Are you taking your thyroid medication properly…are you sure?

thyroid medication

After 3 years of taking thyroid medication for hypothyroidism every day, I found a great new thyroid doctor and for the first time discovered that I was taking my thyroid medication all wrong. I was taking my medication at the very same time as foods, medications, and supplements known to interfere with the absorption of thyroid medication. Yet my previous thyroid doctor and pharmacists never thought to tell me such important information.

I no longer take a T4-only levothyroxine medication like Synthroid, which is a popular prescription for hypothyroidism in mainstream medicine. I felt awful on T4 only. Some do great on these medications but I just didn’t. Our bodies are all different. I now take natural desiccated thyroid which contains both T4 and T3 thyroid hormones. My doctor has me divide my dose to twice a day to spread the affect of T3 in NDT to keep up my energy throughout the day. I take half of my dosage first thing in the morning when I wake up and the other half in the afternoon several hours apart from the food, supplements, and medications mentioned below in this article. First speak to your doctor before changing how you take your thyroid medication.

Written by Kent Holtorf, M.D.

If you are hypothyroid and taking a prescription thyroid hormone replacement drug, you may not be aware of the many rules that need to be followed when taking your medication. Something you may not know is how your other medications, vitamins, supplement, and even food choices are interfering wither thyroid medication.

If you are taking thyroid medication, hopefully your doctor or pharmacist has already shared with you the most important things to remember:

Take on an empty stomach first thing in the morning

Wait one hour before eating breakfast

Take it at the same time each day

Never miss a dose

Don’t take your thyroid medication at the same time as your coffee (coffee may lower the absorption of your thyroid medication)(1,2,3)

These are very important medication instructions to follow, however, there is more to the story when taking thyroid medication that you may not be aware of.

Some thyroid patients may benefit from taking thyroid medication at night.(4) Speak to your doctor before making changes to how you take your thyroid medication.

Many medications, supplements, and foods are important to avoid or not consume within three to six hours of taking your thyroid medication. These interfere with the the body’s ability to absorb and utilize thyroid medication effectively. When an interference of absorption happens, serious things can occur. You may become under-medicated or even over-medicated depending on the substance causing the interference. So, which substances cause an absorption issue?


If you are taking thyroid medication and you are prescribed an antibiotic, you will want to make sure that you know about how thyroid drugs and antibiotics can interact, affecting the absorption of your thyroid medication.

There are a variety of reasons why you may need to take a larger-than-usual dose of thyroid hormone replacement medication— but one of the most common reasons is that you are taking a prescription or over-the-counter medication that affects absorption of your thyroid medication.

Some medications decrease the absorption of thyroid medication while others increase it.

A study from the journal Thyroid found that the antibiotic ciprofloxacin – known more commonly by brand names Cipro, Proquin, Ciproxin, Ciprobay, Cirpoxine, and Ciflox — significantly decreased the absorption of the thyroid medication.(5) [Keep in mind that some experts feel that the warning about ciprofloxacin applies also to similar quinolone antibiotics such as levofloxacin (Levaquin), lomefloxacin (Maxaquin), monifloxacin (Avelox), norfloxacin (Norox-In), and ofloxacin (Floxin).]

This means that if you are taking thyroid drugs and an antibiotic from the quinolone family, it could interfere with absorption, and cause you to become substantially more hypothyroid.

Interestingly, the antibiotic rifampin (also called rifampicin) — and known by brand names Rifadin, Rifamate and Rifater — significantly increased the absorption of the thyroid medication. This means that if you are taking the antibiotic along with your thyroid hormone replacement medication, it could actually cause you to become overmedicated, or experience hyperthyroid symptoms.

Is there a solution? Some studies have found that the impact may be minimized if the antibiotic and thyroid medications were taken at least six hours apart. But it’s not agreed upon across the board by physicians.

Your best bet is to discuss the issue with your practitioner at the time these drugs are prescribed (and before you get the prescription filled). There may be other antibiotics available for your treatment that are less likely to interfere with the effectiveness of your thyroid treatment. To be safe, take antibiotics 6 hours either before or after your thyroid medication.

Other Medications

While many of these other medications are needed, there are time guidelines to follow if you are also taking thyroid medication. Speak to your doctor or pharmacist if you are taking:

  • Sucralfate (Carafate), a medication often prescribed for treatment of peptic ulcer disease or gastroesophageal reflux disease decreases the absorption of thyroid medication and should be taken 8 hours before or after.
  • Cholestyramine and other cholesterol lowering drugs should be taken 4-6 hours apart from your thyroid medication.
  • Raloxifene (Evista) for osteoporosis take 12 hours apart.
  • Antidepressants: Many selective serotonin reuptake inhibitors (SSRI) like Prozac, Zoloft, and Paxil decrease the effectiveness of thyroid medication.
  • Anti-seizure: Medications such as Tegretol, Dilantin, and Phenobarbital increase the metabolism and may require your physician to increase your thyroid dose.
  • Insulin or an oral hypoglycemic drug take at least a few hours apart to avoid interaction.
  • Sevelamer – for kidney disease
  • Antiepileptic drugs – Rifampin, efavirenz, nevirapine, rifabutin and rifapentine
  • St. John’s wort
  • Imatinib (Gleevec) – cancer drug
  • Sertraline (Zoloft)

Talk to your doctor or pharmacist about all drugs and supplements that you are taking alongside your thyroid hormone replacement medication, to make sure that your timing minimizes any interference or absorption problems.


Interestingly, taking iron or calcium supplements, while helpful to your condition, can also affect the way your body absorbs your medication. This includes multivitamins and prenatal vitamins that include iron. Even reaching for an over the counter antacid like Tums or Rolaids (antacids that include calcium carbonate and/or aluminum hydroxide can significantly reduce thyroid medication absorption), needs to be taken into consideration, if you are currently taking any type of thyroid medication, observe the 4 to 6 hour rule.(6)


Similar to supplements, foods rich in iron, fiber, or calcium such as calcium fortified orange juice or yogurt should be enjoyed at least 2 hours before or after taking your thyroid.

Many times we seek different doctors for different reasons. While your endocrinologist could be prescribing your thyroid medication, the general family doctor you seek when sick with bacterial, viral, or maybe stomach issues is completely unaware of any other prescriptions. And we often times forget to mention the over the counter drugs we take, not giving the doctor the whole picture. It is always best to try and keep a list of medication, including supplements, handy to share with each doctor that you see.

Observations of these time guidelines can make a huge difference in keeping your thyroid gland and medication performing at its best.

About Dr. Kent Holtorf

Kent Holtorf, M.D. is the medical director of the Holtorf Medical Group with locations in Los Angeles, Foster City, Atlanta, and Philadelphia. He is also founder and director of the non-profit National Academy of Hypothyroidism (NAH), which is dedicated to dissemination of new information to doctors and patients on the diagnosis and treatment of hypothyroidism.

Dr. Holtorf has personally trained numerous physicians across the country in the use of bioidentical hormones, hypothyroidism, complex endocrine dysfunction, and innovative treatments of chronic fatigue syndrome, weight loss, fibromyalgia, and chronic infectious diseases, including Lyme disease.

He has been a featured guest on numerous TV shows including CNBC, ABC News, CNN, EXTRA TV, Discovery Health, The Learning Channel, The Today Show, The Doctors, Dr. Dean Edell, Glenn Beck, Nancy Grace, Fox Business, ESPN, Rush Limbaugh, CBS Sunday Morning, Sean Hannity, So Cal News, and quoted in numerous print media including the Wall Street Journal, Los Angeles Times, US New and World Report, San Francisco Chronicle, WebMD, Health, Elle, Better Homes and Garden, US Weekly, Forbes, Cosmopolitan, New York Daily News, Self magazine, among many others.


  1. Benvenga, S., et al. Altered Intestinal Absorption of L-Thyroxine Caused by Coffee. Thyroid. 2008; 18(3):293-301.
  2. Mazzaferri, E. Thyroid Hormone Therapy. Clinical Thyroidology for Patients: Summaries for Patients from Clinical Thyroidology. 2008; Vol 1, Iss 1.
  3. Sindoni, A., et al. Case Report: Coffee Impairs intestinal Absorption of Levothyroxine: Report of Additional Cases. Hot Thyroidology. Article 5/09.
  4. Bolk, N., et al. Effects of evening vs morning levothyroxine intake: a randomized double-blind crossover trial. Arch Intern Med. 2010 Dec 13: 170(22):1996-2003
  5. Goldberg, A., et al. Ciprofloxacin and Rifampin Have Opposite Effects on Levothyroxine Absorption. Thyroid. October 16, 2013
  6. Dong, B. How medications affect thyroid function. West J Med. 2000 Feb; 172(2):102-6

READ NEXT: 10 Tips to Lose Weight with Hypothyroidism

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I appreciate every share! Thank you.

About Dana Trentini

Dana Trentini founded Hypothyroid Mom October 2012 in memory of the unborn baby she lost to hypothyroidism. This is for informational purposes only and should not be considered a substitute for consulting your physician regarding medical advice pertaining to your health. Hypothyroid Mom includes affiliate links including the Amazon Services LLC Associates Program.


  1. I had a total thyroidectomy 3 weeks ago. I’m on a starting dose of 100mcg of Levothyroxine and calcium supplement. I also am diabetic and take a Metformin and Januvia combination in the mornings as well as Jardiance, and Metformin at night. I also have high cholestrol so take a statin at night. A heart condition also means I take a blood thinner and blood pressure medications usually in the mornings. On top of that I take a Lansoprazole for GERD. As you can imagine timing all these medications around the Levo is a nightmare. I think I’ve cracked it but now I have realised all the diabetes meds are extended release ones. Will this have any effect on the Levo?

  2. Something not mentioned in the forum that my endocrinologist told me that I feel is VERY important: SOY!! Soy in any form can throw a normal thyroid gland into hypothyroidism and mess up your thyroid medication. I am on Armour thyroid but because my pharmacy got tired of having to order it, they put me on a generic desiccated thyroid pill. Noticed my hair was falling out BIG TIME and then the manufacturer (generic drug company) recalled the pills because the full dose was not in the pills. Now my endocrinologist specifies “no substitutions” on my Armour thyroid.

  3. Thyroxine has a half-life of 7-10 days but a much longer biological effect. Once-daily dosing is appropriate.

  4. Sabrina Devulall says

    Thank you for this educating pos, there’s so many things IV been doing wrong. Please can u tell me what is the natural thyroid medication are u on.

  5. Bonnie Hill says

    Vit D needs Vit K 2 and magnesium to be bio available to the cells. Get a 25 hydroxy vit level check. Mine was low and I was taking 4000 unit a day . I had to increase my dosage.

  6. husband takes hypothyroid med but always gets pains in muscles. he takes 50mg of vit. d. He takes 150 mg thyroid medicine. what’s wrong/

  7. Claudia Phillips says

    Thank you for this! I’ve been taking Armor Thyroid for years. I take it with my coffee every morning. I thought that was okay because it isn’t food. Time to make a change.

    • I think taking it with your coffee is ok….Its only if you add a bunch of creamer that may decline absorption. This is just my opinion on how I felt over the years on T4 due to thyroid cancer. Im constantly battling being in a hypo state, but taking it with plain coffee never seemed to cause me an issue. I love heavy whipping creamer in my coffee and that definitely caused me T4 absorption problem (you can just tell by how you feel) so I now just wait an hour then have my coffee

    • I cut out coffee and felt an immediate improvement to my energy levels. I did this after reading that caffeine can interfere with the absorption of Synthroid by up to 30%. I don’t know if the improved energy and moods is due simply to eliminating caffeine, or if the caffeine had an effect on the absorption of my medication, but I feel markedly better since doing so.

  8. Lindsey Maddox says

    “Stop the Thyroid Madness” is a must read if you have thyroid issues.

  9. Kelly McCann says

    Just a fact-checking thing: none of the medicines listed as “Antiepileptic” are for seizures. They are various types of medications used to treat HIV and it’s complications.

  10. Im 42 years old and i had hyperthyroidism for 21 years…just recently been diagnosed to hypothyroidism since beginning of this year…I’ve been noticing the weight gain gradually..what do I need to eat differently…

  11. Could someone please tell me what natural desiccated thyroid is? I’m assuming it comes from an animal? Pig perhaps?

  12. Carol Martin says

    I am on Armour 60mg sometimes my thyroid gets off but change mg until they get back on track. I have to watch bout other medicine that I would take for colds flu or anything cause it throws me into a thyroid storm . Had 3 the last one was from a generic zpack it was a bad one. If you’re going through alot with your thyroids you might need to look into these can be dangerous for u.

  13. I was already aware of the importance of not eating for at least 1 hour after taking my Levothyroxine and not drinking caffeinated drinks. What I am having problems with is finding recipes that are strict hypothyroid. Some sights have recipes that contain foods that are on the do not eat lists. So confusing I have all but given up and eat whatever I want which undermines my medicine. I was also wondering about taking Benefiber halfway thru the day to help with constipation?

    • Heather R Barrett says

      I had horrible constipation problems! I started taking pre and probiotics and it took it right away has never come back.

  14. Shelley Galloway says

    I take mine at bedtime so I can have coffee in the morning. Plus all the vitamins I take just to feel semi normal. Thyroid disease is epidemic and in Canada most doctors only offer levothyroxin which actually makes a lot of patients gain weight. We aren’t treated right and we need to ad I ate for ourselves. I asked to have extensive blood work done but was ignored. I have asked again and my next test will be more inclusive but in Canada they will not test for reverse T3 as its to expensive as I was told. This is a serious disease not to be taken lightly and it is my wish that the medical community in Canada would treat it with the care and concern the patients who suffer from it deserve.

    • Shelley!
      I am in Ontario and reverse T3 is avaiable by GP, cost $30 in LifeLab. As far as I know, If your Cortisol level is normal your reverse T3 will too. Reverse T3 is also included in Comprehensive Thyroid Panel ordered by ND. I wouldn’t take any thyroid medication close to bed time as we needed it mostly for day. From my experience it is important to keep your free T3 and T4 in the middle range and anti thyroid antibodies low to none. Ferritin at normal range too. I went through many GP, Endo, two alternative MD and come to conclusion you better educate yourself than find Dr who fix and understand you. It is a bad horrible problem. So far system win. Find compationed GP they may help you more than Endo and other MD. Good Luck.

      • Hi Dolly
        I agree with you. I’m curious about your mention of Ferritin. I have higher levels than what is considered normal. I never knew this could also have an impact. Do you have more information on this?


      • Heather R Barrett says

        My reverse T3 was normal and the Levethyroxine only took half my symptoms away. Once put on Armour Thyroid all symptoms went away! Im a nurse of 19 yrs. Doctors should not be treating numbers! Treat symptoms and more people will quit suffering!

  15. I asked if you can drink orange juice (no calcium added) when you take levothyroxine instead of water?S

  16. It states in the article, “I now take natural desiccated thyroid
    which contains both T4 and T3 thyroid hormones.” You don’t
    give the name of it? What is it? Armour? If so, you can only
    take Armour if your T3 levels are off, once your T3 is corrected
    you should no long use it and instead have to find another
    thyroid med that helps to continue to balance your thyroid.
    What would that be if it isn’t Armour? Thank you.

    • i too take natural desiccated thyroid… there is no name, it is specifically mixed at a compounding pharmacy to the dosage required

    • Heather R Barrett says

      Thats not true at all. T4 makes the T3 they figure if your T4 is fine then you will make T3. My T3 was normal range and I was still sick on Levethyroxine. My body wasn’t Making enough T3 to bring it all the way through the body. Now that im on Armour i no longer have symptoms. You can’t treats numbers you have to treat symptoms! Doctors need to get away from that and listen to their patients! Ive been a nurse for 19 years and had to fight to get diagnosed for Hypothyroid and then fight to get the Armour. That is why their is a range. Everyone is different. One Thyroid doc i went to womt even treat a patient with meds until they test 10 for a TSH. I was half dead at 7.5 could no longer function.

    • Heather R Barrett says

      I’m not sure who gave you that advice about Armour Thyroid medicine but you should not tell people that. You do not have to go back off Armour once T3 is normal. Mime was normal to begin with. Just because its in range doesn’t mean its enough. Thats what they have a prescription for. Once you find where you feel the best you keep the medication at that amount so your body continues to have enough of a level to do what it needs.

  17. I’ll just start taking the thyroid medication is it OK if I take half in the morning and half in the evening when can I have a cup. A. Coffee help me please

  18. My numbers were only 5 when the physician put me on. I wanted Armour but they substitute any thing and everything. I am only on 15mg. Can’t seem to lose wait. I am ready to take myself off but I am taking Almstead to lose weight but that is not good for the thyroid I just realized. So after this week I want to get off to see if I can lose weight. When I went on the medication I never had any symptoms and have not noticed any different being on the meds.

  19. Thank you for this sight I think I’m the worst and was embarrassed before reading the comments I take
    My thyroid at night because I’ve been now 2 years taking it with coffee and iron pills did not know all of this info I’ve bern reading .can’t tell you how bad I’ve been feeling, seeing my doctor next week

  20. Do any supplements enhance Armor meds? Like magnesium or selenium? If so would it be helpful to take it with the Armor?

    • Heather R Barrett says

      Yes! I take Armour Thyroid. I also take Magnesium, zinc, vit D and Selenium because they help the Thyroid do different parts of its job. I also tale probiotics and no more constipation. I did add the B complex because I was having fatigue still so bad when still on Levethyroxine. Im currently writing a book about all this because so many people have no idea what or how the Thyroid even works. I’ve been a nurse for 19 years. There are so many people still suffering out their its unreal!

  21. I too have been taking Levothyroxide for twenty five years or more. Also on Lansoprasol and Felodopine. This is how I take mine: first the Lansoprasol, 30 minutes later Levoththyroxide. Have breakfast then take the Felodopine. Will be 80 years old next year and have never had a problem. Walk at least 3 to 4 miles a day. Not eaten meat for 30 years but have a lot of fish especially salmon. Beginning to wonder if I have the times all wrong! Maybe if I change them I could walk further! Good luck and good health to you all.

  22. Hi, I know we’re a few years further, but I was wondering if you have any scientific resources on the relationship between anti depressants and the absorption of thyroid meds? I’m pretty convinced the cymbalta I was taking lead to a lower level of thyroid meds and now I’ve stopped the cymbalta, they’re going up. I’ve scanned through the articles at the bottom but couldn’t find it in those. Thx! Your site has been so helpful

  23. I work 4 nights a week how can I find a time to take my tablets regular and on an empty stomachs use

  24. i take my leovothroxine in the morning after i drink my coffee about 45 min to 1 hour is this wrong?

  25. Is it ok to take hormone (estradiol) at the same time as synthroid, or should that be taken apart?

    • Estradiol lowers the effectiveness of thyroid medication, it’s usually best to take 1 in the morning, and the other at night.

  26. I am a Synthroid user, I also have moderate to severe redness on my face. Have been to dermatologist, no diagnosis.could this be connected to thyroid . I have a fourth of a thyroid, due to thyroidectomy. No cancer, just many cold nodules.

    • Probably rosacea if you are British blood, seems to affect us more then others.

    • Hi. I’m wishing good thoughts for everyone here.
      Note, ALL skin rashes especially rosacea are gut drive. Bad gut goes with bad thyroid too. After almost 10 yrs I’m still losing hair but gut cleanse n probiotic helping tons .
      Also watch out for bad med reactions. It’s what threw me off so bad back in 2018. Also note, bad gut can make you develop food allergies. Just start eliminating using th allergy food list. Most common are nut n dairy ( not butter or aged cheese).
      Th rosacea will clear when th gut is healthy again n so will allergies ( including sinus).
      Love n Prayers

  27. I have been taking levothyroxine for the better part of 30 years. I am amazed that anyone taking it is not up to speed on the basics of when to take it. For at least the last 15 years, probably more, the infomation attached to the medication explains you should take it on an empty stomach, first thing in the morning. THe instruction to take it 30 mins to 1 hour before eating, and to take it at least 4 hours before taking antacids or vitamin/mineral supplements is printed on the prescription label on your pill bottle. I know there is more included on the additional material attached to the prescription bag, and since I am not on any other medications, I have not recently read the remainder of the instructions. It is imperative you read the information given to you with your prescriptions!!!

  28. You mentioned Zoloft. How does this interfere? When should each be taken?

  29. Patricia Roche says

    I too take mine in the morning followed by my coffee 30-45 minutes later. I used to wait an hour but heard 30 minutes is okay. Not sure if there’s any problem with it.

  30. I always take the medicine in the morning but first I take the high blow pressure and then an hour later the the levotaroxine

  31. I had hypothyrodism for 18 years and my doctors told me to take my medication on an empty stomach and take it with water 30 minutes before breakfast or 1 hour after I eat.

  32. So i take my synthroid at 6am. Bp at 9am. Other BP at 7pm. I wait to drink decaf coffee and wait to eat usually now about 2 hrs. I still feel like crap and TSH went up to 3.50. Idk what im doing wrong but tired and sometimes feel like breathing is off

  33. I wake up at least one time a night. Therefore, at that time I take my thyroid pill. It is usually 4 hours after eating and 3 hours before I wake up. So, upon waking up, I have my coffee with no fear of causing a problem.

    • According to instructions with my levothyroxin you are to remain upright after taking the medication because if you lie down you may have issues with your esophagus.

  34. If I take my armor thyroid pill first thing in the morning, do I have to wait an hour before having coffee with cream in it?

  35. Good post, thanks for sharing this. I always try to wait at least 30 min before breakfast and never have coffee at the same time. I have heard that some people even put their alarm to take hormone at 5am… and them go sleep again to wake up at 7 and have a breakfast. Sounds a little crazy, but maybe it is not bad idea? 😉

  36. Julie Lesman says

    I have also read, I can’t remember where, that all suplements (vitamins and minerals) should be taken at least 5 hours after thyroid meds.

  37. Rowena Rahman says

    Great and comprehensive. Thank you so much for putting all the essentials together. A follow up question: is there a time gap that one should observe if one is taking levothyroxine and losartan H (a blood pressure med)? Thanks for your insights..

    Best Regards,

  38. Jo Ann Smallwood says

    I’m very interested in learning more about the thyroid!

  39. So grateful for this post. I was actually taking my medication incorrectly, and neither my Doctor or my Physician mentioned the caffeine issue… which I have finally figured out was affecting my absorption of my medication. I have learned so much from this site.

    • I am taking the meds and drinking coffee. I. Started Bleeding but the doctors dont know from where.? Need more info please.

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