How Long After Taking Levothyroxine Can I Drink Alcohol?

8. Common questions about levothyroxine – How does levothyroxine work? The thyroid gland in your neck makes a hormone called thyroxine. Thyroxine controls how much energy your body uses (the metabolic rate). It’s also involved in digestion, how your heart and muscles work, brain development and bone health.

tirednessfeeling colddifficulty concentratingweight gainfeeling depressed

Levothyroxine is a synthetic version of thyroxine. You take levothyroxine tablets to replace the thyroxine that your thyroid gland cannot produce and prevent the symptoms of hypothyroidism. How long does levothyroxine take to work? Levothyroxine starts working straight away, but it may be several weeks before your symptoms start to improve and you feel any different.

• How long will I take levothyroxine for? Treatment with levothyroxine is usually lifelong.
• If you stop taking levothyroxine your symptoms are likely to come back.
• Are there any long term side effects? Yes, it’s safe to take levothyroxine for a long time, even many years.
• However, high doses of levothyroxine over a long time can sometimes cause weakening of the bones (osteoporosis),

This should not happen if you are on the right dose. It’s important to have regular blood tests to make sure your dose is not too high. Will it affect my fertility? There’s no evidence to suggest that taking levothyroxine reduces fertility in either men or women.

1. However, speak to a pharmacist or your doctor if you’re trying to get pregnant as they may want to review your treatment.
2. Can I drink alcohol with it? Yes, you can drink alcohol while taking levothyroxine.
3. Alcohol does not affect how this medicine works.
4. However, if you have side effects such as headaches, flushing or sweating with levothyroxine, alcohol may make these worse.

Will it make me lose weight? One of the symptoms of an underactive thyroid gland is weight gain. So, once you start taking levothyroxine, you may lose weight as your body’s hormones rebalance. Losing weight can also be a sign that your dose of levothyroxine is too high.

drinks containing caffeine, like coffee, tea and some fizzy drinks, can reduce the amount of levothyroxine your body takes in. Leave at least 30 minutes after taking levothyroxine before you drink them. calcium-rich foods, such as milk, cheese, yoghurt and broccoli, can reduce the amount of levothyroxine your body takes in. Leave at least 4 hours between taking levothyroxine and eating calcium-rich foods. soya in food and supplements may stop levothyroxine working properly. If you regularly eat soya or take soya supplements your doctor might need to do extra blood tests to make sure you’re getting enough levothyroxine. kelp (a type of seaweed) can contain high levels of iodine, which sometimes makes an underactive thyroid worse. Do not take supplements containing kelp if you’re taking levothyroxine.

Can I get thyroid medicines for free? If you have an underactive thyroid, you’re entitled to free prescriptions for all of your medicines (not just your levothyroxine). To claim your free prescriptions you’ll need to have a medical exemption certificate.

The application form for the medical exemption certificate is called FP92A. You can get this from your doctor’s surgery. You will need to fill in the form, then your doctor will sign it and send it off. Will it affect my contraception? Levothyroxine does not affect any types of contraception, including the combined pill or emergency contraception.

However, the combined pill contains oestrogen which can reduce the amount of levothyroxine in your body. Speak to your doctor if you start or stop taking the Pill as your dose of levothyroxine may need to change. If levothyroxine makes you sick (vomit) or you have severe diarrhoea for over 24 hours while you’re taking levothyroxine, your contraceptive pills may not protect you from pregnancy.

If this happens, follow the instructions in the leaflet that comes with your contraceptive pills. Find out more about what to do if you’re on the pill and you’re being sick or you have diarrhoea, Will I lose my hair? It’s having an underactive thyroid that causes hair loss – not treatment with levothyroxine.

Because the natural hair growth cycle takes several months, hair loss related to thyroid disease might only be seen months after the condition has begun. If treatment with levothyroxine has already started, it may seem like the medicine – rather than the underlying illness – is causing the hair loss.

How long after taking thyroid medication can I drink?

What is the best way to take thyroid hormone? – The maintenance of steady and predictable thyroid hormone levels in the blood is essential to health (see normal thyroid hormone levels ). Patients with hypothyroidism need to take thyroid hormone by mouth as a medication each day.

Dietary habits can influence how the body absorbs thyroid hormone. Thyroid medication should be taken on an empty stomach, around the same time each day. Afterwards, we recommend avoiding eating or drinking for 30-60 minutes. Most of our patients take thyroid hormone in the morning upon waking. Breakfast, including any coffee or milk, can be eaten 30-60 minutes later.

The second most popular method is to take thyroid hormone in the evening, at least 3-4 hours after any food intake. You should try to establish a routine that allows you to be consistent each day. Certain medications and supplements decrease absorption of thyroid hormone and should be taken 3-4 hours after taking thyroid hormone.

Can you drink alcohol with thyroid?

How Alcohol Affects the Thyroid Gland – Alcohol can affect thyroid function in both healthy people and those with an existing thyroid condition. Alcohol increases estrogen levels in the body, which can trigger hypothyroidism (an underactive thyroid). If you already have an underactive thyroid, even moderate alcohol consumption can cause goiter (enlarged thyroid) and inflammation resulting in pain.

1. Alcohol also inhibits the conversion of T4 to T3, resulting in lower circulating thyroid hormones and thyroid volume.
2. This leads to symptoms such as tiredness, dry skin and hair loss, and constipation.
3. People with Graves’ Disease (hyperactivity of the thyroid gland) who drink alcohol might experience lengthening or widening eye openings (Graves’ ophthalmopathy).

This is a condition where the muscles around the eyes thicken and cause the eyes to protrude from their sockets. These symptoms can be mild or lead to vision problems, double vision, dryness of the eyes, sleepiness, or pain in one eye. People with hyperthyroidism who drink alcohol have a higher risk of flare-ups, in which the thyroid overreacts to TSH or the thyroid stimulating hormone.

Can I eat 30 minutes after taking levothyroxine?

CLINICAL THYROIDOLOGY FOR PATIENTS A publication of the American Thyroid Association Summaries for Patients from Clinical Thyroidology (from recent articles in Clinical Thyroidology) Table of Contents | PDF File for Saving and Printing THYROID HORMONE THERAPY Taking levothyroxine with breakfast may be fine for many patients BACKGROUND Levothyroxine is the most common therapy for the treatment of hypothyroidism as it is the same as the major thyroid hormone produced by the thyroid gland.

The absorption of levothyroxine in the gut is decreased when taking the hormone at the same time as calcium, iron and some foods and other drugs. Because of this, patients are usually instructed to take levothyroxine on an empty stomach 30-60 minutes before food intake to avoid erratic absorption of the hormone.

For many patients, this means first thing in the morning before breakfast. This is often difficult for many patients, especially those on multiple medications. This study was performed to see if patients can take their levothyroxine with food in the morning and not have to wait 30-60 minutes.

THE FULL ARTICLE TITLE: Perez CL et al. Serum thyrotropin levels following levothyroxine administration at breakfast. Thyroid 2013;23:779-84. Epub June 21, 2013. SUMMARY OF THE STUDY This study was performed in Brazil and included 45 patients who had a diagnosis of hypothyroidism and a normal TSH level on levothyroxine therapy.

For 90 days patients were assigned either to take the levothyroxine 30-60 minutes be- fore a meal or during the morning meal. Then after 90 days, they switched to the other regimen. TSH levels were assessed at baseline, 45, 90, 135 and 180 days after the start of the study.

1. Patients reported all of their food intake at breakfast.
2. As expected, 90% of the patient population was women.
3. The average TSH at the start of the study was 1.7.
4. The TSH level was higher when levothyroxine was taken during breakfast (TSH 2.9) as compared with group who waited 30-60 minutes before taking levothyroxine (TSH 1.9).

Patient preference was assessed at the end of the study and 41% preferred taking levothyroxine and waiting, 33% preferred taking the levothyroxine with breakfast and 26% indicated no preference. WHAT ARE THE IMPLICATIONS OF THIS STUDY? This study shows that the absorption of levothyroxine is indeed decreased when taking the hormone with breakfast.

• Despite an increase in TSH while taking the hormone with breakfast, the TSH remained within the normal range.
• Thus, while taking levothyroxine with breakfast could be an alternative regimen for patients who have difficulties taking the hormone on an empty stomach, this regimen is more likely to cause variability in the TSH level.

It is still advised that patients with a history of thyroid cancer, those who are pregnant or those who are very sensitive to changes in their TSH level need to likely wait 30–60 minutes prior to taking there levothyroxine. —Heather Hofflich, DO ATA THYROID BROCHURE LINKS Hypothyroidism: http://www.thyroid.org/what-is-hypothyroidism Thyroid Hormone Treatment: http://www.thyroid.org/thyroid-hormone-treatment Table of Contents | PDF File for Saving and Printing

Can you drink coffee within 30 minutes of taking levothyroxine?

In studies, coffee reduced the body’s absorption of thyroid medications by about 30%. That’s why experts recommend that you wait at least 60 minutes between drinking coffee and taking thyroid medication.

Why do you have to drink a full glass of water with levothyroxine?

pronounced as (lee voe thye rox’ een) Levothyroxine (a thyroid hormone) should not be used alone or along with other treatments to treat obesity or cause weight loss. Levothyroxine may cause serious or life-threatening problems when given in large doses, especially when taken with amphetamines such as amphetamine (Adzenys, Dyanavel XR, Evekeo), dextroamphetamine (Dexedrine), and methamphetamine (Desoxyn).

Tell your doctor if you have any of the following symptoms while you are taking levothyroxine: chest pain, rapid or irregular heartbeat or pulse, uncontrollable shaking of a part of the body, nervousness, anxiety, irritability, difficulty falling asleep or staying asleep, shortness of breath, or excessive sweating.

Talk to your doctor about the potential risks associated with this medication. Levothyroxine is used to treat hypothyroidism (condition where the thyroid gland does not produce enough thyroid hormone). It is also used with surgery and radioactive iodine therapy to treat thyroid cancer.

Levothyroxine is in a class of medications called hormones. It works by replacing thyroid hormone that is normally produced by the body. Without thyroid hormone, your body cannot function properly, which may result in poor growth, slow speech, lack of energy, excessive tiredness, constipation, weight gain, hair loss, dry, thick skin, increased sensitivity to cold, joint and muscle pain, heavy or irregular menstrual periods, and depression.

When taken correctly, levothyroxine reverses these symptoms. Levothyroxine comes as a tablet and a capsule to take by mouth. It usually is taken once a day on an empty stomach, 30 minutes to 1 hour before breakfast. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.

1. Take levothyroxine exactly as directed.
2. Do not take more or less of it or take it more often than prescribed by your doctor.
3. Swallow capsules whole; do not chew or crush them.
4. Do not remove the capsule from the package until you are ready to take it.
5. Take the tablets with a full glass of water as they may get stuck in your throat or cause choking or gagging.

If you are giving levothyroxine to an infant, child, or adult who cannot swallow the tablet, crush and mix it in 1 to 2 teaspoons (5 to 10 mL) of water. Only mix the crushed tablets with water; do not mix it with food or soybean infant formula. Give this mixture by spoon or dropper right away.

Do not store it for later use. Your doctor will probably start you on a low dose of levothyroxine and gradually increase your dose. Levothyroxine controls hypothyroidism but does not cure it. It may take several weeks before you notice a change in your symptoms. Continue to take levothyroxine even if you feel well.

Do not stop taking levothyroxine without talking to your doctor. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What not to do after taking thyroid medicine?

2. Combining Your Synthetic Thyroid Hormone With Other Medication – Just as there shouldn’t be food in your stomach when you take your hypothyroidism medication, it’s also important to avoid taking any other medication at the same time. Specifically, antacids, calcium, cholesterol drugs, and iron supplements can each interfere with the way the thyroid hormone is absorbed.

Should thyroid patients avoid alcohol?

Alcohol, the liver and the thyroid – The liver has several jobs, including:

Creating and getting rid of bile, which is essential to digestion Activating enzymes Storing minerals and vitamins Excreting fluid and hormones Getting nutrients from food to make energy

Besides these functions, the liver is also the main organ responsible for detoxification, which is the process by which toxic materials are eliminated. Under normal conditions, the average person’s liver takes around two hours to process an alcoholic beverage.

• During this time, the liver will be less able to perform any of the other functions listed above.
• If someone is consuming a lot of alcohol, that can slow down the breakdown of T4 in the liver, which means that there will be less T3 in the body.
• With lower levels of T3, hypothyroidism can happen, which can cause a range of negative health consequences.

Health problems caused by hypothyroidism include:

Constipation Depression Dry skin Facial swelling Fatigue Hoarseness Impaired memory Increased blood cholesterol Joint pain Muscle aches and stiffness Sensitivity to cold Slowed heart rate Weakness in muscles Weight gain

Due to the link between the liver and the thyroid, doctors will only prescribe certain thyroid medications if the liver is in a sufficiently healthy state. This is true of methimazole, which is one of the medications used to treat hyperthyroidism. One of the most common medications for the thyroid is levothyroxine.

This is not recommended for anyone who had had problems with their adrenal glands, which are also connected to the thyroid. What other health problems affect people with alcoholism and thyroid disease? Many of the symptoms which go with thyroid problems are exacerbated by alcohol use. For example, hypothyroidism can cause depression, dry skin, impaired memory, weight gain and fatigue.

Depression, dry skin, weight gain, memory loss and fatigue are also symptoms of alcoholism, Alcoholism and hypothyroidism are an especially bad combination. Hypothyroidism causes various processes in the body to slow down, and alcohol is a depressant, which means that it slows them down even more.

What a thyroid patient should not drink?

Alcohol Doesn’t Play Well With Your Thyroid – Alcohol consumption can wreak havoc on both thyroid hormone levels in the body and the ability of the thyroid to produce hormone, according to a study in the Indian Journal of Endocrinology and Metabolism, Alcohol appears to have a toxic effect on the thyroid gland and suppresses the ability of the body to use thyroid hormone.

Does alcohol affect levothyroxine?

Can I take levothyroxine with alcohol? – Levothyroxine is not to be taken with substances like caffeinated beverages because they negatively affect the absorption of the drug by the body. And so, you may be wondering: what about alcohol? Perhaps you like to have an alcoholic beverage now and then and are wondering if this could cause problems with the efficacy of your thyroid medication.

• The simple answer is that you can take alcoholic beverages while taking levothyroxine, as alcohol does not interfere with the workings of levothyroxine.
• The slightly more complicated answer is that alcohol might worsen some of your symptoms, so when you notice that, you should either cut back on or discontinue your alcoholic intake.

Alcohol is capable of changing the thyroid’s normal functioning by causing direct cellular toxicity on thyroid cells and eventually decreasing thyroid gland volume. This typically results in reduced levels of T3 and T4 in the body. Excessive alcohol intake while taking this medication worsens the side effects of levothyroxine if you’ve already been experiencing any.

Even though strong scientific evidence of negative interactions between levothyroxine and alcohol is yet to emerge, it is recommended that you keep your alcohol consumption low when you’re on this medication. Some common side effects of levothyroxine experienced by some hypothyroid patients include headaches, sweating, nausea, vomiting and diarrhea. If you’ve been experiencing these side effects, alcohol intake could, for instance, compound the problem of dehydration caused by vomiting and diarrhea. In this case, it is expedient to discontinue your intake of alcohol.

The ThyForLife app helps you track your symptoms, making it easy to detect when your symptoms are worsening. It is best to consult with your primary doctor or endocrinologist once you notice this negative pattern in your symptoms.

Avoid excessive alcohol intake if you are hypothyroid and on levothyroxine. Even though these two drugs are not currently known to interact negatively, alcohol consumption could negatively affect your thyroid and overall health. (You may want to review the 2020-2025 Dietary Guidelines for Americans to help guide your consumption of alcohol). Your intake of alcohol may aggravate your existing hypothyroid symptoms or side effects of levothyroxine. If your alcohol intake negatively affects your thyroid or general health, it is best to significantly cut back on or discontinue your alcohol intake altogether. Consult with your doctor if your symptoms worsen. Download the app to help you track and manage your symptoms.

What not to take with levothyroxine?

As mentioned above, levothyroxine should not be taken within 4 hours of medications and supplements like antacids, bile acid sequestrants, ion exchange resins, iron supplements, or calcium.

Is it better to take levothyroxine at night?

Background Levothyroxine sodium is widely prescribed to treat primary hypothyroidism. There is consensus that levothyroxine should be taken in the morning on an empty stomach. A pilot study showed that levothyroxine intake at bedtime significantly decreased thyrotropin levels and increased free thyroxine and total triiodothyronine levels. To date, no large randomized trial investigating the best time of levothyroxine intake, including quality-of-life evaluation, has been performed. Methods To ascertain if levothyroxine intake at bedtime instead of in the morning improves thyroid hormone levels, a randomized double-blind crossover trial was performed between April 1, 2007, and November 30, 2008, among 105 consecutive patients with primary hypothyroidism at Maasstad Hospital Rotterdam in the Netherlands. Patients were instructed during 6 months to take 1 capsule in the morning and 1 capsule at bedtime (one containing levothyroxine and the other a placebo), with a switch after 3 months. Primary outcome measures were thyroid hormone levels; secondary outcome measures were creatinine and lipid levels, body mass index, heart rate, and quality of life. Results Ninety patients completed the trial and were available for analysis. Compared with morning intake, direct treatment effects when levothyroxine was taken at bedtime were a decrease in thyrotropin level of 1.25 mIU/L (95% confidence interval, 0.60-1.89 mIU/L; P <,001), an increase in free thyroxine level of 0.07 ng/dL (0.02-0.13 ng/dL; P =,01), and an increase in total triiodothyronine level of 6.5 ng/dL (0.9-12.1 ng/dL; P =,02) (to convert thyrotropin level to micrograms per liter, multiply by 1.0; free thyroxine level to picomoles per liter, multiply by 12.871; and total triiodothyronine level to nanomoles per liter, multiply by 0.0154). Secondary outcomes, including quality-of-life questionnaires (36-Item Short Form Health Survey, Hospital Anxiety and Depression Scale, 20-Item Multidimensional Fatigue Inventory, and a symptoms questionnaire), showed no significant changes between morning vs bedtime intake of levothyroxine. Conclusions Levothyroxine taken at bedtime significantly improved thyroid hormone levels. Quality-of-life variables and plasma lipid levels showed no significant changes with bedtime vs morning intake. Clinicians should consider prescribing levothyroxine intake at bedtime. Trial Registration isrctn.org Identifier: ISRCTN17436693 (NTR959). Because the prevalence of primary hypothyroidism is high among the general population, 1, 2 levothyroxine sodium is one of the most prescribed medications. Absorption of levothyroxine is approximately 70% to 80% and occurs in the small bowel.3 There is consensus that levothyroxine should be taken before breakfast to prevent interference of its intestinal uptake by food or other medications.4 - 10 In our clinics, we observed several patients whose thyroid hormone levels improved markedly after changing the scheduled intake of levothyroxine to bedtime. A pilot study 11 confirmed this observation among 11 patients. The mean (SD) plasma thyrotropin level significantly decreased from 5.1 (0.9) to 1.2 (0.3) mIU/L (to convert thyrotropin level to micrograms per liter, multiply by 1.0), and free thyroxine (FT 4 ) and triiodothyronine (T 3 ) levels increased when levothyroxine was taken at bedtime. The circadian pattern of thyrotropin rhythm remained intact, which was important regarding the time of blood sampling for thyrotropin levels to monitor levothyroxine therapy. Accordingly, we conducted a randomized double-blind crossover trial to confirm whether levothyroxine taken at bedtime leads to lower thyrotropin and higher FT 4 and T 3 levels. Hypothyroidism can have major effects on health and quality of life (QOL), as it is associated with fatigue, weight gain, cold intolerance, depression, neuromuscular symptoms, diastolic dysfunction, and impairment of renal function.12 - 15 It is also associated with risk factors for cardiovascular disease, such as hyperlipidemia, hyperhomocystinemia, and arterial hypertension, notably in the case of insufficient thyroid hormone supplementation.16, 17 The primary objective of this study was to determine whether a change occurred in thyrotropin and thyroid hormone levels when levothyroxine was taken at bedtime vs in the morning. We further investigated whether a bedtime regimen would affect creatinine and lipid levels, body mass index, heart rate, and QOL. A randomized double-blind crossover trial was performed among consecutive patients with primary hypothyroidism who visited our clinics. The patients had to be 18 years or older and have been on a stable levothyroxine regimen for at least 6 months. Patients with a gastrointestinal tract disorder, those with thyroid carcinoma, and those who were pregnant were excluded from the study. Also excluded were patients who were taking medication known to interfere with the uptake of levothyroxine.4, 7 - 10 The medical ethics committee of the Maasstad Hospital Rotterdam in the Netherlands approved the study protocol, and written informed consent was obtained from each patient. Randomization and treatment After informed consent had been obtained, patients were randomized to start the study period with 1 capsule of levothyroxine in the morning (and 1 capsule of placebo at bedtime) or with 1 capsule of levothyroxine at bedtime (and 1 capsule of placebo in the morning). After 3 months, patients were switched from levothyroxine in the morning to placebo and vice versa for another 3 months. Double-blind study medication was provided by the hospital pharmacy, which performed the randomization. Commercial levothyroxine sodium tablets (Thyrax Duotab, 0.100 mg; Organon, Oss, the Netherlands) were used and were reformulated as capsules with lactose monohydrate as the single excipient (in compliance with Good Manufacturing Practice guidelines, annex 13, manufacture of investigational medicinal products). Every patient received study capsules containing a similar dose of levothyroxine as before entry into the trial. Placebo and levothyroxine capsules were visually identical. Patients were instructed by a research nurse to take the morning capsule on an empty stomach half an hour before breakfast and the bedtime capsule at night just before going to bed. Data collection, follow-up, and compliance At baseline and every 6 weeks, patients were seen in our clinics by a research nurse. At these visits, blood samples were obtained to determine plasma thyrotropin, FT 4, T 3, creatinine, and lipid levels, and blood pressure, heart rate, and body weight were measured. The remaining capsules in the containers were counted to check for compliance. Quality-of-life questionnaires were completed by patients at baseline, at 3 months, and at the end of the study. Blood samples were drawn on the morning of the planned visit to the research nurse. Capsules were not withheld on the day of blood sampling. Serum thyrotropin levels (reference range, 0.4-4.0 mIU/L) were measured by immunometric assay (Immulite 2000; DPC Nederland, Breda, the Netherlands), with a detection limit of 0.002 mIU/L. Levels of FT 4 (reference range, 10.0-24.0 pmol/L; equivalent to 0.78-1.86 ng/dL) and T 3 (reference range, 1.23-2.80 nmol/L; equivalent to approximately 80-182 ng/dL) were measured by competitive immunoassay (Immulite 2000). Creatinine and lipid levels were also measured (Dimension RxL; Dade Behring, Deerfield, Illinois). Quality of life and patient preference Three QOL questionnaires (36-Item Short Form Health Survey, Hospital Anxiety and Depression Scale, and 20-Item Multidimensional Fatigue Inventory) and a specific questionnaire about symptoms of hypothyroidism and hyperthyroidism were completed by patients at baseline, at 3 months, and at the end of the study. Patients completed the questionnaires under the supervision of a research nurse. The 36-Item Short Form Health Survey is a general QOL questionnaire that comprises 8 scales.18 The Hospital Anxiety and Depression Scale consists of 14 items pertaining to anxiety and depression.19 The 20-Item Multidimensional Fatigue Inventory measures 5 different dimensions of fatigue.20 The specific questionnaire for thyroid symptoms assesses 14 symptoms of hypothyroidism and 6 symptoms of hyperthyroidism.21 At the end of the trial before the randomization code was broken, patients were asked during which period of the trial they had felt better. After the trial ended, patients were free to choose at what time of day they preferred to continue taking levothyroxine, in the morning or at bedtime. One year after the trial, we asked every patient at what time he or she was taking the levothyroxine tablet. The primary end point was a change in thyroid hormone variables (thyrotropin, FT 4, and total T 3 levels) between 12 weeks of morning levothyroxine intake and 12 weeks of bedtime levothyroxine intake. Secondary end points were changes in QOL (measured by 3 questionnaires), thyroid symptom score, body mass index, heart rate, and serum lipid and creatinine levels. The direct treatment effect among all variables was measured by performing an independent-samples t test between the differences of week 12 and week 24 in the first group (started with morning levothyroxine) and the second group (started with bedtime levothyroxine).22 The presence of a carryover effect from one period to the other was measured by performing an independent-samples t test on the sum of the variables at 12 and 24 weeks in each patient. All P values were 2-sided and were not adjusted for multiple testing. All calculations were performed using commercially available statistical software (SPSS 17.0 for Windows; SPSS Inc, Chicago, Illinois). To calculate the sample size, we assumed that a difference in thyrotropin level of 1.0 mIU/L between morning and bedtime ingestion of levothyroxine would be clinically relevant. From previous results in a pilot study, we calculated that the standard deviation of the difference between morning and bedtime administration would be between 2.5 and 3.0 mIU/L. Based on these calculations, a sample size of 75 patients would give at least 80% power to detect a significant difference of 1 mIU/L between morning and bedtime administration. Study participants and treatment Between April 1, 2007, and November 30, 2008, a total of 141 consecutive patients with primary hypothyroidism were assessed for study eligibility. Ultimately, 105 patients met the inclusion criteria and gave written informed consent. Reasons for exclusion were current use of interfering medication (n = 11), history of thyroid carcinoma (n = 3), unusual dosage of levothyroxine (n = 6), treatment for breast cancer (n = 1), and Addison disease (n = 1). Fifteen randomized patients withdrew their consent shortly after enrollment in the trial and had baseline data only. The baseline characteristics of these patients did not differ from those of patients who completed the trial. Data for the entire 24 weeks were available for 90 patients (86%) who enrolled in the trial, 47 of whom started with levothyroxine intake in the morning and placebo at bedtime and 43 of whom started with levothyroxine intake at bedtime and placebo in the morning ( Figure 1 ). Baseline characteristics of the 2 groups are given in Table 1, There were differences between the 2 groups in the proportions of male patients, levothyroxine dosages, and thyrotropin levels. On average, patients missed a mean (SD) of 1.3 (6.0) capsules in the morning and 1.9 (10.1) capsules in the evening during 24 weeks of the trial ( P =,54). Because there were no severe symptoms related to hypothyroidism or hyperthyroidism, no patient required a change in levothyroxine dosage during the trial. Results of the primary outcomes are summarized in Table 2 and in Figure 2, Among the group that received morning levothyroxine first, the mean (SD) thyrotropin level decreased from 2.66 (2.53) mIU/L at 12 weeks to 1.74 (2.43) mIU/L at 24 weeks. In contrast, among the group that received bedtime levothyroxine first, the mean (SD) thyrotropin level increased from 2.36 (2.55) mIU/L at 12 weeks to 3.86 (4.02) mIU/L at 24 weeks. When overall changes were compared between the 2 groups, bedtime levothyroxine intake was found to have a direct treatment effect, with a decrease in thyrotropin level of 1.25 mIU/L (95% confidence interval, 0.60-1.89 mIU/L; P <,001) relative to morning levothyroxine intake. The mean (SD) FT 4 level in the group that received morning levothyroxine first increased from 1.48 (0.24) ng/dL at 12 weeks to 1.59 (0.33) ng/dL at 24 weeks. In the group that received bedtime levothyroxine first, the mean (SD) FT 4 level decreased from 1.54 (0.28) ng/dL at 12 weeks to 1.51 (0.20) ng/dL at 24 weeks. Therefore, bedtime levothyroxine intake resulted in a direct treatment effect, with an increase in FT 4 level of 0.07 ng/dL (95% CI, 0.02-0.13; P =,01) relative to morning levothyroxine intake. Changes in TT 3 levels were similar to changes in FT 4 levels. In the group that received morning levothyroxine first, the mean (SD) TT 3 level increased from 121.2 (28.1) ng/dL to 127.0 (31.6) ng/dL. In the group that received bedtime levothyroxine first, the mean (SD) TT 3 level decreased from 128.4 (30.6) ng/dL to 121.9 (36.3) ng/dL. In this case, the direct treatment effect of bedtime levothyroxine was an increase in TT 3 level of 6.5 ng/dL (95% CI, 9.0-12.10 ng/dL; P =,02). No first-order carryover effect was found for thyrotropin, FT 4, or TT 3 levels. There were no differences between the 2 study groups in serum creatinine or lipid levels, blood pressure, body mass index, or heart rate. These results are summarized in Table 2, The 36-Item Short Form Health Survey, Hospital Anxiety and Depression Scale, and 20-Item Multidimensional Fatigue Inventory showed no differences in subscale or total scores between the periods of morning vs bedtime intake of levothyroxine ( Table 3 ). Hypothyroidism symptoms were unchanged between the 2 periods, despite improved thyroid hormone profiles, nor was there a difference in hyperthyroidism symptoms. When asked at the end of the trial (before the randomization code was broken), 34 of 90 patients said that they felt better during the period of morning intake of levothyroxine, 31 patients preferred the period of bedtime intake, and 25 patients indicated no preference. At 1 year after completion of the trial, more than half of the patients still preferred bedtime intake of levothyroxine. We performed this large, randomized, double-blind crossover trial among 90 patients to address whether levothyroxine taken at bedtime instead of in the morning improves thyroid hormone levels. The primary outcomes show a decrease in thyrotropin level of 1.25 mIU/L and an increase in FT 4 and TT 3 levels when levothyroxine is taken at bedtime. Despite the change in thyroid hormone levels, the patient QOL did not differ. Bedtime levothyroxine intake could be more convenient for patients, as they do not have to postpone breakfast. After our study was completed, more than half of the patients decided to continue with bedtime intake of levothyroxine. How can the bioavailability effects of levothyroxine be explained? An interval of 30 minutes between taking levothyroxine and eating breakfast may be too short to prevent interference with gastrointestinal absorption of levothyroxine. Moreover, many patients drink coffee in the morning, often instead of eating breakfast, 6 or may take other medications that interfere with levothyroxine absorption. In contrast, most patients in our study stated that they had eaten no food or snacks for several hours before bedtime, this being their usual routine. Bowel motility is slower at night, resulting in more prolonged exposure of levothyroxine to the intestinal wall and, consequently, in better bioavailability.23 Furthermore, basal gastric acid secretion is highest in the late evening and is lowest in the morning.24 An acidic environment promotes the absorption of levothyroxine.25 These circadian differences in gastrointestinal function could be a pathophysiological explanation for our findings. Thyroid hormone level changes did not translate into QOL changes. There are various explanations for this observation. Patients with hypothyroidism taking adequate doses of levothyroxine (ie, those whose thyrotropin level is in the reference range) can still have significant impairment in psychological well-being and cognitive function compared with control subjects.26, 27 This could be related to their knowing that they have a chronic illness or are overweight. Weight gain and inability to lose weight are known to occur in patients with treated hypothyroidism and hyperthyroidism.28, 29 In our study, body mass index was high in both study groups. A trial investigating T 3 supplementation showed that improved QOL was limited to a subgroup of patients with suppressed thyrotropin levels who had lost weight.30 Based on the results of population studies, 2, 28 it has been suggested that the treatment goal in patients with hypothyroidism should be a thyrotropin level of 1.0 mIU/L or lower. In contrast, plasma thyroid hormone levels may not be representative of thyroid hormone levels at the tissue level (eg, in the brain); therefore, they would be unrelated to QOL.31, 32 Finally, newly discovered thyroid hormone metabolites such as thyronamine that are not replaced by levothyroxine could influence QOL 33 ; furthermore, the presence of an autoimmune disorder (eg, Hashimoto disease) may have an effect on the brain and on QOL independent of thyroid hormone supplementation.34 Primary outcomes of this study are consistent with results of an earlier pilot study.11 Two other studies on the timing of levothyroxine intake have been published. In a retrospective medical record review of 15 nursing home residents, Elliott 35 observed a nonsignificant decrease in thyrotropin levels when levothyroxine intake was switched from after breakfast to midnight. The findings in that nonrandomized trial confirm the results of our study. A 3-period crossover design study 36 showed higher thyrotropin levels when levothyroxine was taken at bedtime instead of before breakfast, but there was no change in FT 4 or TT 3 levels, as in our study. The exclusion criteria for that study were extensive, and only 19% of eligible patients were agreeable to participation. The study also included patients with thyroid cancer, whose thyrotropin levels were maintained at lower levels than those of the rest of the population. Therefore, we believe that the findings in that study extend the generalizability of our study results to the treatment of primary hypothyroidism. Lower thyrotropin levels associated with levothyroxine intake before breakfast vs at bedtime intake in that study could be explained by the longer interval between levothyroxine intake and breakfast (60 minutes vs 30 minutes in our study). Also, most patients in our study stated that they had nothing to eat (or only a small snack) for several hours before bedtime, which differs across cultures. In all studies performed on the timing of levothyroxine ingestion, intake on an empty stomach seems to result in maximal absorption of levothyroxine. Our study shows that if this fasting regimen can be achieved at bedtime, then resulting thyroid hormone levels are better than those associated with levothyroxine intake 30 minutes before breakfast. The crossover design of our study has the advantage that each patient served as his or her own control. Therefore, a statistical difference in thyrotropin values at baseline will not influence primary and secondary outcomes of the study. The study design has potential limitations, including order and sequence effects. We found no first-order carryover effect between the 2 periods, but we looked at no other order or sequence effects. It should also be noted that this was a single-site study in the Netherlands, where eating habits might be different from those in other countries or cultures. Based on the results of our study, clinicians should inform patients with hypothyroidism that levothyroxine intake at bedtime is a good alternative to levothyroxine intake in the morning, provided that levothyroxine is taken on an empty stomach. For patients who do not attain normal thyrotropin or FT 4 levels with morning levothyroxine intake, a switch to bedtime is recommended. Recommendations on timing of levothyroxine intake and on uptake interference by food are found in few guidelines about the management of hypothyroidism.37, 38 Drug information resources and guidelines require revision in this respect. In conclusion, bedtime intake of levothyroxine in our study significantly improved thyroid hormone levels. This may be explained by better gastrointestinal bioavailability at night or by less uptake interference by food or medications. As shown in this study, bedtime administration is more convenient for many patients. Clinicians should inform their patients about the possibility of taking levothyroxine at bedtime. A prolonged period of bedtime levothyroxine therapy may be required for a change in QOL to occur. Correspondence: Nienke Bolk, MD, Department of Internal Medicine, Maasstad Hospital Rotterdam, 315 Groene Hilledijk, 3075 EA Rotterdam, the Netherlands ( [email protected] ). Accepted for Publication: June 1, 2010. Authors Contributions: Dr Bolk had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design : Bolk, Visser, and Berghout. Acquisition of data : Bolk, Jongste, and Berghout. Analysis and interpretation of data : Bolk, Visser, Nijman, Tijssen, and Berghout. Drafting of the manuscript : Bolk, Visser, Nijman, Jongste, Tijssen, and Berghout. Critical revision of the manuscript for important intellectual content : Visser, Tijssen, and Berghout. Statistical analysis : Nijman and Tijssen. Administrative, technical or material support : Nijman and Jongste. Study supervision : Berghout. Financial Disclosure : None reported. Previous Presentation: These study data were presented in preliminary form at the 91st Annual Meeting of The Endocrine Society; June 11, 2009; Washington, DC. Additional Contributions: Liesbeth Ruygrok, PhD, oversaw preparation of the levothyroxine and placebo capsules and randomization of the patients. Maasstad Hospital Rotterdam laboratory technicians processed the blood samples, and employees of the Department of Internal Medicine assisted with patient assessment. We thank the patients who participated in this study for their cooperation.1. Tunbridge WMEvered DCHall R et al. The spectrum of thyroid disease in a community: the Whickham Survey. Clin Endocrinol (Oxf) 1977;7 (6) 481- 493 PubMed Google Scholar Crossref 2. Hollowell JGStaehling NWFlanders WD et al. Serum TSH, T 4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87 (2) 489- 499 PubMed Google Scholar Crossref 5. Liel YHarman-Boehm IShany S Evidence for a clinically important adverse effect of fiber-enriched diet on the bioavailability of levothyroxine in adult hypothyroid patients. J Clin Endocrinol Metab 1996;81 (2) 857- 859 PubMed Google Scholar 6. Benvenga SBartolone LPappalardo MA et al. Altered intestinal absorption of L -thyroxine caused by coffee. Thyroid 2008;18 (3) 293- 301 PubMed Google Scholar Crossref 8. Sachmechi IReich DMAninyei MWibowo FGupta GKim PJ Effect of proton pump inhibitors on serum thyroid-stimulating hormone level in euthyroid patients treated with levothyroxine for hypothyroidism. Endocr Pract 2007;13 (4) 345- 349 PubMed Google Scholar Crossref 9. Campbell NRHasinoff BBStalts HRao BWong NC Ferrous sulfate reduces thyroxine efficacy in patients with hypothyroidism. Ann Intern Med 1992;117 (12) 1010- 1013 PubMed Google Scholar Crossref 11. Bolk NVisser TJKalsbeek Avan Domburg RTBerghout A Effects of evening vs morning thyroxine ingestion on serum thyroid hormone profiles in hypothyroid patients. Clin Endocrinol (Oxf) 2007;66 (1) 43- 48 PubMed Google Scholar 12. Esposito SPrange AJ JrGolden RN The thyroid axis and mood disorders: overview and future prospects. Psychopharmacol Bull 1997;33 (2) 205- 217 PubMed Google Scholar 13. Duyff RFVan den Bosch JLaman DMvan Loon BJLinssen WH Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psychiatry 2000;68 (6) 750- 755 PubMed Google Scholar Crossref 14. Tielens ETPillay MStorm CBerghout A Changes in cardiac function at rest before and after treatment in primary hypothyroidism. Am J Cardiol 2000;85 (3) 376- 380 PubMed Google Scholar Crossref 15. den Hollander JGWulkan RWMantel MJBerghout A Correlation between severity of thyroid dysfunction and renal function. Clin Endocrinol (Oxf) 2005;62 (4) 423- 427 PubMed Google Scholar Crossref 16. Friis TPedersen LR Serum lipids in hyper- and hypothyroidism before and after treatment. Clin Chim Acta 1987;162 (2) 155- 163 PubMed Google Scholar Crossref 18. Van der Zee KISanderman S Het Meten van de Algemene Gezondheidstoestand met de RAND-36: een Handleiding, Groningen, the Netherlands Noorderlijk Centrum voor Gezondheidsvraagstukken, Rijks Universiteit Groningen1993; 20. Smets EMGarssen BBonke BDe Haes JC The Multidimensional Fatigue Inventory (MFI): psychometric qualities of an instrument to assess fatigue. J Psychosom Res 1995;39 (3) 315- 325 PubMed Google Scholar Crossref 22. Kenward MGRao CRRao DC Design and analysis of cross-over trials. Handbook of Statistics,2nd ed. Amsterdam, the Netherlands Elsevier Science2008;464- 490 Google Scholar 23. Wilson PPerdikis GHinder RARedmond EJAnselmino MQuigley EM Prolonged ambulatory antroduodenal manometry in humans. Am J Gastroenterol 1994;89 (9) 1489- 1495 PubMed Google Scholar 25. Centanni MGargano LCanettieri G et al. Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis. N Engl J Med 2006;354 (17) 1787- 1795 PubMed Google Scholar Crossref 26. Saravanan PChau WFRoberts NVedhara KGreenwood RDayan CM Psychological well-being in patients on "adequate" doses of L -thyroxine: results of a large, controlled community-based questionnaire study. Clin Endocrinol (Oxf) 2002;57 (5) 577- 585 PubMed Google Scholar Crossref 27. Wekking EMAppelhof BCFliers E et al. Cognitive functioning and well-being in euthyroid patients on thyroxine replacement therapy for primary hypothyroidism. Eur J Endocrinol 2005;153 (6) 747- 753 PubMed Google Scholar Crossref 28. Hamilton TEDavis SOnstad LKopecky KJ Thyrotropin levels in a population with no clinical, autoantibody, or ultrasonographic evidence of thyroid disease: implications for the diagnosis of subclinical hypothyroidism. J Clin Endocrinol Metab 2008;93 (4) 1224- 1230 PubMed Google Scholar Crossref 29. Hoogwerf BJNuttall FQ Long-term weight regulation in treated hyperthyroid and hypothyroid subjects. Am J Med 1984;76 (6) 963- 970 PubMed Google Scholar Crossref 30. Appelhof BCFliers EWekking EM et al. Combined therapy with levothyroxine and liothyronine in two ratios, compared with levothyroxine monotherapy in primary hypothyroidism: a double-blind, randomized, controlled clinical trial. J Clin Endocrinol Metab 2005;90 (5) 2666- 2674 PubMed Google Scholar Crossref 31. Escobar-Morreale HFObregón MJEscobar del Rey FMorreale de Escobar G Replacement therapy for hypothyroidism with thyroxine alone does not ensure euthyroidism in all tissues, as studied in thyroidectomized rats. J Clin Invest 1995;96 (6) 2828- 2838 PubMed Google Scholar Crossref 32. Roos ALinn-Rasker SPvan Domburg RTTijssen JPBerghout A The starting dose of levothyroxine in primary hypothyroidism treatment: a prospective, randomized, double-blind trial. Arch Intern Med 2005;165 (15) 1714- 1720 PubMed Google Scholar Crossref 33. Scanlan TS Minireview: 3-iodothyronamine (T1AM): a new player on the thyroid endocrine team? Endocrinology 2009;150 (3) 1108- 1111 PubMed Google Scholar Crossref 34. Vonk Rvan der Schot ACKahn RSNolen WADrexhage HA Is autoimmune thyroiditis part of the genetic vulnerability (or an endophenotype) for bipolar disorder? Biol Psychiatry 2007;62 (2) 135- 140 PubMed Google Scholar Crossref 35. Elliott DP Effect of levothyroxine administration time on serum TSH in elderly patients. Ann Pharmacother 2001;35 (5) 529- 532 PubMed Google Scholar Crossref 36. Bach-Huynh TGNayak BLoh JSoldin SJonklaas J Timing of levothyroxine administration affects serum thyrotropin concentration. J Clin Endocrinol Metab 2009;94 (10) 3905- 3912 PubMed Google Scholar Crossref 38. Singer PACooper DSLevy EG et al. Standards of Care Committee, American Thyroid Association, Treatment guidelines for patients with hyperthyroidism and hypothyroidism. JAMA 1995;273 (10) 808- 812 PubMed Google Scholar Crossref

Does levothyroxine make you tired?

What Causes Tiredness on Levothyroxine? – Extreme tiredness is a commonly reported side effect of Levothyroxine. Many people begin treatment but feel no better after starting medication, which may be because they are experiencing this effect. You feel more tired while taking Levothyroxine because the hormones in your body have been effectively reduced.

• Thyroxine is produced by the thyroid and is responsible for activating metabolic processes, energy production, and many other functions in your body.
• When you take Levothyroxine, your cells aren’t able to receive signals from thyroxine as much as they once did.
• This means that the cells in your body are unable to carry out their required functions effectively.

Considering this decrease in thyroxine means that your cells are working to total capacity, they get tired and you experience fatigue.

What if I forgot to take my thyroid pill this morning?

Missed Dose – If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Can I take levothyroxine one hour before bed?

Yes, you can take your thyroid medication at night, as long as you are taking it on an empty stomach.

Thyroid medication is absorbed best when taken on an empty stomach, as having food in the stomach lowers how much is absorbed. Often patients are advised to take thyroid medication in the morning 30 to 60 minutes before breakfast, but you can take it in the evening on an empty stomach if this suits your lifestyle better.

Some medications interact with thyroid medicine and shouldn’t be taken together at the same time, so take this into consideration when deciding when you should take your thyroid medicine. The most important thing when taking your thyroid medicine is that you take it consistently by taking it the same way, every day.

For maximum and consistent absorption of levothyroxine the latest guidelines from the American Thyroid Association recommend if possible levothyroxine should be taken 60 minutes before breakfast or at bedtime (3 or more hours after the evening meal).

Armour Thyroid Nature-Throid Westhroid Thyroid Porcine

It’s best to take these on an empty stomach with a glass of water at least 30 to 60 minutes before breakfast or another snack or meal. These drugs can be stimulating and may affect your ability to get a good night’s sleep. Levothyroxine Levothyroxine, the name of all man-made forms of the thyroid hormone T4, mimics the hormone that is produced by your thyroid.

Synthroid Levoxyl Levothroid Unithroid Tirosint

Why do I need a thyroid medication? The thyroid gland regulates your body’s metabolism by producing thyroid hormones. If the thyroid gland is underactive, it no longer produces enough thyroid hormone. Symptoms may include:

Fatigue Weight gain Feeling cold Thinning hair Depression

Taking natural thyroid or levothyroxine will help return your thyroid hormone levels to the normal range. You will need to have bloods tests to ensure your thyroid levels are within the normal range, and your doctor may need to adjust the dose of your medicine.

How do you know if levothyroxine is working?

2. Key facts –

Levothyroxine is a synthetic version of a hormone called thyroxine. It replaces thyroxine if your thyroid gland cannot produce it and prevents the symptoms of hypothyroidism.Levothyroxine starts working straight away, but it may be several weeks before your symptoms start to improve.The most common side effects of levothyroxine are caused by taking a bigger dose than you need. Your doctor can lower your dose to help reduce any side effects.Before you start taking levothyroxine, your doctor will do a blood test. Once you start taking the medicine you’ll have regular blood tests to see how well it’s working.Levothyroxine doses need to be carefully monitored during pregnancy. If you’re planning to become pregnant or think you may be pregnant, it’s important to talk to your doctor to get the right care for you and your baby.

Why was levothyroxine taken off the market?

IBSA Pharma Inc. Issues Voluntary Nationwide Recall of Select Lots of TIROSINT®-SOL (levothyroxine sodium) Oral Solution Due to Subpotency | FDA.

How do I know if my thyroid medication is working?

Signs and Symptoms of Overmedication/Undermedication – Undermedication of thyroid deficiency is serious: If left untreated, it can cause coma and be fatal in severe cases. You and your doctor should set up a plan to test and measure thyroid-stimulating hormone (TSH) every few weeks after beginning medication.

Unexplained weight gain Constipation General joint and muscle pain Feeling anxious or depressed Exhaustion Hair loss and breakage Skin changes, including very dry skin on your hands, elbows and feet; unusually smooth skin; a face rash called miliaria; or rough skin patches on your shins Menstrual periods that are heavier, more frequent, more lengthy or erratic Fertility problems

On the other end of the spectrum, according to Cleveland Clinic, signs of mild overtreatment for hypothyroidism include feeling hot or shaky, heart palpitations, difficulty falling asleep, and excessive sweating. Keep your doctor up to date on any of these side effects. If any of these symptoms of severe overtreatment occur, contact your doctor right away:

Anxiety Mood swings Hand tremors Diarrhea Muscle weakness, mainly in the thighs and shoulders Weight loss Inability to sleep or focus Abnormally increased heart rate, even at rest Forgetfulness

Do I have to take levothyroxine forever?

Taking levothyroxine – If you’re prescribed levothyroxine, you should take it at the same time every day. It’s usually recommended that you take your tablet (or tablets) in the morning, although some people prefer to take them at night. The effectiveness of the tablets can be altered by other medicines, supplements or foods, so they should be swallowed with water on an empty stomach, and you should avoid eating for 30 minutes afterwards.

1. If you forget to take a dose, take it as soon as you remember, if this is within a few hours of your usual time.
2. If you do not remember until later than this, skip the dose and take the next dose at the usual time, unless advised otherwise by a doctor.
3. An underactive thyroid is a lifelong condition, so you’ll usually need to take levothyroxine for the rest of your life.

If you’re prescribed levothyroxine because you have an underactive thyroid, you’re entitled to a medical exemption certificate. This means you do not have to pay for your prescriptions. See getting help with prescription costs for more information on this.

Can I sleep immediately after taking thyroid medication?

Can I lie down after I take levothyroxine? There is no warning or instruction about lying down after you take in the drug’s detailed prescribing information. Unless your doctor gives you different directions, you can lie down after taking it. The prescribing information for levothyroxine advises you to take one pill daily on an empty stomach 30 minutes to 1 hour before breakfast.

You should swallow the tablet or capsule whole. Do not chew or crush the tablet or capsule. Take the medication with a full glass of water. Some medications may interfere with levothyroxine, so tell your doctor about all of the medications you take, including over-the-counter medications and any supplements. Certain medications may slow down its absorption, and you should take these medicines at least 4 hours before taking levothyroxine. Some foods may also affect levothyroxine. Ask your doctor about consuming walnuts, fiber supplements, soybeans and grapefruit juice.

If you miss a dose, you should take it as soon as you remember, unless it is almost time for the next daily dose—then you should just take the next dose. Never double the dose to make up for a missed dose from the day before. : Can I lie down after I take levothyroxine?

Can you take paracetamol with levothyroxine?

No interactions were found between Basics Paracetamol and levothyroxine. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

What if I forgot to take my thyroid pill this morning?

Missed Dose – If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Why can’t you take thyroid medicine at night?

Background Levothyroxine sodium is widely prescribed to treat primary hypothyroidism. There is consensus that levothyroxine should be taken in the morning on an empty stomach. A pilot study showed that levothyroxine intake at bedtime significantly decreased thyrotropin levels and increased free thyroxine and total triiodothyronine levels. To date, no large randomized trial investigating the best time of levothyroxine intake, including quality-of-life evaluation, has been performed. Methods To ascertain if levothyroxine intake at bedtime instead of in the morning improves thyroid hormone levels, a randomized double-blind crossover trial was performed between April 1, 2007, and November 30, 2008, among 105 consecutive patients with primary hypothyroidism at Maasstad Hospital Rotterdam in the Netherlands. Patients were instructed during 6 months to take 1 capsule in the morning and 1 capsule at bedtime (one containing levothyroxine and the other a placebo), with a switch after 3 months. Primary outcome measures were thyroid hormone levels; secondary outcome measures were creatinine and lipid levels, body mass index, heart rate, and quality of life. Results Ninety patients completed the trial and were available for analysis. Compared with morning intake, direct treatment effects when levothyroxine was taken at bedtime were a decrease in thyrotropin level of 1.25 mIU/L (95% confidence interval, 0.60-1.89 mIU/L; P <,001), an increase in free thyroxine level of 0.07 ng/dL (0.02-0.13 ng/dL; P =,01), and an increase in total triiodothyronine level of 6.5 ng/dL (0.9-12.1 ng/dL; P =,02) (to convert thyrotropin level to micrograms per liter, multiply by 1.0; free thyroxine level to picomoles per liter, multiply by 12.871; and total triiodothyronine level to nanomoles per liter, multiply by 0.0154). Secondary outcomes, including quality-of-life questionnaires (36-Item Short Form Health Survey, Hospital Anxiety and Depression Scale, 20-Item Multidimensional Fatigue Inventory, and a symptoms questionnaire), showed no significant changes between morning vs bedtime intake of levothyroxine. Conclusions Levothyroxine taken at bedtime significantly improved thyroid hormone levels. Quality-of-life variables and plasma lipid levels showed no significant changes with bedtime vs morning intake. Clinicians should consider prescribing levothyroxine intake at bedtime. Trial Registration isrctn.org Identifier: ISRCTN17436693 (NTR959). Because the prevalence of primary hypothyroidism is high among the general population, 1, 2 levothyroxine sodium is one of the most prescribed medications. Absorption of levothyroxine is approximately 70% to 80% and occurs in the small bowel.3 There is consensus that levothyroxine should be taken before breakfast to prevent interference of its intestinal uptake by food or other medications.4 - 10 In our clinics, we observed several patients whose thyroid hormone levels improved markedly after changing the scheduled intake of levothyroxine to bedtime. A pilot study 11 confirmed this observation among 11 patients. The mean (SD) plasma thyrotropin level significantly decreased from 5.1 (0.9) to 1.2 (0.3) mIU/L (to convert thyrotropin level to micrograms per liter, multiply by 1.0), and free thyroxine (FT 4 ) and triiodothyronine (T 3 ) levels increased when levothyroxine was taken at bedtime. The circadian pattern of thyrotropin rhythm remained intact, which was important regarding the time of blood sampling for thyrotropin levels to monitor levothyroxine therapy. Accordingly, we conducted a randomized double-blind crossover trial to confirm whether levothyroxine taken at bedtime leads to lower thyrotropin and higher FT 4 and T 3 levels. Hypothyroidism can have major effects on health and quality of life (QOL), as it is associated with fatigue, weight gain, cold intolerance, depression, neuromuscular symptoms, diastolic dysfunction, and impairment of renal function.12 - 15 It is also associated with risk factors for cardiovascular disease, such as hyperlipidemia, hyperhomocystinemia, and arterial hypertension, notably in the case of insufficient thyroid hormone supplementation.16, 17 The primary objective of this study was to determine whether a change occurred in thyrotropin and thyroid hormone levels when levothyroxine was taken at bedtime vs in the morning. We further investigated whether a bedtime regimen would affect creatinine and lipid levels, body mass index, heart rate, and QOL. A randomized double-blind crossover trial was performed among consecutive patients with primary hypothyroidism who visited our clinics. The patients had to be 18 years or older and have been on a stable levothyroxine regimen for at least 6 months. Patients with a gastrointestinal tract disorder, those with thyroid carcinoma, and those who were pregnant were excluded from the study. Also excluded were patients who were taking medication known to interfere with the uptake of levothyroxine.4, 7 - 10 The medical ethics committee of the Maasstad Hospital Rotterdam in the Netherlands approved the study protocol, and written informed consent was obtained from each patient. Randomization and treatment After informed consent had been obtained, patients were randomized to start the study period with 1 capsule of levothyroxine in the morning (and 1 capsule of placebo at bedtime) or with 1 capsule of levothyroxine at bedtime (and 1 capsule of placebo in the morning). After 3 months, patients were switched from levothyroxine in the morning to placebo and vice versa for another 3 months. Double-blind study medication was provided by the hospital pharmacy, which performed the randomization. Commercial levothyroxine sodium tablets (Thyrax Duotab, 0.100 mg; Organon, Oss, the Netherlands) were used and were reformulated as capsules with lactose monohydrate as the single excipient (in compliance with Good Manufacturing Practice guidelines, annex 13, manufacture of investigational medicinal products). Every patient received study capsules containing a similar dose of levothyroxine as before entry into the trial. Placebo and levothyroxine capsules were visually identical. Patients were instructed by a research nurse to take the morning capsule on an empty stomach half an hour before breakfast and the bedtime capsule at night just before going to bed. Data collection, follow-up, and compliance At baseline and every 6 weeks, patients were seen in our clinics by a research nurse. At these visits, blood samples were obtained to determine plasma thyrotropin, FT 4, T 3, creatinine, and lipid levels, and blood pressure, heart rate, and body weight were measured. The remaining capsules in the containers were counted to check for compliance. Quality-of-life questionnaires were completed by patients at baseline, at 3 months, and at the end of the study. Blood samples were drawn on the morning of the planned visit to the research nurse. Capsules were not withheld on the day of blood sampling. Serum thyrotropin levels (reference range, 0.4-4.0 mIU/L) were measured by immunometric assay (Immulite 2000; DPC Nederland, Breda, the Netherlands), with a detection limit of 0.002 mIU/L. Levels of FT 4 (reference range, 10.0-24.0 pmol/L; equivalent to 0.78-1.86 ng/dL) and T 3 (reference range, 1.23-2.80 nmol/L; equivalent to approximately 80-182 ng/dL) were measured by competitive immunoassay (Immulite 2000). Creatinine and lipid levels were also measured (Dimension RxL; Dade Behring, Deerfield, Illinois). Quality of life and patient preference Three QOL questionnaires (36-Item Short Form Health Survey, Hospital Anxiety and Depression Scale, and 20-Item Multidimensional Fatigue Inventory) and a specific questionnaire about symptoms of hypothyroidism and hyperthyroidism were completed by patients at baseline, at 3 months, and at the end of the study. Patients completed the questionnaires under the supervision of a research nurse. The 36-Item Short Form Health Survey is a general QOL questionnaire that comprises 8 scales.18 The Hospital Anxiety and Depression Scale consists of 14 items pertaining to anxiety and depression.19 The 20-Item Multidimensional Fatigue Inventory measures 5 different dimensions of fatigue.20 The specific questionnaire for thyroid symptoms assesses 14 symptoms of hypothyroidism and 6 symptoms of hyperthyroidism.21 At the end of the trial before the randomization code was broken, patients were asked during which period of the trial they had felt better. After the trial ended, patients were free to choose at what time of day they preferred to continue taking levothyroxine, in the morning or at bedtime. One year after the trial, we asked every patient at what time he or she was taking the levothyroxine tablet. The primary end point was a change in thyroid hormone variables (thyrotropin, FT 4, and total T 3 levels) between 12 weeks of morning levothyroxine intake and 12 weeks of bedtime levothyroxine intake. Secondary end points were changes in QOL (measured by 3 questionnaires), thyroid symptom score, body mass index, heart rate, and serum lipid and creatinine levels. The direct treatment effect among all variables was measured by performing an independent-samples t test between the differences of week 12 and week 24 in the first group (started with morning levothyroxine) and the second group (started with bedtime levothyroxine).22 The presence of a carryover effect from one period to the other was measured by performing an independent-samples t test on the sum of the variables at 12 and 24 weeks in each patient. All P values were 2-sided and were not adjusted for multiple testing. All calculations were performed using commercially available statistical software (SPSS 17.0 for Windows; SPSS Inc, Chicago, Illinois). To calculate the sample size, we assumed that a difference in thyrotropin level of 1.0 mIU/L between morning and bedtime ingestion of levothyroxine would be clinically relevant. From previous results in a pilot study, we calculated that the standard deviation of the difference between morning and bedtime administration would be between 2.5 and 3.0 mIU/L. Based on these calculations, a sample size of 75 patients would give at least 80% power to detect a significant difference of 1 mIU/L between morning and bedtime administration. Study participants and treatment Between April 1, 2007, and November 30, 2008, a total of 141 consecutive patients with primary hypothyroidism were assessed for study eligibility. Ultimately, 105 patients met the inclusion criteria and gave written informed consent. Reasons for exclusion were current use of interfering medication (n = 11), history of thyroid carcinoma (n = 3), unusual dosage of levothyroxine (n = 6), treatment for breast cancer (n = 1), and Addison disease (n = 1). Fifteen randomized patients withdrew their consent shortly after enrollment in the trial and had baseline data only. The baseline characteristics of these patients did not differ from those of patients who completed the trial. Data for the entire 24 weeks were available for 90 patients (86%) who enrolled in the trial, 47 of whom started with levothyroxine intake in the morning and placebo at bedtime and 43 of whom started with levothyroxine intake at bedtime and placebo in the morning ( Figure 1 ). Baseline characteristics of the 2 groups are given in Table 1, There were differences between the 2 groups in the proportions of male patients, levothyroxine dosages, and thyrotropin levels. On average, patients missed a mean (SD) of 1.3 (6.0) capsules in the morning and 1.9 (10.1) capsules in the evening during 24 weeks of the trial ( P =,54). Because there were no severe symptoms related to hypothyroidism or hyperthyroidism, no patient required a change in levothyroxine dosage during the trial. Results of the primary outcomes are summarized in Table 2 and in Figure 2, Among the group that received morning levothyroxine first, the mean (SD) thyrotropin level decreased from 2.66 (2.53) mIU/L at 12 weeks to 1.74 (2.43) mIU/L at 24 weeks. In contrast, among the group that received bedtime levothyroxine first, the mean (SD) thyrotropin level increased from 2.36 (2.55) mIU/L at 12 weeks to 3.86 (4.02) mIU/L at 24 weeks. When overall changes were compared between the 2 groups, bedtime levothyroxine intake was found to have a direct treatment effect, with a decrease in thyrotropin level of 1.25 mIU/L (95% confidence interval, 0.60-1.89 mIU/L; P <,001) relative to morning levothyroxine intake. The mean (SD) FT 4 level in the group that received morning levothyroxine first increased from 1.48 (0.24) ng/dL at 12 weeks to 1.59 (0.33) ng/dL at 24 weeks. In the group that received bedtime levothyroxine first, the mean (SD) FT 4 level decreased from 1.54 (0.28) ng/dL at 12 weeks to 1.51 (0.20) ng/dL at 24 weeks. Therefore, bedtime levothyroxine intake resulted in a direct treatment effect, with an increase in FT 4 level of 0.07 ng/dL (95% CI, 0.02-0.13; P =,01) relative to morning levothyroxine intake. Changes in TT 3 levels were similar to changes in FT 4 levels. In the group that received morning levothyroxine first, the mean (SD) TT 3 level increased from 121.2 (28.1) ng/dL to 127.0 (31.6) ng/dL. In the group that received bedtime levothyroxine first, the mean (SD) TT 3 level decreased from 128.4 (30.6) ng/dL to 121.9 (36.3) ng/dL. In this case, the direct treatment effect of bedtime levothyroxine was an increase in TT 3 level of 6.5 ng/dL (95% CI, 9.0-12.10 ng/dL; P =,02). No first-order carryover effect was found for thyrotropin, FT 4, or TT 3 levels. There were no differences between the 2 study groups in serum creatinine or lipid levels, blood pressure, body mass index, or heart rate. These results are summarized in Table 2, The 36-Item Short Form Health Survey, Hospital Anxiety and Depression Scale, and 20-Item Multidimensional Fatigue Inventory showed no differences in subscale or total scores between the periods of morning vs bedtime intake of levothyroxine ( Table 3 ). Hypothyroidism symptoms were unchanged between the 2 periods, despite improved thyroid hormone profiles, nor was there a difference in hyperthyroidism symptoms. When asked at the end of the trial (before the randomization code was broken), 34 of 90 patients said that they felt better during the period of morning intake of levothyroxine, 31 patients preferred the period of bedtime intake, and 25 patients indicated no preference. At 1 year after completion of the trial, more than half of the patients still preferred bedtime intake of levothyroxine. We performed this large, randomized, double-blind crossover trial among 90 patients to address whether levothyroxine taken at bedtime instead of in the morning improves thyroid hormone levels. The primary outcomes show a decrease in thyrotropin level of 1.25 mIU/L and an increase in FT 4 and TT 3 levels when levothyroxine is taken at bedtime. Despite the change in thyroid hormone levels, the patient QOL did not differ. Bedtime levothyroxine intake could be more convenient for patients, as they do not have to postpone breakfast. After our study was completed, more than half of the patients decided to continue with bedtime intake of levothyroxine. How can the bioavailability effects of levothyroxine be explained? An interval of 30 minutes between taking levothyroxine and eating breakfast may be too short to prevent interference with gastrointestinal absorption of levothyroxine. Moreover, many patients drink coffee in the morning, often instead of eating breakfast, 6 or may take other medications that interfere with levothyroxine absorption. In contrast, most patients in our study stated that they had eaten no food or snacks for several hours before bedtime, this being their usual routine. Bowel motility is slower at night, resulting in more prolonged exposure of levothyroxine to the intestinal wall and, consequently, in better bioavailability.23 Furthermore, basal gastric acid secretion is highest in the late evening and is lowest in the morning.24 An acidic environment promotes the absorption of levothyroxine.25 These circadian differences in gastrointestinal function could be a pathophysiological explanation for our findings. Thyroid hormone level changes did not translate into QOL changes. There are various explanations for this observation. Patients with hypothyroidism taking adequate doses of levothyroxine (ie, those whose thyrotropin level is in the reference range) can still have significant impairment in psychological well-being and cognitive function compared with control subjects.26, 27 This could be related to their knowing that they have a chronic illness or are overweight. Weight gain and inability to lose weight are known to occur in patients with treated hypothyroidism and hyperthyroidism.28, 29 In our study, body mass index was high in both study groups. A trial investigating T 3 supplementation showed that improved QOL was limited to a subgroup of patients with suppressed thyrotropin levels who had lost weight.30 Based on the results of population studies, 2, 28 it has been suggested that the treatment goal in patients with hypothyroidism should be a thyrotropin level of 1.0 mIU/L or lower. In contrast, plasma thyroid hormone levels may not be representative of thyroid hormone levels at the tissue level (eg, in the brain); therefore, they would be unrelated to QOL.31, 32 Finally, newly discovered thyroid hormone metabolites such as thyronamine that are not replaced by levothyroxine could influence QOL 33 ; furthermore, the presence of an autoimmune disorder (eg, Hashimoto disease) may have an effect on the brain and on QOL independent of thyroid hormone supplementation.34 Primary outcomes of this study are consistent with results of an earlier pilot study.11 Two other studies on the timing of levothyroxine intake have been published. In a retrospective medical record review of 15 nursing home residents, Elliott 35 observed a nonsignificant decrease in thyrotropin levels when levothyroxine intake was switched from after breakfast to midnight. The findings in that nonrandomized trial confirm the results of our study. A 3-period crossover design study 36 showed higher thyrotropin levels when levothyroxine was taken at bedtime instead of before breakfast, but there was no change in FT 4 or TT 3 levels, as in our study. The exclusion criteria for that study were extensive, and only 19% of eligible patients were agreeable to participation. The study also included patients with thyroid cancer, whose thyrotropin levels were maintained at lower levels than those of the rest of the population. Therefore, we believe that the findings in that study extend the generalizability of our study results to the treatment of primary hypothyroidism. Lower thyrotropin levels associated with levothyroxine intake before breakfast vs at bedtime intake in that study could be explained by the longer interval between levothyroxine intake and breakfast (60 minutes vs 30 minutes in our study). Also, most patients in our study stated that they had nothing to eat (or only a small snack) for several hours before bedtime, which differs across cultures. In all studies performed on the timing of levothyroxine ingestion, intake on an empty stomach seems to result in maximal absorption of levothyroxine. Our study shows that if this fasting regimen can be achieved at bedtime, then resulting thyroid hormone levels are better than those associated with levothyroxine intake 30 minutes before breakfast. The crossover design of our study has the advantage that each patient served as his or her own control. Therefore, a statistical difference in thyrotropin values at baseline will not influence primary and secondary outcomes of the study. The study design has potential limitations, including order and sequence effects. We found no first-order carryover effect between the 2 periods, but we looked at no other order or sequence effects. It should also be noted that this was a single-site study in the Netherlands, where eating habits might be different from those in other countries or cultures. Based on the results of our study, clinicians should inform patients with hypothyroidism that levothyroxine intake at bedtime is a good alternative to levothyroxine intake in the morning, provided that levothyroxine is taken on an empty stomach. For patients who do not attain normal thyrotropin or FT 4 levels with morning levothyroxine intake, a switch to bedtime is recommended. Recommendations on timing of levothyroxine intake and on uptake interference by food are found in few guidelines about the management of hypothyroidism.37, 38 Drug information resources and guidelines require revision in this respect. In conclusion, bedtime intake of levothyroxine in our study significantly improved thyroid hormone levels. This may be explained by better gastrointestinal bioavailability at night or by less uptake interference by food or medications. As shown in this study, bedtime administration is more convenient for many patients. Clinicians should inform their patients about the possibility of taking levothyroxine at bedtime. A prolonged period of bedtime levothyroxine therapy may be required for a change in QOL to occur. Correspondence: Nienke Bolk, MD, Department of Internal Medicine, Maasstad Hospital Rotterdam, 315 Groene Hilledijk, 3075 EA Rotterdam, the Netherlands ( [email protected] ). Accepted for Publication: June 1, 2010. Authors Contributions: Dr Bolk had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design : Bolk, Visser, and Berghout. Acquisition of data : Bolk, Jongste, and Berghout. Analysis and interpretation of data : Bolk, Visser, Nijman, Tijssen, and Berghout. Drafting of the manuscript : Bolk, Visser, Nijman, Jongste, Tijssen, and Berghout. Critical revision of the manuscript for important intellectual content : Visser, Tijssen, and Berghout. Statistical analysis : Nijman and Tijssen. Administrative, technical or material support : Nijman and Jongste. Study supervision : Berghout. Financial Disclosure : None reported. Previous Presentation: These study data were presented in preliminary form at the 91st Annual Meeting of The Endocrine Society; June 11, 2009; Washington, DC. Additional Contributions: Liesbeth Ruygrok, PhD, oversaw preparation of the levothyroxine and placebo capsules and randomization of the patients. Maasstad Hospital Rotterdam laboratory technicians processed the blood samples, and employees of the Department of Internal Medicine assisted with patient assessment. We thank the patients who participated in this study for their cooperation.1. Tunbridge WMEvered DCHall R et al. The spectrum of thyroid disease in a community: the Whickham Survey. Clin Endocrinol (Oxf) 1977;7 (6) 481- 493 PubMed Google Scholar Crossref 2. Hollowell JGStaehling NWFlanders WD et al. Serum TSH, T 4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87 (2) 489- 499 PubMed Google Scholar Crossref 5. Liel YHarman-Boehm IShany S Evidence for a clinically important adverse effect of fiber-enriched diet on the bioavailability of levothyroxine in adult hypothyroid patients. J Clin Endocrinol Metab 1996;81 (2) 857- 859 PubMed Google Scholar 6. Benvenga SBartolone LPappalardo MA et al. Altered intestinal absorption of L -thyroxine caused by coffee. Thyroid 2008;18 (3) 293- 301 PubMed Google Scholar Crossref 8. Sachmechi IReich DMAninyei MWibowo FGupta GKim PJ Effect of proton pump inhibitors on serum thyroid-stimulating hormone level in euthyroid patients treated with levothyroxine for hypothyroidism. Endocr Pract 2007;13 (4) 345- 349 PubMed Google Scholar Crossref 9. Campbell NRHasinoff BBStalts HRao BWong NC Ferrous sulfate reduces thyroxine efficacy in patients with hypothyroidism. Ann Intern Med 1992;117 (12) 1010- 1013 PubMed Google Scholar Crossref 11. Bolk NVisser TJKalsbeek Avan Domburg RTBerghout A Effects of evening vs morning thyroxine ingestion on serum thyroid hormone profiles in hypothyroid patients. Clin Endocrinol (Oxf) 2007;66 (1) 43- 48 PubMed Google Scholar 12. Esposito SPrange AJ JrGolden RN The thyroid axis and mood disorders: overview and future prospects. Psychopharmacol Bull 1997;33 (2) 205- 217 PubMed Google Scholar 13. Duyff RFVan den Bosch JLaman DMvan Loon BJLinssen WH Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psychiatry 2000;68 (6) 750- 755 PubMed Google Scholar Crossref 14. Tielens ETPillay MStorm CBerghout A Changes in cardiac function at rest before and after treatment in primary hypothyroidism. Am J Cardiol 2000;85 (3) 376- 380 PubMed Google Scholar Crossref 15. den Hollander JGWulkan RWMantel MJBerghout A Correlation between severity of thyroid dysfunction and renal function. Clin Endocrinol (Oxf) 2005;62 (4) 423- 427 PubMed Google Scholar Crossref 16. Friis TPedersen LR Serum lipids in hyper- and hypothyroidism before and after treatment. Clin Chim Acta 1987;162 (2) 155- 163 PubMed Google Scholar Crossref 18. Van der Zee KISanderman S Het Meten van de Algemene Gezondheidstoestand met de RAND-36: een Handleiding, Groningen, the Netherlands Noorderlijk Centrum voor Gezondheidsvraagstukken, Rijks Universiteit Groningen1993; 20. Smets EMGarssen BBonke BDe Haes JC The Multidimensional Fatigue Inventory (MFI): psychometric qualities of an instrument to assess fatigue. J Psychosom Res 1995;39 (3) 315- 325 PubMed Google Scholar Crossref 22. Kenward MGRao CRRao DC Design and analysis of cross-over trials. Handbook of Statistics,2nd ed. Amsterdam, the Netherlands Elsevier Science2008;464- 490 Google Scholar 23. Wilson PPerdikis GHinder RARedmond EJAnselmino MQuigley EM Prolonged ambulatory antroduodenal manometry in humans. Am J Gastroenterol 1994;89 (9) 1489- 1495 PubMed Google Scholar 25. Centanni MGargano LCanettieri G et al. Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis. N Engl J Med 2006;354 (17) 1787- 1795 PubMed Google Scholar Crossref 26. Saravanan PChau WFRoberts NVedhara KGreenwood RDayan CM Psychological well-being in patients on "adequate" doses of L -thyroxine: results of a large, controlled community-based questionnaire study. Clin Endocrinol (Oxf) 2002;57 (5) 577- 585 PubMed Google Scholar Crossref 27. Wekking EMAppelhof BCFliers E et al. Cognitive functioning and well-being in euthyroid patients on thyroxine replacement therapy for primary hypothyroidism. Eur J Endocrinol 2005;153 (6) 747- 753 PubMed Google Scholar Crossref 28. Hamilton TEDavis SOnstad LKopecky KJ Thyrotropin levels in a population with no clinical, autoantibody, or ultrasonographic evidence of thyroid disease: implications for the diagnosis of subclinical hypothyroidism. J Clin Endocrinol Metab 2008;93 (4) 1224- 1230 PubMed Google Scholar Crossref 29. Hoogwerf BJNuttall FQ Long-term weight regulation in treated hyperthyroid and hypothyroid subjects. Am J Med 1984;76 (6) 963- 970 PubMed Google Scholar Crossref 30. Appelhof BCFliers EWekking EM et al. Combined therapy with levothyroxine and liothyronine in two ratios, compared with levothyroxine monotherapy in primary hypothyroidism: a double-blind, randomized, controlled clinical trial. J Clin Endocrinol Metab 2005;90 (5) 2666- 2674 PubMed Google Scholar Crossref 31. Escobar-Morreale HFObregón MJEscobar del Rey FMorreale de Escobar G Replacement therapy for hypothyroidism with thyroxine alone does not ensure euthyroidism in all tissues, as studied in thyroidectomized rats. J Clin Invest 1995;96 (6) 2828- 2838 PubMed Google Scholar Crossref 32. Roos ALinn-Rasker SPvan Domburg RTTijssen JPBerghout A The starting dose of levothyroxine in primary hypothyroidism treatment: a prospective, randomized, double-blind trial. Arch Intern Med 2005;165 (15) 1714- 1720 PubMed Google Scholar Crossref 33. Scanlan TS Minireview: 3-iodothyronamine (T1AM): a new player on the thyroid endocrine team? Endocrinology 2009;150 (3) 1108- 1111 PubMed Google Scholar Crossref 34. Vonk Rvan der Schot ACKahn RSNolen WADrexhage HA Is autoimmune thyroiditis part of the genetic vulnerability (or an endophenotype) for bipolar disorder? Biol Psychiatry 2007;62 (2) 135- 140 PubMed Google Scholar Crossref 35. Elliott DP Effect of levothyroxine administration time on serum TSH in elderly patients. Ann Pharmacother 2001;35 (5) 529- 532 PubMed Google Scholar Crossref 36. Bach-Huynh TGNayak BLoh JSoldin SJonklaas J Timing of levothyroxine administration affects serum thyrotropin concentration. J Clin Endocrinol Metab 2009;94 (10) 3905- 3912 PubMed Google Scholar Crossref 38. Singer PACooper DSLevy EG et al. Standards of Care Committee, American Thyroid Association, Treatment guidelines for patients with hyperthyroidism and hypothyroidism. JAMA 1995;273 (10) 808- 812 PubMed Google Scholar Crossref

What if I forgot to take my thyroid pill before eating?

What should I do if I forget to take my thyroid medication? If you miss a dose of your thyroid medication, take it as soon as you remember. It’s best to take thyroid hormone on an empty stomach, 1 hour before or 4 hours after eating or taking other medications or supplements.

How long after starting thyroid medication will I lose weight?

How long after starting thyroid medication will I lose weight? – When you start taking thyroid medication like levothyroxine, don’t expect instant weight loss, The first barrier is getting the right dose of thyroid medication. Once you have reached your ideal dose, you may notice some weight loss after around three to six months of continuous use.

• It’s important to keep in mind that weight loss isn’t a universal side effect of thyroid medication.
• For example, a 2014 study found that only 52% of patients with diagnosed hypothyroidism lost weight after taking thyroid medication.
• For patients who did lose weight, they lost on average 3.8 to 4.4 lbs after five months of treatment.² Losing excess water weight is also a common reason why patients notice a difference in their weight after taking thyroid medication, rather than fat loss.

One study found that after a year of treatment with thyroid medication, patients’ experienced a significant reduction in their body weight. However, this weight loss did not affect the amount of fat or bone mass each patient had, leading researchers to conclude that the weight loss was likely due to the excretion of excess water that can build up as a result of hypothyroidism.³