Physician On-Call Article: The Confusing World of Taking Thyroid Medications

By: Julia Lindower, MSN, APRN.

When it comes to thyroid medication for hypothyroidism, there is a lot of information out there. Take it with a full glass of water, or just a sip of water. It must be first thing in the morning, but maybe you can take it at night too. You can’t eat for an hour…well or at least 30 minutes. Sometimes it gets hard to remember what you should do.

When talking specifically about medications with names like Levothyroxine, Synthroid, Unithroid, Tirosint, Levoxyl, there are a few standard recommendations:

1. It is recommended that you take your medication first thing in the morning with water. It doesn’t have to be a full glass of water. Older thyroid medications like Euthyrox and Levo-T brands were very sensitive to stomach acidity and had to be taken with specific amounts of water. Those brands are discontinued in the United States. However, if it does say to take your medication with a full glass of water please do that because they are still available in other countries. If you are on the generic Levothyroxine, you may be taking Euthyrox.
2. Wait 30 minutes to eat or take other medication. Thyroid medication should be taken by itself.
3. If you like walnuts, grapefruit juice, soy milk or coffee some brands recommend you wait a full hour because they affect the absorption of the medication. For vitamins and supplements you should separate them by 4 hours.

If you are like me sometimes the smell of coffee is what gets me stumbling out of bed in the morning and thinking about waiting a full hour for that is tortuous! Frequently people end up missing doses because the morning java becomes more important than medication. So, for the late morning, coffee-loving crew, here are some tips to make sure you get your medication. Remember though, consistency is KEY. Also make sure you let your provider know that you are taking your medication with an altered schedule so they can determine if any adjustments are needed.

1. If you wake up anytime in the middle of the night, take your medication then with a little water and go back to bed. That way you can take other medication or coffee first thing in the morning.
2. You can take your medication alone before bed as long as you stop eating 3-4 hours before bed, so your stomach is empty. Otherwise, it won’t be absorbed correctly.

And if all this doesn’t help, the Journal of Clinical Endocrinology and Metabolism just published a study that found for those that absolutely could not take their medication without eating, there is hope. If this is consistent behavior and you work with your provider, an increased dose of medication can still provide stable thyroid levels. TSH stable 74.4% in the fasting group vs 73.3% in the breakfast group. (The Journal of Clinical Endocrinologist and Metabolism 2026. Willems, JIA, Va Twist, DJL, Helmich F, et al). Meaning that you can still get good control with your medication.

Life happens, and if you can keep some consistently, you can achieve good control of hypothyroidism with your medication. Just remember: be consistent with your medication and keep your provider in the loop.