What time should I take my Levothyroxine?

on Wed 19 Aug

Despite levothyroxine being the treatment of choice for those with an underactive thyroid there are few guidelines in term of timing.


Patients are usually advised that the drug should be taken on an empty stomach and preferable 30 minutes before breakfast.  But for some people this is tricky, particularly when they may be on several other medications requiring similar restrictions.


Some studies suggest that it’s actually the length of time before eating which is more important than the time of day it is taken.


Might thyroid hormone levels be optimised by taking levothyroxine just before bed on an empty stomach?


A trial involving 90 patients with primary hypothyroidism saw them receiving levothyroxine either in the morning or in the evening with a switch after three months.


Results showed that taking Levothyroxine at bedtime actually improved thyroid hormone levels compared to taking it in the morning.  There was a reduction in serum thyrotropin (TSH) of 1.25 mIU/L and small increases in free thyroxine (T4) and total triiodothyronine (T3) concentrations.


Whether such small changes in serum TSH have any clinical impact in patients on levothyroxine is still uncertain. Despite the change in thyroid hormone levels, the patient quality of life and other secondary outcomes didn’t differ and it’s possible that a longer duration of study is required to demonstrate any benefit.  


However, bedtime levothyroxine intake may be more convenient for patients and will therefore enable greater compliance.


If a dose is missed on one day you can always take double the dose the next day. If you take double the dose one day you can miss the dose the following day.


In summary it is advised to take levothyroxine on waking with a glass of water half an hour before breakfast to maximize absorption. In some people the timing may not be so important and the key thing is remembering to take the dose daily. 



Although every effort is made to ensure that all health advice on this website is accurate and up to date it is for information purposes and should not replace a visit to your doctor or health care professional.

As the advice is general in nature rather than specific to individuals Dr Vanderpump cannot accept any liability for actions arising from its use nor can he be held responsible for the content of any pages referenced by an external link.


acanthosis nigricans Acromegaly Addison's disease adolescent diabetes problems adolescent thyroid problems Adrenal crisis adrenal fatigue Adrenal glands Anovulation artificial pancreas Autoimmune Thyroiditis Bariatric Surgery blood glucose levels blood pressure breastfeeding CAH Charcot foot cholesterol CHT coffee cold and flu medications Conception Congenital adrenal hyperplasia congenital hypothyroidism Consultant Endocrinologist London coronavirus cortisol covid-19 Cushing's disease Cushing's syndrome Depression Diabetes diabetes and bone health diabetes and heart health diabetes and oral health diabetes and parkinsons diabetes and sexual dysfunction diabetes and skin conditions diabetes and thrush diabetes in China diabetes insipidus diabetes latest diabetic ketoacidosis diabetic neuropathy Diabetic prevalence diabetic retinopathy diet for diabetes diet for obesity Disability Act Down's Syndrome Dr Mark Vanderpump e-consulting endocrine system fertility folic acid Freestyle Libre frozen shoulder and thyroid Fruit sugars gestational diabetes Gigantism Glucose Monitoring Glucose Tolerance Test gluten free Goitre Graves Disease Graves Orbitopathy guthrie test hair loss Hashimoto's Disease healthcare services hearing loss Heart Disease heel prick test Hepatitis C Hormones - most important how to lose weight hyperparathyroidism Hypersecretion Hyperthyroidism hyperthyroidism and respiratory problems Hypocalcaemia Hypogonadism hypoparathyroidism hypophysitis Hyposecretion Hypothyroidism hypothyroidism and respiratory problems IFG IGT immunotherapy side effects Impaired Fasting Glucose Impaired Glucose Tolerance Insulin Resistance Iodine IR iron Labour and birth late onset hypogonadism Levothyroxine Long Covid losing weight Low testosterone Mark Vanderpump MEN1 MEN2 menopause metabolic syndrome mood changes morning sickness Multiple endocrine neoplasia neuroendocrine tumour neuropathy Obesity obstructive sleep apnoea older patients online doctor OSA Osteoporosis overactive thyroid ozempic Pancreas Pancreatic Cancer Pancreatic Diabetes parathyroid glands Patient Resources Patient Support Groups PCOS PCOS and acne PCOS and fertility PCOS and Insulin PCOS diet Phaeochromocytomas Pituitary Gland POF Polycystic Ovary Syndrome Post menopause thyroid problem Post pregnancy thyroid problem postnatal diabetes medication postnatal thyroid medication Prader-Willi Syndrome pre-eclampsia prediabetes pregnancy Pregnancy and Diabetes Pregnancy and Thyroid Disease Premature Ovarian Failure prolactinomas PTH puberty Radioactive Iodine RAI resistant hypertension semaglutide Sheehan's Syndrome Skin tags sleep and diabetes sleep and obesity soy Soya steroid dependent subacute thyroiditis T4 Tara Palmer Tomkinson testosterone Tetany The endocrine system Thyroid thyroid and menstruation thyroid cancer Thyroid disease in children thyroid nodules Thyroid Storm thyroid tests Thyroiditis Thyrotoxic Periodic Paralysis Thyroxine TSH levels TSH Testing tumours Type 1 diabetes Type 2 Diabetes Type 3 diabetes underactive thyroid Vitamin B complex Vitamin D Waist circumference weight gain weightloss

Please get in touch

Phone: 07565 978310

Contact form