Make Every Thyroid Pill Count!

Make every thyroid pill count

“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 EndocrinologyGut, and Oncotarget.

Her clinical practice is located in sunny Charleston, South Carolina and is called The Charleston Thyroid Center. Along with her co-author Allison Futterman, Dr. Henderson wrote the book What You Must Know About Hashimoto’s Disease: Restoring Thyroid Health Through Traditional and Complementary Medicine.

READ NEXT: WHAT YOU MUST KNOW ABOUT YOUR THYROID MEDICINE: FALSEHOODS, FORMULATIONS & FILLERS

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About Dana Trentini

Dana Trentini M.A., Ed.M., 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.

Comments

  1. lois semones says

    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

  2. Michelle says

    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.

  3. Karen Felton says

    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! 🙂

  4. Susan D Skinner says

    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!

  5. 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.

  6. 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.

  7. 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.

  8. Renee Givens says

    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.

  9. 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?

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