How best to take levothyroxine

[Rezzar]

I take 100mg a day of levothyroxine. I take it 2 hours after a meal and dissolve it under my tongue. Does this sound wise, or should I swallow it whole, or does it not matter?

My TSH level is 4.2 (but it does fluctuate from 1.8 to 4.2)

[MrWellness94]

Hello Rezzar,

I have read a few posts about how levothyroxine needs to be swallowed whole because the molecules of the pill are too big to be absorbed under the tongue. I suggest you swallow and see if you notice a difference. There are people who feel better taking it first thing in the morning 1 hour before breakfast. Others state that taking it at night 2-3 hours after a meal works better for them. It truly depends on what works for you, I encourage you to tweak it around for a few weeks and find what works for you as what might work for some might not work for all. Also make sure that you leave at least 4 hours before taking any supplements that contain iron or calcium as these can reduce absorption of levo.

[helvella Administrator Thyroid UK in reply to MrWellness94]

Doesn't much matter if the pill is whole - or "dissolved" in saliva - as far as I can tell. Of course, a particularly hard pill could end up not dispersing fully even in the gut.

[MrWellness94 in reply to helvella]

Helvella,

Oh I see, I always hear that it needs to be swallowed whole from GPS and what not. I never once thought one could dissolve it under the tongue or in water etc. One thing I do know is that it depends on the individual.

[greygoose in reply to MrWellness94]

The point of taking certain things under the tongue - sublingually - is that the active element passes through the skin more easily, there, and directly into the blood. But, the thing with T4 is, not only are the molecules too large to pass through, but the T4 needs stomach acid to free it from the sodium molecule to which it is attached.

Presumably, the pill will dissolve under the tongue and be swallowed, but some people have found that they absorb the T4 less efficiently that way - maybe because it doesn't all reach the stomach that way.

Same goes for T3 and NDT.

[helvella Administrator Thyroid UK in reply to greygoose]

Further, levothyroxine dissolves better in the alkaline environment in the gut after the stomach.

That is why peak FT4 after taking levothyroxine is typically around two hours later. Mouth to stomach (acid) to gut (alkaline).

[SandraSims]

I take it whole before bed. I have tried in the morning but have found it works so much better at night

[Jazzw]

Rezzar , just swallow the pill with water, preferably on an empty stomach. You’ll absorb more of it that way.

[SlowDragon Administrator]

Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take on waking, but it may be more convenient and possibly more effective taken at bedtime

Many of us find taking at bedtime is more effective.

verywell.com/should-i-take-...

[Rezzar]

Wow thank you everyone, I shall try what you all suggest.

[cwill in reply to Rezzar]

So how you take it aside is that your TSH of over 4? What is the range?

[ShootingStars]

Your TSH is too high for being on meds. What are your two main actual thyroid levels and what are your symptoms? Food could very well be interfering with thyroid medication absorption. TSH swinging that much is very odd. It should barely change each lab test, meaning less than 0.50 change. Anything much larger than that, and something is interfering with absorption or you need a higher dose.

For optimal absorption and effectiveness, thyroid meds are to be taken on a completely empty stomach, which is 4 hours after eating, or first thing in the morning. Then you must wait at least one hour before eating or drinking anything besides water.

For comparison, I test my TSH, FT3 and FT4 almost every 6 weeks and there is never more than <0.25 change in TSH levels. I’ve been on the same dose of T3 and T4 for 10 months. My meds are always taken utilizing first thing in the morning protocol. My TSH is nicely suppressed under 0.50, and T4 is over half range and T3 is optimal at 3/4 range. I have no hypo symptoms and I feel great thyroid-wise.

[Carole81]

Hi ,don't worry about it I just take my 100mcg levothyroxine when I wake up with a coffee been on it for years it's fine .x

[LizzieAFib]

Hi Rezzar. Like many others, I take my levothyroxine tablets with water when I go to bed thus ensuring I’m taking it on an empty stomach (I don’t eat after my evening meal which I generally finish about 7pm) whereas if I took it first thing in the morning I’d have to wait for an hour before I could eat - no good for me, my metabolism needs food when I wake up

[Sammie46]

Definarely do not take after food but on a empty stomach with water. Wait at least 30 minutes before drinkung coffee or tea as it affects the absorption.

[nobbyclarke74]

the best time to take levothyroxene is half an hour before breakfast on an EMPTY stomach

then a light meal along with any other medication

[helvella Administrator Thyroid UK in reply to nobbyclarke74]

Why do you say "half an hour before breakfast"? Rather than, for example, at bed-time.

[nobbyclarke74 in reply to helvella]

this is whats recommended by my chemist and is stated on the packet I find that with a routine I am coping well with my conditions.

[helvella Administrator Thyroid UK in reply to nobbyclarke74]

Trouble is that research suggesting that bed-time dosing is an option, and might even have advantages for some patients, has never made it into Patient Information Leaflets.

I would not say it is right for everyone, that would fall into the "one size fits all" approach that can be so harmful. But it certainly seems to be right for some.

[Catseyes235]

Having taken thyroxine for 35 years, and always in the morning on an empty stomach that I had reckoned on my own was better, I actually got some instructions on the packets two months ago!! It said take first thing in the morning half hour before food. Pretty much what I do anyway but if I forget any I'll take a few hours later or divide the dose over 3 days to go with regular dose. I would never ever take pills under the tongue unless recommended by doctor. Meds under the tongue are generally for quick release into the blood stream and I wouldn't recommend a quick intake of thyroxine.

[Barann]

Because I take high end painkillers for a back problem which I take first thing in the morning at 7ish, I find when I go for the inevitable visit to the loo, usually between 2-4 in the morning that I take my Levo then with a swig of water.

[Hidden]

I am on AED's daily, 1000mg. per day, which interrupts with the taking of levothyroxine regularly. Taking first thing in the morning never works due to epileptic drugs taken in the morning and throughout the day. Night time is Phenytoin and Ranitidine after a meal. Perhaps taking between 2-4 in the morning might work? Any advice?

[Rezzar]

Gosh what a lot of information. I currently take 100mg of thyroxine 2.5 hours after lunch and 2 hours before supper. I felt it suited my lifestyle, my reasoning was; that as I like a hot drink (tea or coffee with milk) first thing in the morning and eat late in the evening (often 9 - 9.30pm), my longest period without food was in the afternoon! However, I am concerned with my tsh levels and how they fluctuate. I remember in the very early days my consultant saying to keep the tsh levels below 1. However, my GP is not concerned with my levels! So I think it is time for me to change the timing of thyroxine. I shall try taking it first thing in the morning and then a hot drink 1 hour later. I would like my levels below 1. My T4 levels range from 16-17 (but I'm not always told what they are! )

I plan to try my new regime for 3 weeks and then ask for a blood test.

Thank you everyone so much for sharing your experience.

Oh, and one further question: I recently bought some wakami seaweed, thinking it would be beneficial for someone with thyroid problems, however this may not be the case, in fact it may be detrimental. Does any one know why?

[TSH110]

You deserve a medal for taking Levothyroxine sublingually, I found the taste very unpalatable even swigging it down with a glass of water!