When Should You Take Your Thyroid Medication?
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
Comments
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 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