Thyroid UK
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a little help please

I have just been diagnosed with an under-active thyroid and have started the process in getting my medication right. But i also suffer from severe heart burn and have been on omeprazole for two years. When i questioned a nurse about this medication cancelling out the other i was told that as long as there was half hour between taking the medication then it would be fine. But two separate chemists have told me that it should be more than four hours. Who do i believe. Even the warnings that come with the medication say no to omeprazole but are you not supposed to believe your doctors and nurses. Help !!!

7 Replies


I'd go with the pharmacists advice, they know more about drug interactions than most doctors and nurses.

Levothyroxine can be taken at any time of the day or night if you observe the following information.

For maximum absorption Levothyroxine should be taken with water 1 hour before or 2 hours after food and drink, 2 hours away from most other medication and supplements, and 4 hours away from calcium, iron, vitamin D supplements and oestrogen (and Omeprazole).

It takes 7-10 days for Levothyroxine to be absorbed before it starts working and it will take up to six weeks to feel the full impact of the dose.

You should have a follow up thyroid test 6-8 weeks after starting Levothyroxine. Arrange an early morning and fasting (water only) blood draw when TSH is highest, and take Levothyroxine after your blood draw.

Most people will find symptoms resolve after their TSH drops to around 1.0 with FT4 in the upper range but symptoms can lag a couple of months behind good biochemistry.


I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

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When pharmacists get it wrong, it seems to be more often the other way round. Their cautious four hours is absolutely what I would have expected.

Sometime nurses with specific knowledge are excellent but a lot are not so very good outside their areas.


Omeprazole does impair levothyroxine absorption but I don't think it is a big effect (very difficult to find studies to show the actual effect). Just take your omeprazole a few hous away from the levothyroxine and you should be OK. Better to take the levothyroxine before the omeprazole.

Often heart burn disappears once hypothyroidism is treated, so you may be able to gradually reduce your omeprazole over time.


Its highly likely the last thing you actually have is high stomach acid or need omerprazole .....hashimotos normally causes LOW stomach acid and you need to take pepsin or betaine instead of omerprazole which blocks your absorption ov iron and vital vitamins

If only doctors would face all the symptoms abnd concomitant problems of hashimotos


PPI can reduce magnesium, affecting ability to utilise Levo.

There are plenty of postings on here about connection between low stomach acid and being hypo. (Symptoms are very similar to high acid .....treatment is different)


I had the same issues as you and was also prescribed Omeprezole - but you shouldn't take it for too long. As reallyfedup123 has said, your problem is with LOW stomach acid not high. I stopped taking the Omeprezole and started with the Betain & Pepsin tablets (Lifeplan Digestive Enzymes is what I bought) and also organic Apple Cider Vinegar with it's mother which I bought from Amazon. You'll find that you are not absorbing vitamins & minerals because of the low stomach acid and Omeprezole just makes the problem worse albeit making you feel temporarily better. You will get all kinds of symptoms from low Vitamin & Mineral levels so I would get these checked. As other more knowledgeable members keep drumming it in: Get your Vitamin B12, Vitamin D, Ferritin & Folate checked and supplement if they are not at optimal levels not just 'in range'. I have noticed a HUGE difference since I started supplementing B12 & D (with K2) and taking the levothyroxine and T3.

Before I was diagnosed with Hashimotos I had terrible acid reflux and was prescribed Omeprezole before they even thought that I could have thyroid problems. I recently went to see a Functional Medicine Doctor and he wrote WTF on my notes where it mentioned that I was prescribed Omeprezole!

So, to summarize, I don't have acid reflux anymore since doing all of the above and also giving up gluten (very important). I think the stomach problems are caused by food intolerances and lack of thyroid hormones which leads to the low stomach acid which leads to the vitamins and minerals not being absorbed which makes everything worse. The only time I have stomach problems now is when I eat sugar or gluten or drink alcohol (these are my intolerances).

The food intolerances also used to make me vomit & have severe migraines as well (sorry TMI) but now I know the triggers I can avoid all that.

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Have you any idea if you have an overgrowth of h-pylori, and/or candida in your stomach? Or, do you have any food intolerances? Check out the symptoms online.

I am waging war on my previously rubbish gut flora to bring it back to health.

I've been using (i) mastic gum to kill bad bacterial overgrowth: It is natural and has no side effects. n.b. I'm not on Omeprazole, because it failed to work the last time I had GERD. My problems with sore stomach / gut were also helped by taking a teaspoon of (ii) L- glutamine powder dissolved in water twice a day. (iii) Digestive enzymes helped for a while (to digest meals) until my gut health began improving. (iv) Cutting down on food that fed the nasties (cheap carbs - white flour in particular) also helped a lot and I discovered that I'd been becoming lactose intolerant. (v) Supplementing with good bacteria with pills was ok, but now I'm finding that homemade Kefir works better still.


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