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Originally published on 7th November 2016 Last updated on 20th February 2019
How difficult can it be, to take your thyroid medication correctly? You just swallow the pill with water and that’s that.
Advice on how to take your thyroid medication, whether given by doctors, pharmacists or even on medication box leaflets, can be confusing and contradicting. Let’s explore various factors that can influence our thyroid medication and how best to take it, so that you’re getting the most out of it as possible.
Most of us read the leaflet that comes with a new medication, paying particular attention to the listed side effects and interactions section, but not everyone.
Aiming for Optimal Absorption
It’s important to be aware of how other things you eat, drink or medications you take, can affect the absorption and effectiveness of your thyroid medication.
You should always take your thyroid medications at least one hour away from any other food or drink (excluding water) and medications and four hours away from supplements and medications containing calcium, oestrogen, magnesium and iron (including antacids and antibiotics). Not doing so can affect how much of the thyroid hormone in your medication you absorb, meaning you’re not getting as much as you should be.
It is also worth noting that coffee has been reported to affect the absorption of T4-only thyroid medication which is why thyroid patients need to wait at least an hour after taking their meds before drinking any tea or coffee, too. 
I personally would avoid all caffeine within an hour of taking any thyroid medication, not just Levothyroxine, to be on the safe side. To get around this, an option could be to take levothyroxine medication at night. Some studies have shown that taking levothyroxine at bedtime may improve absorption. It also allows for you to have your morning cup of coffee without worrying about it affecting your thyroid medication. 
Studies show that there may be a link between absorption of levothyroxine and grapefruit juice, too, so ensure you eat the occasional grapefruit at least a few hours away from taking your thyroid medication.
Timing is Important
You should also aim to take your thyroid medication at the same time every day, and if you take T3 containing thyroid medication, this is often multi-dosed throughout the day.
However, I multi-dosed my NDT for a few years and then recently went back to taking it once a day and saw no difference in how I felt at all. So for now I’m taking it once a day as it’s easier to manage.
If you’re on T4-only medicine such as Levothyroxine or Synthroid and still feel unwell, then you’d probably benefit from the direct T3 found in NDT and synthetic T3 medication, so discuss this with a doctor. See a list of thyroid medication options here.
Check The Date
Your medications can also become less effective if they’re past their expiry date, so always check the date when you’re first given them and make a mental note (or physical note) about when it’ll need replacing.
Never Miss Doses
Ensure you never run out and never miss or skip doses as this can cause you to feel unwell as hypothyroid symptoms creep back in.
Stopping thyroid medication altogether can be life threatening.
Pay Attention To Brand
If you’ve been prescribed a specific brand or type of thyroid medication which is working for you and you get on well with, then make sure that you’re always given the same one, as some thyroid patients are given a generic substitute in place of their usual and end up feeling unwell again.
Do you follow any of these?
You can click on the hyperlinks in the above post to learn more and see references to information given.
Jacqueline McDonaldOctober 27, 2020 at 11:28 pm
Thank you for this information, I have been taking Thyroxine for approximately 10 years but have been having a cup of tea within 15 minutes of taking medication in the morning. I suffer quite badly with fatigue and I don’t sleep very well either so I am going to change taking my meds before bedtime and see if it makes a difference. I can then take my supplement vitamins in the morning. Thank you so much for information. By the way Rachel I have just purchased your book ‘Be your own Thyroid Advocate’ which I’m sure will be very informative for me.
DebSeptember 20, 2020 at 12:34 am
I didn’t know this about caffeine and my prescription only says wait 30 mins but recently I accidentally bought caffeine free tea and do feel suddenly better. Could this make a difference please?
CazMarch 22, 2020 at 5:54 pm
I’ve been on Levothyroxine for 12+ years now and I used to take it first thing in the morning. About 3-4 years ago I was reading a similar article to this that Rachel had written, looking at foods that could affect the medications efficacy and best times to take. After reading I decided to change taking my meds to before bed with a glass of water. It took a few months, but I noticed (for me anyway) that I felt I had more energy. My body didn’t feel so heavy when I got up. I sleep better because I feel better. In the long run you have to look at your lifestyle and work out what is going to be best for you. I also used to take supplements (B12, Cod Liver Oil and Iron), but I get enough now through the foods I eat.
Thank you Rachel you’ve helped me to adjust and accept and been an inspiration. Stay well in these trying times.
Debbie SmithAugust 26, 2018 at 6:50 pm
So .I take nature throid and do so sublingually in am when I wake ..it is my understanding that it bypasses stomach which us why I take it this way and it stopped my nausea…do I need to wait for my cup of tea since I am absorbing it via blood vessels under tongue into bloodstream? Do I need to wait for anything really?