What is the best times for me to take levothyroxine and liothyronine given that I can't take them two hours before eating in the morning?


I recently joined your club. I have read many times that thyroid meds should be taken at least 2 hours before and after any food or drink except water.

I have been on levothyroxine 100 for the past 13 years and on liothyronine 20mg, three times a day for the past 8 years. In spite of seeing four consultants in that time and several doctors, I have never been told that.

My problem is that I take my levothyroxine and first liothyronine tablet as soon as I wake up. But I am always really hungry in the morning and I have to eat almost immediately. If I don't eat, then I feel really unwell ( muzzy, headache, stomach pains etc ) and this lasts all day.

Any suggestions on how to take my meds would be appreciated. Is there a better way?

I thought getting really hungry as I always do - having to eat something every 3 to 4 hours was part of my hypothyroidism and was normal. I haven't had blood tests for over two years - my last tests showed I was "over medicated" and had argument with my doctor when I refused to reduce either or preferably both meds. I had previously tried reducing levothyroxine and then liothyronine. I was really unwell both times with different problems. I changed doctors and my present doctor has been very helpful. He allowed me to continue with the same doses - insisting on a test for brittle bones, which was normal. But we've agreed to avoid blood tests.

I was diagnosed with a vitamin D deficiency last year. I have read that vitamin D deficiency causes inaccurate tsh test results.

Since I am now taking vitamin D supplements, is it safe for me to have blood tests again?

13 Replies

  • You are doing fine, taking your levo/T3 first thing before breakfast. You only need to wait 30 minutes/1 hour before eating. Take them with 1 glass water.

    Some people have found that taking a dose at bedtime suits them better and the two hour gap is for the night-time dose and then you should have nothing to eat for 2 hours before taking the meds.

    You are doing the right thing in not allowing them to adjust your dose of meds due to the TSH. It should always be on how you are feeling and clinical symptoms.

  • I don't think the before meals and water apply to the t3, only T4. So, as suggested above why not take T4 at night and t3 in the day?

    If your Dr wants to reduce again, perhaps you could reduce T4 and increase T3, but it would be useful to see your FT4 and FT3 levels first. Do you have the last test results?


  • I agree with Shaws, that taking the Levo at bedtime is a good way to get round the food problem in the morning.

    The T3 on the other hand is something which many people feel they need to take in the morning rather than at night because it is the time at which nature would give a boost of T3.

    While there is no doubt that T4 has to be takne away from food, interestingly no-one seems to have any evidence about T3. you might like to read this blog and the answers:


    Maybe you could take the T3 with a drink before you actually get out of bed in the morning, and then eat immediately you get up.

    It seems that people do it many different ways with the T3, and you may find this helps you, by taking the T4 at night but the T3 in the morning first thing. Some people even find that T3 at night helps them sleep - others say the exact opposite!

    Difficult, isn't it? We are all so individual.

    Hope that you can get some ideas from these answers.

    Marie XX

  • Thanks for that, I'll switch T4 to evening. I thought rule applied to both meds.

    Unfortunately, I can not wait even 30 mins to an hour before eating. I am really hungry when I wake up.

    Doctor will not consider increasing either of them - I tried that quite forcefully. I don't have any test results. I haven't had any thyroid tests for over two years. I did ask for my test results after the last blood test and I was refused - "they are never printed out for patients". I was given result verbally but did not have a pen and paper with me. I tried to get them over the phone the following day, but was told results are only given out by one of the doctors. Not terribly helpful, but only surgery in my village.

  • What you will find if you look around the internet is many places which have clearly based advice about T3 on what is known about T4. So it frequently looks as if the same is true for both.

    This seems a reasonable start point, but I have never found any proper research on T3 absorption with/without food, etc. Without anything else to go on, that does not seem unreasonable, if only as warning of what the effects could be.

    It is bad when otherwise good sites simply repeat the T4 advice but don't tell you that is what they have done.


  • Thanks Marie, but I have to take liothyronine three times a day. I was told to space them as near every 8 hours as possible.

    I currently take levothyroxine and first dose of liothyronine as soon as I wake up and am still in bed ( about 8.00am ). I then eat breakfast within ten minutes of taking the meds - I shower and dress after having eaten as I get so hungry.

    I take the second dose of liothyronine as near 3.30pm as I can.

    Then take the last dose of liothyronine whilst in bed before I put the light out.

    I can't see how it is possible to vary when I take liothyronine. I can try taking levothyroxine last thing at night.

  • Hi dizzy at the moment I take 25mcg of t4 in the morning dissolving it under my tongue. I then take 60mcg of t3 at bedtime and sleep all night most nights. When I was taking my t3 during the day I always got palpitations when I needed my next dose but I don't get that now. Feel pretty good. The doctor did tell me to take my t3 in split doses but I didn't like it plus I kept forgetting about the times hence the palpitations.

    Jo xx

  • I think to take the T4 at night and then the T3 spaced through the day sounds very practical, at least the T4 would be well away from food, which makes for better absorption. I agree that you cannot change the times of the T3 especially if it suits you that way.

    If you do try the T4 at night, do please come back and let us know how you get on.

    Marie XX

  • Blimey.... that sounds like a right palava.... I would have problems remembering all that myself. I also take 20mcg Liothyronine but take the whole tablet on waking with 100mcg Levo. I then get ready for work and have breakfast about 45 mins. after taking them and all is well.

    My consultant said that it was ok to do this after my GP and pharmacist put the fear of God in me about having to chop the pills up etc. Well I tried.... but most of it pinged across the floor and after doing some research, decided to just take it in one go instead.

    My biggest problem was the GP trying to go against what my consultant said by starting me off on 75mcg Levo instead of 100mcg.... after he introduced Liothyronine into my routine. As a result, I felt like complete sh*t.... but it's all sorted now :-)

    Hope you manage to find a way forward that suits you :-)

  • I am surprised about the way people on this site take T3. I was told by doctors and a consultant that Liothyronine is absorbed quickly by the body and it's affects only last 8 hours. Hence, the advice that they gave me to take my 60mg in three doses every 8 hours. Yet, many people seem to be going against this and taking one big dose.

    Until I found this site, there was no real information available anywhere in this country as the NHS web site only gives out information to medical staff and not the general public.

    In the U.S. at least all information is made available to everyone.

    Surely, it's time that proper research was carried out into the affects of hypo and hyper thyroidism and the correct diagnosis levels and treatments. I believe that this information should then be made available on government websites to ALL interested parties and not just medical personnel. There seems to be an ever increasing number of people suffering unnecessarily because they have not been diagnosed. I suffered for nearly 4 years before being diagnosed by a consultant that was prepared to, "bend the rules". I thought I was a rare case and was shocked to find out later that I was the norm.

    Unfortunately, there's no sign of this happening any time soon.

    When I've had arguments with doctors and consultants about my dosage levels, I've had to use info from U.S. sites, which they claim are irrelevant.

    I wonder if the refusal to set acceptable standards for tests is more to do with economics than medical need. A thyroid diagnosis means free prescriptions !!!

  • dizzy864, I know it's been awhile since your post, but I just wanted to comment about how hungry you feel in the mornings. I wanted to tell you my experience and maybe it will be helpful to you. When I eat fairly clean and healthy throughout the day, i.e. not eating a bunch of junk, then I don't feel a whole lot of hunger the next morning until a few hours after I wake up. Whereas, when I eat a bunch of junk, bread products, candy, cookies, etc, the next morning I'm completely ravenous. I don't know what the physiological reason is for this, since I'm obviously not 'starving' - I've still got all that crap in my belly from the day before - I suspect it's to do with the blood levels of ghrelin and other things that cause my brain to THINK I'm 'hungry'. Anyway I recommend you review your eating habits, just as one way to try and identify why you're so hungry in the morning. If you're eating a bunch of junk, or maybe even stuff your body is sensitive to, try cutting it out or cutting down on it for a week or two and I think you'll notice a difference in how hungry you are in the morning. Good luck!

  • Hi, Thanks for the suggestion. Unfortunately, it does not apply in my case as I never eat junk food. I am vegetarian so no fatty fry ups! I have never had a sweet tooth so don't eat, sweets, cakes biscuits etc. more than very ocasionally.

    I eat lots of fruit and veg. I found several years ago that bread is one thing that really upsets my tummy although I've no idea why this should be. So I rarely eat bread and never more than once a week. I've also found as I get older that alcohol also upsets my tummy so I do drink less than I used to. I do eat pretty similar foods every day so that at least explains why I am hungry every morning.

  • Hi, I used to wake up hungry every morning. Since keeping a bottle of water at the side of my bed and drinking anytime I woke up this is no longer a problem. I have my tablets as soon as I waken with a cup of either hot or cold water. I truly believe I was dehydrated and not hungry. Some of your other symptoms could also be caused by dehydration. I am now able to take my time before needing breakfast. I take Liothyronine 20 mcg in split doses. One on wakening and the other before 2pm avoiding lunch. I take Thyroxine on waking too before getting out of bed. My GP is checking alternative time to take Thyroxine. I have read a study that says it is absorbed slower at night therefore more effective.

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