“Take your thyroid pill every day and you will be fine.” I really wish it was that simple. Do you know there are common prescription medications, over-the-counter supplements, and even foods and drinks that can impact the absorption of your thyroid medication?
Written by Brittany Henderson, MD, ECNU
Regardless of what type of thyroid replacement you use, it’s important to get the maximum benefit from your medication. Food, prescription medications, and nutritional supplements can interact with thyroid hormone(s) and affect the way it’s absorbed. Taking your medicine too close to certain foods or prescription medications can dramatically decrease the amount of thyroid medicine absorbed into the body. Instead of absorbing 100% of your thyroid replacement medicine, which is the goal, various foods and medications can decrease absorption by 20-80%.
In order to get the maximum thyroid benefit and overall health benefit from your thyroid hormone, you should be aware of—and avoid interactions whenever possible.
Your Thyroid Pills & Food
WARNING: This may be bad news for morning coffee drinkers! Coffee (and creamer) can significantly impact the amount of thyroid medicine absorbed into the body.
Several other food groups can also impact thyroid medicine absorption. Be sure to adhere to the following guidelines:
- Always take your thyroid medication on an empty stomach, at least two hours away from food. Even if your prescription label says 30 minutes is enough – trust me, it’s not! If you need coffee to function in the morning, consider taking your thyroid medicine in the middle of the night or at bedtime.
- There are many types of foods/drinks that can interfere with thyroid medication absorption. It’s very important to avoid taking any of these within two hours of your medicine.
- caffeine
- dairy products and creamers
- foods/drinks fortified with calcium
- high fiber foods
- foods rich in iron, magnesium, calcium or other minerals
- walnuts
- soy-based products
Your Thyroid Pills & Prescription Medications
Several types of medications can strongly interact with thyroid hormone supplementation. Some impact thyroid medicine absorption from the gut while others affect the metabolism and/or action of the medicine in the bloodstream. If you have to take any of the following prescription medicines, be sure to take them as far away as possible from your thyroid replacement as possible—at least several hours. It’s even better if you can take them at opposite ends of the day. Because so many medicines affect the absorption of thyroid medicine, a good rule of thumb is to notify your thyroid doctor when any new prescription medicines are added so that he/she can adjust your thyroid dose as needed.
Below is a list of the most common interfering prescription medicines:
- Acid Indigestion Medicines: Cimetidine (Tagamet), Carafate, Prilosec, Protonix, Nexium, and Tums
- ADHD Medicines: Vyvanse, Ritalin, Adderall
- Antibiotics & Antifungals: Ciprofloxacin, Levaquin, and Avelox, Ketoconazole
- Blood Pressure Medicines: Beta Blockers (Propranolo, Metoprolol, Atenolol), Diuretics (Acetazolamide, Lasix), Spironolactone
- Blood Thinners: Aspirin, Heparin
- Cancer Therapies: Ipilimumab, Nivolumab, Octreotide, Pembrolizumab, Sunitinib, Sorafenib, Lenvatinib, y-Interferon, 5-FU
- Cholesterol lowering medications: Bile Acid Sequestrants (Colestid, Questran, Welchol) and Zetia
- Diabetes Medicines: Metformin
- Estrogen & Estrogen Disruptors: Birth Control Pills, Selective estrogen receptor modulators (SERMs) (Femara, Clomid, Tamoxifen, Raloxifene)
- Kidney Medicines: Phosphorus Binders (Renagel, Renvela)
- Heart Medicines: Amiodarone, Aspirin
- IV Contrast: Iodinated Contrast
- Pain Medicines: NSAIDS (Diclofenac, naproxen), Opiates (morphine and derivatives)
- Psychiatric Medicines: Haldol, Lithium
- Seizure Medications: Phenobarbital, carbamazepine
- Steroids: Prednisone
- Weight Loss Medicines: Phentermine
- Miscellanous: Bromocriptine, Levodopa, Methimazole, PTU, Reglan
*Never stop or alter prescription medications without consent from your doctor.
Your Thyroid Pills & Supplements
A wide variety of supplements can affect thyroid health. Here are common supplements that specifically interfere with the absorption of thyroid hormone. If you take any of these, it’s best to wait at least four hours after your thyroid medicine before taking your supplement.
- Calcium: Found in tablets, gummies, and chocolate chews
- Iron: Over-the-counter or prescription
- Magnesium: If you take magnesium at night, you might also get an added relaxation/sleep benefit.
- Soy: I already mentioned that foods made from soy can affect the absorption of thyroid medication. The same is true of other soy supplements including soy-based protein powders and bars.
Final Tips for Optimizing Thyroid Levels
- Try to take your thyroid medication the same time every day.
- Try not to miss any days. But if you do, check with your doctor to confirm if it’s safe to double-up the following day.
- If you take Synthroid/Levothyroxine (only), and morning dosing doesn’t work for you, try taking it at night and let your doctor know. Wait at least two hours after eating.
Don’t let poor thyroid medicine absorption hold you back. Make sure you absorb 100% of your thyroid medicine all day, every day. Make every pill count and live your best thyroid life!
About Brittany Henderson, MD, ECNU
Dr. Brittany Henderson is board-certified in internal medicine and endocrinology, with advanced training in thyroid disorders, including Hashimoto’s thyroiditis, Graves Disease, thyroid nodules, and thyroid cancer. Originally from Cleveland, Ohio, she graduated in the top 10% of at her class at Northeastern Ohio Medical University, where she received the honor of Alpha Omega Alpha (AOA). She completed her endocrinology fellowship training under a National Institutes of Health (NIH) research-training grant at Duke University Medical Center. She then served as Medical Director for the Thyroid and Endocrine Tumor Board at Duke University Medical Center and as Clinical Director for the Thyroid and Endocrine Neoplasia Clinic at Wake Forest University Baptist Medical Center.
She has received multiple prestigious grants from the American Thyroid Association (ATA) and ThyCa (Thyroid Cancer Survivors’ Association, Inc.). Her work has been featured on the cover of Thyroid and in many other scientific journals including Endocrinology, Gut, and Oncotarget. The Charleston Thyroid Center is located in South Carolina.
About Dana Trentini
Hi!! Thanks so much for this article – I jump around from hyper (mainly when I’m breastfeeding) to hypo. Now that we’re done having kiddos I’m back to hypo. Curious – how do we know if the med isn’t absorbing? I’m on armor and a t4 and take my meds at 5am and get up and workout. Do I need to move mine to a different time? Say 830am? I wake up and have coffee and preworkout around 615 so would bumping to later morning be ok? I know before dinner wouldn’t work – I eat dinner at 630 and then a snack at 9. I love to eat haha! Thanks so much for any info!
Good day, I have had a total thyroidectomy, I have been taking Eutirox and I take it at 5:30 in the morning and wait 30 minutes before having breakfast is this time frame long enough a time for absorption to take place.
Can you tell me what your thoughts are on the food you should and should not eat when you have total removal of the thyroid?
Hy, i am on euthyrox too.
For 2 years. First half 50mg/day, 1 year 75mg and i realized i got weight in a year from 55 up to 63 (before i was 55 for 12 years…). This happened when i started gluten free diet ad gave up normals moking and changed to iqos.
I also eat healthy foods an dmore watet, liquid.. So. After a while i felt my thyroids very heawy and it hurt.i had 7 cysts too… So i changed dose back to 50mg and it is much better…i also take it 30 minutes before breakfast, but i thubj i beed 1 or 2 hours…so i just want to te you, it can happen that the dosage can cause also couse the opposite, hyperthyr.
Be careful.
When do researchers discover some tool like in diabetes so we could check our hormones (t3, ft3, t4, ft4, tsh and anti tpo/tg) daily from blood… So we could take the right dosageb/day.. Not more not less.. Terrible.
Hy, i am on euthyrox too.
For 2 years. First half 50mg/day, 1 year 75mg and i realized i got weight in a year from 55 up to 63 kilos (before i was 55 kgs for 12 years…). This happened when i started gluten free diet and gave up smoking and changed to iqos.
I also eat healthy foods and dink more water, liquid.. So. After a while i felt my thyroids very heawy and it hurt.I had 7 cysts too… So i changed the dosage back to 50mg and it is much better…i also take it 30 minutes before breakfast, but i think i need 1 or 2 hours…so i just want to tell you, it can happen that the dosage alos can cause the opposite, like hyperthyr.
Be careful.
When do researchers discover some tool like in diabetes so we could check our hormones (t3, ft3, t4, ft4, tsh and anti tpo/tg) daily from blood… So we could take the right dosageb/day.. Not more not less.. Terrible.
I’m on levothyroxine for 4 years and have gained 35 pounds and can’t seem to shake the weight. I eat lots of greens and eat fairly healthy, I drink lots of water. I’m tired during the day can’t sleep at night. I don’t have much energy, I used to go non stop and never have a problem. My blood levels are good…apparently. I have lost 1/2 of my hair. I was taking biotin but my pharmacist says it will through off the blood levels.
I eat gluten free, dairy free, soy free. It has really helped me. Also, I take collagen I-VII along with Biotin. My hair finally started thickening up alot. It took about 6 months to really see a difference.
I have hoshimoto’s and several other autoimmune diseases. I take my levothyroxine between 2-5am, wait four hours before other meds, wait at least 2-4 hours before eating. Through having to stop vitamins for blood work I realized my hair stopped falling out when I stopped taking vitamins. When I take vitamins I have 2-3 times hair falling out the next day. Not sure why, don’t care, just know it works.
I take my tablet in a morning before breakfast. If I was to start taking it at night time when would I start.
I have Multiple Myeloma and Hashimoto’s. On opiates, 2 thyroid medication, and a maintenance Revlimid. Any suggestions on time too take thyroid meds? Any problem with them
I have a hard time swallowing pills without a bite of food but we are supposed to take it on an empty stomach..I chew it and drink water..is that ok?
Vitamin C dramatically increases absorption of thyroid meds. When my doctor refused to raise my dose of NP Thyroid, I started taking it with Vitamin C so I could get more out of the same dose. Now my Free T4 is high so I will need to cut back on my supplemental levothyroxine. The Vitamin C really works!
How much Vit C do you take? I am going to try this because I feel like my meds aren’t working
This is interesting. I will try vitamin C.
I have been taking Levothyroxcine for 6 years now and I’ve felt fine overall with routine dosage adjustments, however my hairline is receding really quickly and it’s making me panic. Does anyone have any suggestions?
Hello , I’ve just been diagnosed with hypothyroidism and have only been taking levothyroxine for 2months , but I’ve had the symptoms for quite a time including hair loss and my hairline has gone back quite a bit , no one at my GPS surgery picked up on the fact that I could have a thyroid problem until a new Doctor started and ordered blood tests . I have been reading quite a lot about thyroid problems and diet etc , and I’ve just found an article about “collagen “ supplements , tablets and powder , and how collagen can help with hair growth . I am in the process of finding out which is the best to take . I suggest you do some homework and find out all the information you can about the collagen supplements.
I take 4000 Mg of biotin per recommendation of my Rheumatologist. This is for Hair skin and nails. it seems to stop the thinning hair. when the hair loss started up again, I had my thyroid checked and sure enough my numbers changed and had to increase my Levothyroxine…Pay attention to your body, hair loss, emotions, etc.
Hummm, article doesn’t mention which thyroid medication is effected by these foods. I am on Armor thyroid.
All of them.
Does your insurance pay for Amour? Is it costly?
I also take Armour
Thanks for sharing this blog. Thyroid disease is a medical condition that affects the function of the thyroid gland. The thyroid, certain symptoms, and physical changes can be seen. Only a small fraction of the circulating thyroid hormones are unbound or free, and, Higher than normal doses are often administered to prevent recurrence. If you want to know more about thyroid then please visit our blog- blog.astocare.com
Diane, I have a similar issue reading as much as you can and trying new things to heal if things aren’t working. Never give up on your health
I have been taken thyroid medication for 40 years. Now i have hyperparathyroism and ostoporis. Lots of kidney stones and very depressed and tiered. What can i do.
I have graves disease and take levonthyroxine daily@5 am.I was diagnosed in 2016 and still not balanced.I weigh over 200 lbs, lost a lot of my hair and try my best to eat the right foods.The unfortunate part of it all, I never weighed so much and no matter what I do, my weight been
stuck at the same number for 6 months. Sometimes I find muself depressed and the mood swings are the worst.Im also in menopausal window for the past year.I tried exercise(poloties
walking and diet change.Nothing changed and I really don’t know what else to do.Any suggestions please help me if it is so.
I was in the same position. Just lost 45 lb by starting keto. Not sure if you’ve tried this. It isn’t ideal, but I got used to it very quickly. I’m now off of one of my blood pressure medicines and my thyroid level needs rechecked because last month it was actually hyperthyroidism with the same medicine I’ve had for years and years. Will check again and not drink my sparkling ice waters or take biotin which can skew results. I feel a lot better. Nothing ever worked for me, but realized how much inflammation carbs cause for me. Sometimes with thyroid issues you also end up with gluten sensitivities as well. Hope it helps you.
I have Graves and I take armour Thyorid . Some days I feel good and I went from a 7-8 jeans to a 14 16 in about a month. I wish sometime I would of let them cut mine out,because when they killed it with the radiation they killed it all and now I cant grow my hair, never wore glasses. Never been this heavy. I crave sugar. I stay sore and feel like someone has beat me somedays. I cant sleep at night good anymore but once I do get to sleep I can sleep till late in the day and thats not good.Had a hysterectomy a few years ago and now I have a big belly. Seems as I can never win.
I am finding the past couple of years that Amour isn’t working like it used to. I have been losing alot of hair and have the aches and pains etc..Don’t know what to take to feel good.
I am thankful I found this sight to share thoughts and suggestions it is helpful to see what others are doing and to know I am not the only one. With no energy I have put on so much weight and I am finding out it is my metabolism. I hope to find a way to get it stronger. Blessings to everyone
Im on synthroid I take it at 5 am my tsh levels seem to fluctuate. Fasting labs my tsh is really good like 1.63 non fasting im up to 3.59 with 3.74 being high I also have low t3 and they liothyronine didnt make any difference when I was on it. I do have stage 3 kidney disease which I believe can make t3 low. I wanted to up my synthroid by 12.5 mcg’s because im still losing hair and I am super tired and my dr wont do it. I also have Sjogrens Syndrome as well. Im just tired of being tired.
Have you ever been checked for Lupus? You have all the symptoms of it.
All this time I have been taking my Lansoprazole right along with my Synthroid at 6 am then going back to bed until 8ish. My gastroenterologist told me there is zero affect on Synthroid by doing this! My endocrinologist just increased my Synthroid to 175mcg. I am going to switch this to Synthroid at 5 am, Lansoprazole at 6 am then 8ish am smoothie and coffee and see if this makes a difference. That’s why they call them practice’s (as in medical practice) folks! 🙂
This June, I started taking my Armor Thyroid when I get up in the middle of the night to use the bathroom. Best change I’ve made recently!
Hi Susan..I take 120mg of Armour but my weight stays the same! I modelled 20 yrs.weighed 106-110 am 5’10” Had siding put on our house..thought they did a good job! But, 2.5yrs later My Mom died suddenly in my arms as we had just talked about her upcoming BDAY in 6 days! DIDN’T have any medical issues! Siding covered 18 foundation vents! My daughter & I were ordered out of the house 22 days later never allowed back in! Entered a 2 yr.lawsuit then house & ALL contents were torn down hauled away! They sent us to 3 different Drs.3 times! I had never even thought or talked about WEIGHT since I bought the same food my whole life! Didn’t know Anything about Organic but we ate the same foods! My jeans had started to feel tighter! 1st Dr.said I had Mold induced hypothyroidism! Started me on .88mcg Synthroid lost the 30lbs that month..stayed off..then switched me to levothyroxin..anyway I found Dr.Teitlebaum who explained about T4 and T3..My problem us Both of those are T4 and my body won’t allow it to change T4 into T3..the active part! Talked about Armour already being broken down in to both! Worked for awhile as it’s not from food! I’ve never taken in at bedtime so maybe I’ll try that? I have 80lbs on ME! If it were what I ate or the portions..I would change it! But, I get full fast and ear small portions! Anyway, Thank you and I’m going to try taking at bedtime!!
I also take Armor. I am on my 4-5 month at 30mg daily and I take it every morning at 5:30ish and wait 30-45 minutes before taking my blood pressure med(Lisinopril 10mg). I do feel a little better as far as energy levels, but not 100% and my hair is still thinning! Mostly around my forehead/bang area…….. the weight is coming off VERY SLOWLY…. I am so worried about my hair and how to get it back! Any suggestions would be great. I’ve had some ladies tell me they used the means Rogain and it has worked for them, at this point I am willing to try anything!
Men’s Rogain…… I will be 48 this Friday
After reading this article, I started taking mine in the middle of the night — sometime between 12:30 and1:30A and have no problem going back to sleep (if I do, it’s not because of this pill!). My goal is to get this shifted back to closer to midnight on a regular basis so that I have a good 5 hours on either end food/drink free.
Hi! About 5-6yrs ago, I was having a lot of tummy issues and decided to take Tums to help (besides the fact that it would supplement my calcium since I’m lactose intolerant). I started taking it on the afternoons/evenings (around dinner) and I would take my Synthroid 1st thing every morning. In 1 month, my TSH went from 4 to 20! I went to my Dr. and he asked what changed, why did my TSH skyrocketed in just 1 month? I told him the ONLY thing was the Tums I was taking at night but he said that shouldn’t have an impact at all, I could keep taking them. He told me to go back 1 month to repeat the test. I looked it up myself and saw other people who had issues with iron or calcium supplements so I decided to stop taking the Tums. One month later, the TSH was back to the 4 range “within normal range”. When I told my Dr. that I had just stopped taking the Tums he was amazed and advised it’s strange but to find other ways to relieve my tummy issues & supplement calcium. So, based on personal experience, if anyone here starts having issues with TSH after starting any supplements, consider stopping said supplement/vitamins and see if the TSH comes back to normal. I can eat certain cheeses and tolerate some yogurts to supplement my calcium. I’ve since gone gf too which has greatly helped with my tummy troubles.
I’m afraid to take it at night bcus I don’t sleep well. And, won’t it keep me awake. I also, take it with organic coconut water just to have some electrolytes in my system, until I eat something within an hour due to my hyperglycemia.
I take synthroid before bedtime and it’s the best decision I made. I find I sleep better and have more energy during the day. It doesn’t keep me up at all. I don’t have to worry about any food interfering as I don’t eat late.
I want to take my levoxyll at bedtimes but I take night meds as well at about 10:00 pm
So should I move my meds to 8:00 pm?
Does taking Levothyroxine at night cause you to gain or lose weight?
I’m prescribed levothyroxine 100mcg. I take simvastatin amlodipine in the morning I take lyrica three times a day a klonopin at night. I’d also like to take vitamin b12 calcium 600+d3 vitamin e and melatonin. My thyroid seems to come back ok. I don’t feel any different taking the snythroid or not. I’m tired all the time but I also have fibromyalgia. Could u give me the right time I could take it to get the full effect? I only go to a family physician.
If I switch from taking my Armor Thyroid in the morning to taking Armor Thyroid at bedtime , Is there a recommendation regarding how many hours after dinner it would have to be in order for optimum absorption?
Do you sleep well, doesn’t it affect your sleep?
I have always been told that caffeine did NOT affect my levothyroxin! Wow! I may need to switch to taking my levo at night right before bedtime. We normally eat early, so this would be about 3-4 hours after eating. BUT, I’m also taking trazodone for insomnia around 8:00 PM which says to take with food, and Tamsulosin at 8:00 PM which is supposed to relax my ureter (bladder issues). What food can I take at 8:00 with the trazodone that won’t impact the levo? And does the trazodone or tamsulosin affect the levo?
I had started out taking Levothyroxine and couldnt tell any difference in how I felt at all!! Then I read on the internet somewhere where some people need to be on a t3 and t4 med like Np thyroid, so I asked my doc to change it and she did. But Instill cant tell any kind of difference. I have refractory epilepsy and im currently on Briviact, Onfi, Lyrica, and Medical cannabis which does absolutely NOTHING for me!! I take my thyroid at 5:25am and all my other meds at 9:30am. I never have energy, always feel tired. I have to make myself clean and cook for my family. Oh and im on Amitryptiline for sleep and Buspar for anxiety. I forgot those…which reminds me my memory is awful and feels like it gets worse everyday! Whether its the seizures I have everyday, medications, and thyroid issues, I dont even know which way to go, if that makes any sense? Indont and cant work because of my seizures and use to take b12 thinking that would give me energy but it did the exact opposite which doesnt make any sense at all either. I feel like im just a “lost cause” nobody knows what to do with me anymore.?? Im about to start a clinical drug trial for Alprazolam Inhaler for refractory seizures. I try to keep my mind busy by crocheting but i dont know??? Forgot what else I was going to say, I apologize! Anybody have any suggestions? Thank you!!
A methylated b complexed helped my energy more than just b12
If you could get something other then xanax thats works, please do. Alprazalom is poison, very addictive and a hell, living nightmare to get off of
Can I take ambien after taking my thyroid pill at night?
I was taking mine at night and was having better luck with it. However, I started taken CBD oil and started having absorption issues and switched to taking my thyroid meds in the morning. CBD oil might need to be added to the list of supplements that block absorption, especially if you’ve had a TT like me.
I wondered about CBD oil and thyroid meds. What type of absorption issues were you having?
Do these recommendations apply to t3 pills like cytomel as well?
I was diagnosed with Hashimoto’s Thyroiditis almost 20 years ago. I’ve always had a difficult time getting in under control and a couple years after the diagnosis was up to over 150 mcg Synthroid. 5 years ago I was dx’d with Celiac disease which makes absorption much more difficult and I’m now at 250 mcg. I still don’t feel symptom free. I’d never heard of taking the med before bed so will start that tomorrow. Any other suggestions would be appreciated!!
I take vitamins. Omega 3, D3, Lactofferrin, B Complex and Biotin. Would these interfere with my Levothyroxine. I also have hashimotos.
Can I just take at night before bed?
They put me on 150 ml of Armor Thyriod meds but I just can’t get my energy back I was put on this after levoxyl, didn’t work for me after total thyroidectomy. They put me on Klonopin 1mil 3 times a day for the severe anxiety I get now. I have hashimoto’s also. No matter what they do they can’t balance my levels. My weight is out of control. Please help!
Your on klonepin that might be contributing to your low energy
I’m on Klonipin as well, but I take it PRN as I noticed it also decreased my energy. Sadly it’s a catch-22.
I am definitely changing the time I take my thyroid pill. I did not realize the need for the two hour gap. This might just be the answer for me. Thank you SO much for posting this article.
Thanks for the advice..throid cancer survivor here