Optimizing Levothyroxine Absorption by the Body
What is Levothyroxine?
If you have an underactive thyroid (also known as hypothyroidism) taking your levothyroxine medication correctly is crucial to maintain optimal thyroid health. Levothyroxine is a synthetic hormone that acts as a substitute for your thyroxine hormone when your thyroid doesn’t produce enough of it. It is available under several brand names, including Synthroid, Euthyrox, Unithroid, and Levoxyl.
How Should I Take My Levothyroxine?
Always follow your healthcare provider's advice on how to take your medicines. In general, you should take your levothyroxine early in the morning, on an empty stomach. You should swallow your tablets or capsules whole with a drink of water. In case you have difficulty swallowing, your healthcare provider might prescribe you levothyroxine in liquid form. Ideally, you should wait at least 60 minutes after your morning levothyroxine dose before having your breakfast or any drinks like coffee, tea, or some sodas.
Some other foods don’t mix well with levothyroxine:
- Calcium-rich foods like milk, cheese, yoghurt, or foods that are fortified with calcium can reduce the amount of levothyroxine that your body takes in. You should try to leave at least 4 hours between your levothyroxine and these foods.
- Soy foods or supplements may stop levothyroxine from working properly so you may have to reduce your intake and also increase the time between your medication and soy consumption. If you consume soy regularly, your healthcare provider might ask for extra blood tests just to make sure that you are getting the right amount of levothyroxine.
- Kelp (a type of seaweed) contains very high levels of iodine and may be bad for your hypothyroid. You should avoid kelp if you are on levothyroxine.
Some medicines should not be taken at the same time as levothyroxine as they could interfere with its absorption:
- Antacids
- Calcium
- Iron
- orlistat, a medicine used for weight loss
- sucralfate, a medicine used to treat stomach ulcers
- some cholesterol-lowering medicines such as colestyramine, colestipol or colesevelam
Have a chat with your healthcare provider about deciding how much time to leave between your levothyroxine dose and these medications. Always consult your healthcare provider before making any changes to your medication timings.
An ideal levothyroxine intake practice ensures that your body adequately absorbs the medication.
What Happens if I Miss My Levothyroxine Medication One Day:
If you miss a dose, take it as soon as you remember, unless it's close to your next scheduled dose. If that's the case, skip the missed dose and continue with your regular dosing schedule. Avoid taking two doses at once to compensate for a missed dose. Consider setting an alarm to help you remember your doses if you frequently forget.
Can I Take My Levothroxine Medication at Bedtime?
Guidelines given by the American Thyroid Association recommend dedicating at least 60 minutes after taking your levothyroxine before proceeding to breakfast. While these guidelines are intended to push for the better absorption of levothyroxine, they sometimes can pose considerable practical challenges to some hypothyroid patients.
A recent study has shown the benefits of bedtime ingestion of levothyroxine. Bolk, N., et al. (2010), conducted a randomised clinical trial that showed taking levothyroxine at bedtime resulted in better absorption than taking it before breakfast. This confirms that taking levothyroxine at different times can result in varying levels of thyroid hormones in the blood, emphasising the need to take it at the same time every day. This study also confirmed that taking levothyroxine at bedtime is an effective alternative to taking it before breakfast. A more recent 2015 study by Ala, S., et al, revealed that changing levothyroxine administration from before breakfast to before dinner only minimally reduced the therapeutic efficacy of levothyroxine for hypothyroidism patients. If you are finding it difficult to take your levothyroxine medication in the morning, talk to your healthcare provider about switching it to before bedtime.
Boosting Accessibility with Liquid Levothyroxine
Cappelli, C., et al. (2016) showed that liquid levothyroxine might offer more flexibility to patients in terms of dosing time. In their trial, they found no significant difference in thyroid function tests when taking liquid levothyroxine at breakfast versus 30 minutes before, irrespective of breakfast composition. A recent systematic review by Ducharme et al. (2022) found that new formulations of levothyroxine, in particular liquid formulations, can be taken simultaneously with drugs thought to interfere with the absorption of levothyroxine tablets. They reported that soft gel capsules need more studies to support this claim. Guglielmi, R., et al. (2018), also attest to the benefits of the liquid form of levothyroxine. They studied the impact of switching patients from the tablet form to the liquid one, taken at breakfast instead of an hour before it as needed for the tablets. They found an improved quality of life among the patients due to the ease of compliance brought by the liquid form.
With these insights at your disposal, if you find yourself constantly struggling with waiting an hour before breakfast after medication, considering Tirosint-SOL might be a step in the right direction. Consult your healthcare provider if this is right for you.
Navigating Cost Implications
Despite the convenience and increased absorption rates posed by liquid levothyroxine, you might run into hurdles with your insurer. However, the Dispense as Written (DAW) prescription might come in handy when making a case with your insurer.
At Eureka, we dedicate ourselves to offering free recommendations to improve thyroid health. We urge our cherished readers and everyone in society to optimize thyroid function, a pivotal measure in relieving unresolved symptoms. Consider planning a consultation with us or getting a home thyroid test kit from Eureka for a convenient thyroid check in the comfort of your home!
References
- Effects of evening vs morning levothyroxine intake: a randomized double-blind crossover trial by Bolk, N., et al. (2010). This study explored the difference in thyroid hormone levels when levothyroxine is taken in the evening versus the morning, suggesting that evening ingestion may be more beneficial for some patients. Read more.
- Dose administration time from before breakfast to before dinner affect thyroid hormone levels? by Ala, S., et al. (2015). This study evaluated the effects of changing levothyroxine administration from before breakfast to before dinner, showing minimal but significant changes in TSH and T4 levels. Read more.
- A Double-Blind Placebo-Controlled Trial of Liquid Thyroxine Ingested at Breakfast: Results of the TICO Study. by Cappelli, C., et al. (2016). This trial explored the efficacy of taking liquid levothyroxine at breakfast versus 30 minutes before, finding no significant difference in thyroid function tests, suggesting flexibility in dosing time. Read more.
- Liquid levothyroxine formulations in patients taking drugs interfering with L-T4 absorption by Ducharme et. al (2022). This review described the literature on thyroid hormonal profile in patients on liquid L-T4 therapy and drugs known to interfere with L-T4 absorption. Read more.
- Shift from Levothyroxine Tablets to Liquid Formulation at Breakfast Improves Quality of Life of Hypothyroid Patients by Guglielmi, R., et al. (2018). This study assessed the impact of switching from tablet to liquid levothyroxine taken at breakfast, finding improved quality of life due to easier compliance. Read more.
