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.


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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.


  1. Katy Mitchell says

    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!!

  2. Can I take ambien after taking my thyroid pill at night?

  3. 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.

  4. Jennifer says

    Do these recommendations apply to t3 pills like cytomel as well?

  5. 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!!

  6. I take vitamins. Omega 3, D3, Lactofferrin, B Complex and Biotin. Would these interfere with my Levothyroxine. I also have hashimotos.

  7. Can I just take at night before bed?

  8. 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!

  9. 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.

  10. Thanks for the advice..throid cancer survivor here

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