Q: My husband takes a thyroid medicine called levothyroxine. He went to his doctor last week because he’d been feeling tired and the doctor told him it’s because he’s taking his thyroid pills wrong. All these years he’s taken it with his other morning pills at breakfast, but now he’s supposed to take it 30 minutes BEFORE his breakfast instead. He’s tried to make the switch but it’s really hard for him to remember to take it first thing in the morning. Is there anything we can do?
Levothyroxine is a very potent medicine; even small changes in the dose can create big differences in how much energy you have. How much levothyroxine you need can depend not only on how much medicine is prescribed by your doctor, but also on HOW you take those pills. Your husband may not be getting the entire dose of his thyroid medicine because food can interfere with the ability of levothyroxine to get into your body.
Like most medicines, in order to do its job levothyroxine must first get into your body. It needs to jump from a pill sitting in an amber prescription bottle all the way into your thyroid gland, where it works to support your metabolism and give you energy.
When you swallow a pill it doesn’t magically dissolve in your stomach and do its thing right then and there. Most medicines need to get into your bloodstream first before they can get to where they need to go and do what they are supposed to do. Although your pills dissolve in your stomach they can’t jump into your body from there. Instead, medicines and nutrients have to leave your stomach and move into your small intestine before they can be launched into your body.
Your small intestine is a busy place. Its walls are covered with blood vessels and specialized cells designed to transport nutrients and medicines into your bloodstream, where they get carried on throughout your body and delivered to where they need to be, like levothyroxine going to your thyroid gland.
The process of medicine going from a pill you swallow to entering your bloodstream is called absorption. Some medicines are better at being absorbed than others. While many medicines are completely absorbed after you take them, other medicines like levothyroxine can run into trouble along the way, resulting in less of it getting into your body and doing its job.
Your husband will get more consistent results from taking his levothyroxine on an empty stomach because food and certain minerals can attach themselves to it and prevent it from making the trip through the wall of his small intestine into his bloodstream and on to his thyroid gland.
But the most important thing of all is taking it consistently, every day, the same way. His doctor will use blood tests to adjust his levothyroxine dose if he needs more.
Here Are 5 Tips For Best Results When Taking Levothyroxine:
- Levothyroxine is absorbed best on an empty stomach, either AT LEAST 30 minutes before a meal OR 3-4 hours after you’ve finished eating.
- If you have trouble remembering to take your levothyroxine first thing in the morning, try taking it at bedtime instead, as long as it’s been at least 3 hours since your evening meal. Taking it at bedtime may be easier to remember than taking it all by itself in the morning, especially if you take other medicines at the same time.
- If you forget to take your levothyroxine before breakfast, go ahead and take it anyway. Don’t worry, your stomach is not going to blow up, your intestines are not going to fall apart and your thyroid is not going to die. If you take levothyroxine with your meal you may not absorb the whole dose but if you skip entirely it you won’t get ANY of it absorbed! And that’s worse.
- If trying to take levothyroxine on an empty stomach is too complicated to do, don’t panic. It’s perfectly okay to take levothyroxine with your breakfast or other meal, as long as you take it that way all the time. Many patients are perfectly successful taking levothyroxine because they ALWAYS take it with their breakfast and don’t skip any doses.
- If you take calcium or iron supplements, don’t take them at the same time as levothyroxine. These minerals can significantly reduce the amount of levothyroxine that you absorb, so it’s best to separate them by at least 3-4 hours.
