewhere in the normal range then no big deal it concerns me as i had also had to not take meds for 6 weeks for a test and my levels went from .5 to 98.68 i now have them down to the “normal range” but im concerned that no one is monitoring this properly and i feel sick allll the time please help me know what i should be doing to maintain my health and feel “normal” again

July 2, 2013 at 12:03 am
(3) Cheryl says:

It’s not just that the dosage would need to be raised if taking thyroid hormone with food but monitoring would be important for a while unless the same thing was eaten every morning. Eating different things for breakfast on different days that have various amount of calcium and/or iron would affect the effectiveness of the thyroid hormone. I definitely feel the difference when I take mine on an empty stomach at least one hour before breakfast and when I take it with breakfast. When I was taking it with breakfast, I felt good sometimes and other times not so good. Some mornings I ate eggs and bacon, other mornings I ate yogurt (calcium) and fruit. I don’t want to have to be concerned with whether or not what I’m eating for breakfast is going to interfere with my thyroid hormone so I take it on an empty stomach 1-2 hours before I eat. It’s simple that way.

July 2, 2013 at 2:36 am
(4) berni says:

Jan Nathan, unless you have ever taken your meds for a period of time how can you say either way if it would affect you differently to taking them with food? not being funny here but what works well for one person does not work well for another, I think the main issue is that if how anyone takes their meds is working well then continue along that road. :-)

Amy, if you are still feeling ill on the level you are taking please keep going back to your doctors, i do hope youbtell them how it is affecting you, if you are still feeling crap then the meds aren’t yet at the right level for you love x

July 2, 2013 at 11:27 am
(5) Kaz says:

I take Armour twice daily: 45 mg in the AM and 30 mg in the afternoon.
I phoned Forest the mfg of Armour and they suggested to take both dosages on empty stomach.

Interesting, Dr. Mercola recommends taking with food.

Your comments please.

July 2, 2013 at 12:09 pm
(6) Alan says:

A very good bit of research and thank you for including it on this site.
My Chemist advised that I take Levothyroxine first thing before food and wait at least an hour – I am retired from work so I can actually leave it for a couple of hours – the Chemist also warned of taking Calcium chewable tabs along with Levothyroxine for the same period so I leave that as well for the two hours – Dont forget – calcium in milk !!!.

Thanks for a great site – always informative with up to date info.

July 2, 2013 at 3:23 pm
(7) Amy S says:

Amy, you should get a new dr.

July 2, 2013 at 3:53 pm
(8) Elizabeth M.T. O'Nan says:

I take a compounded T3 & T4 that is in a timed release form, I take it morning and early evening before I eat. I would like to hear from others who use a timed release form of thyroid meds? They seem to work for me, but I have a lot of health issues from an inoperable base of skull brain tumor to Toxicant Induced Loss of Tolerance disabilities…

July 2, 2013 at 7:48 pm
(9) wakingdream says:

I take my Synthroid in the evening, three hours after dinner with a full glass of water. No snacking, which is a good thing. I am careful not to take my calcium supplements any later than midday. I had been a morning pill taker, but it was just too hard to wake up and not eat for an hour and have stomach sensitivity from the pill first thing. I feel there is greater absorbency taking the Synthroid before bed and less “waiting”.

July 2, 2013 at 9:29 pm
(10) Joan says:

I take both compounded, time-release T4/T3, as well as Armour thyroid. I take it when I get up in the am, before breakfast, as then I don’t have to worry if I eat something that can block its absorption, like calcium. I also take my multivitamin in the pm for that reason. I also take compounded micronized progesterone (bio-identical) in the pm, as this definitely interferes with thyroid meds. I found this out the hard way by taking both together. I got hypo really fast. So, anyone who is using birth control pills, for example, would do well to take them at the opposite end of the day from thyroid meds.

July 4, 2013 at 3:20 pm
(11) Linda says:

I take it first thing in the morning on an empty stomach with glass of water. However, I have a light breakfast about 15 minutes later (black coffee, small roll and grapefruit). Would this count as “with breakfast”? I don’t have time to wait around awhile as my morning is a dash to get ready for work.

July 6, 2013 at 1:13 pm
(12) Kai says:

In response to Amy Flett, I have found and heard of some excellent thyroid doctors from this very site. Click on the link that says thyroid doctors or Top thyroid doctors or type these terms into About.com search engine and you will find some doctors that patients highly recommend. You need to see a good thyroid doctor who will give you the help you seek. Not sure what part of the country you live in, but the doctors can be sorted by states by just clicking on the links on the side for whichever state you live in. From the patient recommended doctors, you should be able to find at least one or two really excellent thyroid physicians or even holistic doctors in your area who can get you back to optimal health.

July 6, 2013 at 4:03 pm
(13) youniquelikeme says:

It used to be that taking your pills consistantly (same time, same way) was how they were precribed, however, knowing that some food will block absorption and absorption of the medication takes place in the gut, it seems wiser to care what is or isn’t in your gut when you take your meds.

Some people have been normal from the beginning on meds, but for those of us who have never been balanced (Hashimotos means you can be both hypo and then hyper so who needs more chance of extreme rollercoasting?) Rather than worry/wonder/be in flux because your body is getting more or less meds because the food you eat is affecting absorption (and isn’t being balanced more important than eating immediately) why not remain vigilant to take them on an empty stomach an hour before eating, and 2 hours after eating?

July 8, 2013 at 6:06 pm
(14) Cdeuser says:

I take my levothyroxine at 4:15am. I chose to do this based on my research, hours and hours and articles and research papers…blah blah blah of hypothyroidism and the medication. Once researched to my satisfaction and not able to find other Intel; I determined, to keep my T3/T4 TSH at a consistent level, It/(I) must be taken on an empty stomach…this is to ensure the medication does not react (+ or -). Before I was unaware how the medication is (was) affected by food, caffeine, calcium…I felt awful, like dog dodo, no energy, brain dead, and depressed…but now after taking it consistently for 5 months at 4:15am (I eat breakfast at 8:15ish), I am a new person…I can run again (3 miles) work out regular…tis awesome…..!!!!

August 13, 2013 at 6:30 am
(15) beck777 says:

Hi all,
After numerous blood tests my doctor said my FSH level was fine. I asked for my results as my naturopath wanted to see them and I saw that I have a FSH reading 4.0.
I also have Polycystic ovarian syndrome and the past 1.5 years I have been eating very clean and exercise 5-6 days a week.
And haven’t dropped any weight and have recently gained 2kgs in 1 week.
Would 4.0 really be considered to be in the “normal range”?
Any feedback would be great :)

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