Q: The label on my bottle of thyroid medicine says to take it in the morning on an empty stomach. But sometimes I forget to take it until AFTER I've eaten breakfast. Is it still okay to take it?
The synthetic thyroid hormone levothyroxine is the most prescribed medication in the United States. My mother took levothyroxine and constantly worried about what might happen if she didn’t take it “correctly ."After sitting down to breakfast, if she saw her yellow levothyroxine tablet still on the counter, she’d skip her dose that day.
“It says right on the pill bottle to not take my thyroid medicine with food.”
“Mom, if you DO forget to take your levothyroxine before you eat breakfast, the worst that could happen is your body won't get the full dose. That's because your food will interfere with how well levothyroxine is absorbed from your stomach and intestine.”
“Taking your thyroid pill with breakfast will give you a lower dose for that day, but skipping it entirely guarantees you'll get NONE at all, which will affect you more than getting less than the full dose."
My mother wasn’t the only one who struggled to take her thyroid medicine.
85-year-old Ellen set her alarm for 5 a.m. every day to take her levothyroxine in the mornings before she ate anything. Otherwise, she worried that she’d forget to take it.
Ellen took her thyroid at 5 a.m., her morning heart medicine with breakfast at 8am, her evening heart medicine with dinner, and her cholesterol medicine simvastatin at bedtime. Taking medications 4 times a day felt overwhelming.
“I want to take my medicines correctly, but it’s so hard to remember to take all of them the way I’m supposed to.”
“You don’t have to take your thyroid in the morning," I assured her.
I suggested she take her thyroid and cholesterol medicine together at bedtime, so she only had to take pills three times a day. She could ensure she was taking levothyroxine on an empty stomach if she took it at least 3 hours after her evening meal.
Within 2 weeks of taking her thyroid medicine at night instead of waking up at 5 am, she felt less overwhelmed and more energetic. Just as important, she no longer worried about taking her medicine correctly.
"It's a relief to have less to remember and wonderful to have more energy!”
Thyroid hormones control an essential part of your metabolism. First, your thyroid gland secretes a form of thyroid hormone called T3, or liothyronine, into your bloodstream. Your T3 is then converted to the more active form of thyroid hormone, called T4. Specialized proteins called enzymes change your less active T3 molecules into T4. Levothyroxine is a synthetic version of T4 that is taken once daily.
Your doctor monitors your thyroid level by measuring the amount of TSH (thyroid stimulating hormone) in your blood.
TSH is only a messenger, not your thyroid hormone. Low thyroid hormone levels will trigger the secretion of TSH into your blood. This tells your thyroid gland to release more T3, which your body transforms into the active thyroid hormone, T4.
It may seem backward, but when the TSH in your blood is elevated, your body is asking for MORE thyroid hormone. If your TSH is too low, you need LESS thyroid hormone.
5 Ways to Get the Most Out of Taking Levothyroxine:
1. Be consistent.
Levothyroxine is absorbed best if you take it with a completely empty stomach. This means at least 30 minutes before a meal or 3-4 hours after eating. Taking it the same way, every time will give you a consistent dose and help keep your thyroid level stable.
2. Avoid taking it with coffee and tea.
Coffee and tea can decrease how much levothyroxine you absorb by nearly 30%. If possible, take your thyroid supplement BEFORE your first cup of coffee.
3. Don't skip doses.
Even if you forget to take it at your usual time, absorbing some of the thyroid medication you need is FAR better than getting none.
4. Avoid taking mineral supplements with levothyroxine.
Many minerals interfere with levothyroxine absorption. This includes calcium, iron, aluminum, magnesium, and any supplements containing those minerals. Take these mineral supplements later in the day, at LEAST 2 hours before and 4 hours after taking levothyroxine.
5. Consider taking it at bedtime.
If you can avoid snacking after your evening meal, bedtime can be an ideal time to take levothyroxine. Allow 3-4 hours between your dinner meal and taking your thyroid.
Dr. Louise Achey, Doctor of Pharmacy, is a 44-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog, TheMedicationInsider.com. Ó2023 Louise Achey
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