Hi
It might seem like a silly question but I have never been told by my Dr. what time of the day is best to take Levothyrox and if it is with , before or during meals! So I thought it might be an easy question to answer for the members of this forum 😊
I have a multi nodular thyroid. I had a sub- total thyroidectomy in 1989 and it grew back!
Thanks for your feedback.
Take care
Lilypocket
Levothyroxine should be taken on it's own, on an empty stomach, one hour before or 2 hours after food, with a glass of water only and water only either side. This ensures that nothing affects it's absorption.
Any other medication or supplements should be taken 2 hours away, some need 4 hours.
Many people take it first thing in the morning. Others take it at night. I take mine in the early hours of the morning when I regularly need the bathroom, so it's well away from any food or medication/supplements.
Hi Thank you for your reply. I take mine about 45" before I eat breakfast but as I take other medication at the same time I may take it before bed following your advice! I take no medication at night. I've been told that magnesium supplement is not a good mix with Levo - is this true? Does taking Levo at night quicken the heart? I have Paroxysmal Afib probably the result of taking high doses of Levo as my endocrinologist wanted to reduce my TSH to nearly nothing as he said it reduced the possibility of thyroid cancer. But it provoked a fast heart rate and it was eventually reduced. But I developed Afib.
Take care
Lilypocket
If you take your Levo before bed and your evening meal is the largest meal of the day, it's best to leave 3 hours after your meal before taking your Levo. And don't forget, water only for one hour either side.
There is no problem with taking a magnesium supplement for a hypo patient. However, magnesium is one of the supplements that needs to be taken 4 hours away from Levo.
Does taking Levo at night quicken the heart?
I can't say for definite but I've not heard that before.
Thanks for the reply. I'm not hypo or hyper just got benign nodules. But wondering why magnesium is contra indicated with Levo 🤔
By definition if you are on Levothyroxine you are hypothyroid as you need replacement hormone as your own thyroid is not producing enough
Hi CrJsThank you for replying. I have a normally functioning thyroid but full of nodules - see my reply to Seaside Susie . 🙂
Lilypocket
If you are taking levothyroxine it's because your own thyroid can't make enough thyroid hormone for your needs therefore you are hypothyroid.
As I said it's fine to take magnesium if you are on Levo. It's just one of the supplements that need to be taken 4 hours away from it, it's the same with Vit D, iron, calcium, oestrogen - they all need a 4 hour gap from Levo as they decrease the effect of Levo. See
singlecare.com/blog/thyroid....
particularly :
4. Vitamins and supplements
“You should also avoid any drugs or supplements that contain iron, calcium, or magnesium for at least four hours after taking your thyroid medications,” says Dr. Jaiswal. That also includes multivitamins that contain these minerals.
No my Professor endocrinologist here in a big hospital in France where I live put me on Levo so my thyroid which is functioning normally, didn't need to work too hard which helps inhibit the growth of nodules and in a larger dose shrinks them. But the larger dose annoyed my heart. I have a multi- nodular thyroid goitre which is genetic. If I stopped the Levo my thyroid would carry on functioning normally but my nodules might get bigger. I know many endocrinologists don't believe in doing this but this was the treatment 30 years ago and which I have continued and seems to work for me. When he retired I briefly saw another Dr but she didn't seem to be up to speed on the thyroid and preferred to discuss diabetes type 2 - goodness knows why. I have a BMI of 24 and normal blood tests. So I returned to the hospital to see another specialist renowned for the thyroid. It's easier in France to see a specialist for a reasonable price and not a long waiting list.Take care
Thank you so much, I have been taking Levo and Vit D supplement rather close together so will change this routine. Very helpful of you.😀
Time gap doesn’t apply to vitamin D mouth spray
Thanks for the info. I know nothing about VitD mouth spray. Can you recommend one?
Many many people on here use this
betteryou.com/vitamin-d-ora...
One with vitamin K2 in as well saves needing separate K2
Thank you. I ve started taking actual tablet form so will space these to several hours later from levo.
Hi I know,I may be butting in here but I used to take my levo at night but now take when I get up an hour before any food and leave all supplements and medications for at least 4 hours but I take it with no added sugar diluting juice. Is this ok or does it have to be water?
I can't answer your question I'm afraid. I prefer to make absolutely sure that nothing interferes with absorption of my thyroid meds so I just stick to water only. If there's no added sugar in your cordial then it must include an artificial sweetener and I have no idea if this would interefere or not.
I take mine at bed-time - always have. So cannot compare other regimes.
Some people report that changing to bed-time has a similar effect to a small dose increase - maybe 12.5 to 25 micrograms at most. Others say no difference.
That's interesting. So maybe a night-time dose may increase HR.
I'd be very wary of making that or any other assumptions - but good to be aware it is a possibility! 
Like helvella i take mine at bedtime, as I find this much easier and I do like an espresso in the morning before work. I take my magnesium at 5pm to allow a sufficient gap. This timing still gives me the benefit of magnesium aiding sleep.
Thanks for the tip!
A fib can be caused by low Ft3 too
pubmed.ncbi.nlm.nih.gov/175...
Poor conversion of Ft4 to ft3 is common if vitamins are low
Essential to get FULL Thyroid and vitamin testing done
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common
Ask GP to test vitamin levels
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Is this how you do your tests?
Thank you for your interesting reply. It seems to be really difficult for dr's to take into consideration that one has 2 pathologies which interact. My cardiologist doesn't seem to connect that my heart condition is strongly linked to my thyroid medication which probably caused it .I check my vit D regularly bit didn't know about the others you mentioned. Why can't drs recommend these blood tests. We are left to trying to find out ourselves through the internet on helpful forums like this What are TPO and TG antibodies?
All my blood tests are well before I eat breakfast 🥐
With last levothyroxine dose 24 hours before test?
Yes as I take my Levo before breakfast so the blood test the next day is a good 24hrs after my dose
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.
Link about thyroid blood tests
thyroiduk.org/getting-a-dia...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
List of hypothyroid symptoms
thyroiduk.org/signs-symptom...
EXTREMELY common to have low vitamin levels, poor conversion of levothyroxine (Ft4) to active hormone (Ft3) as direct result
Poor conversion leads to high Ft4 (can cause A fib)
And low Ft3 (can cause A fib)
Great in-depth article here
thyroidpatients.ca/2020/09/...
Absolutely essential to test TSH , Ft4 and Ft3 together and all four vitamins optimal
Thanks for your (again!🙂) Informative reply!
I’ll throw in a slightly different view that I’m sure we’ve discussed fairly recently on this forum—which is, you could actually take your levothyrox with food if you were finding it too difficult to fit other supplements in.
The key is consistency—to take it regularly in such a way that your body gets used to having it and making use of it. It might mean you need a slightly larger dose—taking levothyroxine with food may result in you absorbing less of it—but sometimes that too could be a good thing if you’re someone who needs a maintenance dosage that’s slightly lower than the standard-sized pills we’re prescribed (usually 25mcg, 50mcg, 75mcg, 100mcg etc).
We very often recommend taking it on an empty stomach here because in the U.K. it can be difficult to get doctors to prescribe a high enough dosage and we need to squeeze every μg of Levo out of our inadequate prescriptions. Taking it on an empty stomach will also be the most accurate method of finding out your ideal dose and the effect it has on your blood work. But if trying to do so causes problems, it’s important not to rule out taking it with food as that can end up being the best solution all round.
Hello JazzwThat makes sense. I'm used to taking it before breakfast but at the same time as my magnesium and heart meds ( Bisoprolol and Flecainide). No Dr ever told me when it was best to take it and what to avoid taking it with etc. However the replies I received make sense and I am taking the Levo tonight instead and see how it goes. However as I don't have a dysfunctional thyroid ( yet 🙂) fine tuning the dosage as some people need to get optimal results is less imperative in my case. And as you say my body and thyroid more specifically have probably adapted to my usual routine. However I hope taking it at night won't strengthen the dose so to speak and have an impact on my Afib.
I’d be surprised if it did—levothyroxine isn’t the sort of drug that (in theory at least) has that effect on the body.
Definitely worth trying—hope it works out for you!
Thanks! I used to take levo 150 prescribed by a thyroid specialist to inhibit nodule growth. I think this dose was responsible for kicking off my paroxysmal Afib. Very low TSH is according to my cardiologist not good for the heart. So I have to balance it myself as the dr's don't connect the two pathologies.
Your cardiologist is not up to speed on latest research
heart.bmj.com/content/84/4/...
(From research published in 2000)
Over replacement with thyroxine?
There is some concern that administering thyroxine in a dose which suppresses serum TSH may provoke significant cardiovascular problems, including abnormal ventricular diastolic relaxation, a reduced exercise capacity, an increase in mean basal heart rate, and atrial premature contractions.12 Apart from an increase in left ventricular mass index within the normal range, these observations have not been verified.13 Moreover, there is no evidence, despite the findings of the Framingham study, that a suppressed serum TSH concentration in a patient taking thyroxine in whom serum T3 is unequivocally normal is a risk factor for atrial fibrillation.
First thing in the morning works best for me, 30 mins to an hour before a cup of tea or food.
Great thanks! That's how I take it at the moment but also some meds. Apparently it should not be taken with supplements and other meds according to some advice from members so I shall try at night before bedtime. Take care.
I swapped to before bed a couple of months ago, but I am going to swap back to first thing in the morning because I am sleeping even worse than I was previously.
Interesting. I am a bad sleeper too. I'll keep going for a week and see what happens and depending on the result I'll go back to mornings if my sleep or lack of gets worse.
Do what's good for you, I'm an evening eater so works best for me in the morning and I take my bp and cholesterol meds in the evening. I hope you find your balance 😀
Thanks! Yes will probably try nighttime for a while but since I take all my meds in the morning before breakfast I'm bound to forget the " evening orphan". 😛
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