This paper featuring uk patients showed a sizeable population don’t adhere to the guideline about 30-60min gap between thyroxine and food/drink. Many cited difficulties of trying to synchronise with breakfast and other medicines ie PPIs. Having taken it since childhood I was totally unaware of this requirement til I read it here in my 50s. As some will recall I am also required to take calcium tabs and no clinician ever advised me to leave a 4 hr gap. So the issue is two fold- one to ensure clinicians (mainly pharmacists) remind patients of these requirements and also a handy online pill timetabler where you can insert all your pills and relevant wake/sleep/meal times and other relevant info eg snacker
I take 14 pills daily and would so appreciate someone working out a timetable for me especially when a new often temporary med is added such as an antibiotic that can’t be taken with food and you have to take 2 hrs away from thyroxine /30 mins double dose lio and calcium/magnesium. My mind just fries.
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bikebabe
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I’m also on a lot of meds, usually between 12-16 a day depending on how I have to adjust them. I haven’t stuck to any schedule for years mainly because it’s impossible with the timing. As long as I can get them all in 3-4 times a day I don’t worry to much, it works for me 🤷♀️
I agree. I keep calcium and magnesium at a four hour distance but I don’t worry too much about a regimen for others.
The number of pills I take as I get older makes it almost impossible to observe the conventions which exist.
As new medications are added or taken away, not much changes in my TFT results.
I took T3 only for years and was told by endo I could take it with food but not calcium supplements. Nothing is included in Patient Information Leaflet to indicate that it should not be taken with food
I also need to take calcium and active D3 twice daily and none of the doctors told me to keep the calcium 4 hours away from levothyroxine. When I first started taking them I would usually take the first dose around the same time as my levothyroxine. I used to feel fine but I’m thinking maybe it was because the doses were high enough that it was ok if they were cancelling out a bit. With all the vitamins I’m taking, I use alarms on my phone to remind me when to take which (given that I take calcium and levothyroxine twice daily, and other vitamins like iron which also needs to be away from levothyroxine), and that helps me not needing to do figure out the timings daily.
There is a problem in taking levothyroxine with food. Inconsistency.
You might eat exactly the same breakfast every day. But something happens, you are travelling, you are simply on holiday, you feel sick and skip breakfast, for some reason you change your breakfast cereal - even just another brand of the same description. You delay your levothyroxine because you are having a blood test. Or you need to take another medicine with food. All of these could alter the amount you absorb quite substantially.
Empty stomach is likely the most consistent most of us can achieve.
A one day variation won't usually have much impact. But, say, a switch from nutri-grain-mega-cereal (with multiple added substances such as iron and vitamins) with milk to porage made with water as winter comes along might make a real impact.
Of course, if we notice a change, we might be able to adjust our dose to compensate. But all too many of us do not notice for some time. Or find it difficult to adjust the dose with the tablets available in our houses.
My solution was to take at 3am. Actually helps with my night time visit to toilet as I now set my alarm. All other pills are grouped to what I can take with what and taken either in morning or night. Great solution for me as has improved my the effect of the limited levo I'm given. However as a CPAP user the problem of going back to sleep is not a problem.
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Antenolol and thyroid meds interference
Time gap between medications and T3
Levo and other meds? 
Posters in the 88th Meeting of the American Thyroid Association: Malabsorption, T4 and GI problems
A couple of questions about thyroid meds and interaction with other things
