Q: On the bottle of my thyroid medicine it says to take it in the morning on an empty stomach. But sometimes I forget and don’t realize it’s still there until after I’ve eaten my breakfast. Is it safe to take it then?
My mother took the thyroid medicine levothyroxine, and her prescription bottle said to take it 30 minutes before breakfast. Every day she worried about what might happen if she didn’t take it “correctly”. If she took her first bite of breakfast and noticed that her yellow levothyroxine tablet was still sitting on the counter, she’d skip her dose for that day rather than risk getting an upset stomach or worse.
“Louise, what if it CAN’T be safely mixed with food? What if taking thyroid medicine with food in my stomach starts a deadly chain reaction and my stomach ruptures?”
“It’s okay, Mom. Your stomach won’t rupture if you accidently take your thyroid medicine at the same time as your breakfast. If you take it with breakfast what happens is your body might not get all of the medicine in that pill. That’s because food can change how much of the levothyroxine your body absorbs.”
“But the label on the bottle says to take it BEFORE breakfast. Are you SURE it’s safe if I take it later than that? I don’t want to get into trouble.”
“You might get less of your thyroid medicine if you take it with your breakfast, but skipping it completely guarantees you’ll get NONE of the dose. ZERO medicine. That can affect you even more than if you messed up and took it with breakfast.”
Levothyroxine is one of the most commonly prescribed medicines in the United States, and it can be hard to remember to take it first thing in the morning.
Kate struggled to take her pills every day according to the directions on the labels. She’d even set her alarm for 6am just so she could take her levothyroxine in the morning before breakfast. Otherwise she’d forget it completely. She took her regular morning pills right after she finished breakfast, then took her blood thinner warfarin at 5pm and her cholesterol medicine simvastatin at bedtime. She had to remember to take her medicines 4 times a day every day and it felt overwhelming.
“I want to take my medicines like the doctor wants me to, but it’s so hard to remember to take all of them every day.”
I suggested she move her thyroid medicine and her blood thinner to bedtime, the same time she was taking her simvastatin. That way she only had to take her pills twice a day, which would be easier than 4 times a day.
When she started taking her thyroid medicine more consistently she felt more energetic and no longer worries about taking her medicine correctly. “It’s such a relief to have less to remember, and I love having more energy!”
Here are some tips on how to take this common medicine:
- There’s nothing that says you must take levothyroxine in the morning. It won’t hurt you if you take it at a different time, like at breakfast or bedtime.
- Although levothyroxine is absorbed better if you take it on an empty stomach (30 minutes to an hour before a meal or 4 hours afterward), as long as you take it the same way every time, you’ll get a consistent dose.
- Don’t just skip your dose if you forget to take it before you eat. Even some of your thyroid medicine is better than none.
- There are some medicines that should be taken 4 hours from levothyroxine: calcium pills, iron pills, or multivitamins with minerals containing calcium or iron. An easy way to do this is to take any multivitamins or supplements with calcium or iron at your lunch or dinner meal.
- If you take thyroid medicine, then if you also take medicine for building bones like alendronate (Fosamax®) take the alendronate FIRST, on an empty stomach and your thyroid medicine at least 30 minutes later.
