Hi Everyone,
So glad to have found this community. I hope you can help. I’m newly diagnosed with hypothyroidism and have been given Levothyroxin to take but no advice as to when to take or how. Any advice greatly appreciated. Also my blood test was just for T4 and T3 levels. Should I ask for more detailed tests.
Many thanks
Hi BeBeMum, welcome to the forum. 🙂
Sorry you haven’t had much advice from your doctor—sadly not unusual these days!
A good place to start is with the information posted on the parent site for this forum, which is the community forum for a charity called “Thyroid UK”.
Here’s some info about levothyroxine: thyroiduk.org/if-you-are-hy...
I think most people take their levothyroxine first thing in the morning with water before eating or drinking—best to leave it at least half an hour if not longer before having tea/coffee and food. That said, the most important thing is probably consistency—take it under the same conditions every day. You’ll soon get into the swing of it.
However, there are a number of people here who take their levothyroxine last thing at night before going to bed (again avoiding food and drink within half an hour to an hour before taking it).
So to some extent it comes down to what suits you best really. 🙂
Finally, a bit more info about the condition of hypothyroidism, just so that you know a bit more about it and can feel better informed when you next see the doctor. thyroiduk.org/if-you-are-hy...
Not sure half an hour after eating is long enough when taking levo at night. It should be more like two to three hours. 
welcome to the forum
What are your results
How much levothyroxine has GP started you on
Which brand of levothyroxine have you been prescribed
at next test in 6-8 weeks request that vitamin D, folate, ferritin and B12 levels are tested
Plus thyroid antibodies for autoimmune thyroid disease if not been tested yet
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime or in middle of the night
verywellhealth.com/best-tim...
markvanderpump.co.uk/blog/p...
markvanderpump.co.uk/blog/p...
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
Thyroid testing
Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
Hi SlowDragon,
Thanks for your post. Very informative. The GP has started me on 25mg . The current packet is from MercuryPharma. GP just said book an annual review blood test. My results of the last blood test 8 weeks after the initial blood test and taking 25mg of levothyroxin daily are as follows:-
serum TSH level 4.74mU/L (0.35 - 5.5)
Serum free T4 level 13.3 pool/L (10.5 - 21.0)
My previous blood test results don’t show any T3/T4 results so I’m not sure what to post here.
Many thanks for your help.
How old are you?
25mcg is very low dose ……as it’s such low dose may initially make you feel more hypo
Levothyroxine very quickly doesn’t “top up” your own thyroid, it replaces it
Being on too low a dose can result in becoming more hypo
Unless over 65 years old, standard starter dose is 50mcg or higher
GP just said book an annual review blood test. My results of the last blood test 8 weeks after the initial blood test and taking 25mg of levothyroxin daily are as follows:-
serum TSH level 4.74mU/L (0.35 - 5.5)
Serum free T4 level 13.3 pool/L (10.5 - 21.0)
So these results are AFTER being on 25mcg for 8 weeks?
See/contact GP for increase in Levo to 50mcg daily
Free T4 (fT4) 13.3 pmol/L (10.5 - 21)
Ft4 is only 26.7% through range
If GP is reluctant request a “trial “ increase
But with TSH over 4 the GP should have increased straight away to 50mcg daily
Retest again in another 6-8 weeks after being on 50mcg
Repeat this process until symptoms are improved, Ft4 and Ft3 and vitamin levels all optimal
On Levo TSH should ALWAYS be below 2
Most people when adequately treated with Ft4 and Ft3 at least 60% through range will have TSH around or below 1
Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)
cks.nice.org.uk/topics/hypo...
bnf.nice.org.uk/drugs/levot...
nhs.uk/medicines/levothyrox...
Adults usually start with a dose between 50 micrograms and 100 micrograms taken once a day. This may be increased gradually over a few weeks to between 100 micrograms and 200 micrograms taken once a day.
Some people need a bit less than guidelines, some a bit more
TSH should be under 2 as an absolute maximum when on levothyroxine
gponline.com/endocrinology-...
Graph showing median TSH in healthy population is 1-1.5
web.archive.org/web/2004060...
Comprehensive list of references for needing LOW TSH on levothyroxine
healthunlocked.com/thyroidu....
onlinelibrary.wiley.com/doi...
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
sciencedirect.com/science/a...
The optimal daily dose in overt hypothyroidism is 1·5–1·8 μg per kg of bodyweight, rounded to the nearest 25 μg
Have these guidelines ready to quote from to get necessary dose increases over coming months
Come back with new post once you get results after dose increase to 50mcg daily ……and get vitamin levels and antibodies tested at next test
Or test privately
Many thanks
I find the best results (for me) are on waking, then ensure to leave an hour before food/tea or anything with milk in it because calcium affects absorption of thyroxine. The pill info suggests leaving a gap of 2 hrs when taking other medication particularly things that affect the stomach. Drugs.com is a good resource. And if you ever need calcium tabs in later life , remember to leave 4 hr gap. So thyroxine when wake up, calcium when going to bed or other way round.
Iodine in Multivitamin and best time to take levo
When is the best time to take T3
best time to take Levothyroxine 
Best time to take medication?
