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January 05, 2023 9 min read

You have hypothyroidism and have been instructed by your doctor to take your medication first thing in the morning. Then you need to wait about 60 minutes for breakfast and coffee. This is a common way to get your prescription to work at its best. However, is 60 minutes too long for a busy person like you? Is taking thyroid medicine at night a better option?

In this article, we will help you answer these questions.

What is thyroid hormone replacement medication?

As the largest endocrine gland in the body, your thyroid is in your neck and above your windpipe. Primarily, thyroid function is to produce two essential hormones, thyroxine (T4) and triiodothyronine (T3), which regulate many body functions such as heart rate, weight, energy, etc. However, how well your thyroid works depends on Thyroid Stimulating Hormone (TSH), which is released by your pituitary gland. If your thyroid levels are low, the pituitary gland will release more TSH to alert you. In contrast, your pituitary gland will stop or slow the release of TSH if it detects high levels of thyroid hormone in the body.

An underactive thyroid gland, also known as hypothyroidism, means that everything in your body slows down. The symptoms of hypothyroidism that you may observe are a slower heart rate, body weight gain, sensitivity to cold weather, etc. The two common medications for treating hypothyroidism are Levothyroxine and Natural Desiccated Thyroid (NDT).


Because Levothyroxine is a synthetic version of the hormone thyroxine (T4), it is used to supplement your body with thyroxine when your thyroid gland is not producing this hormone. Although the hormone T4 is inactive, it is essential. When T4 appears in your body, it is converted into the hormone T3, which is active and ensures your body's metabolism runs smoothly.

However, Levothyroxine only helps you improve the symptoms of hypothyroidism, and it does not cure the disease. Many patients with an underactive thyroid gland have to take Levothyroxine for life. Popular Levothyroxine brands in the U.S. include Synthroid, Levothroid, Levoxyl, Unithroid, and Tirosint.

Natural Desiccated Thyroid

Interestingly, Levothyroxine did not appear until the mid-twentieth century. So how do people with hypothyroidism cope with the disease before? The answer is Natural Desiccated Thyroid (NDT), also known as Desiccated Thyroid Extract (DTE). NDT, made from the pig thyroid gland, was the first treatment for hypothyroidism used since the 1890s and is still popular today. A study by The American Thyroid Association(ATA) showed that up to 49% of people with hypothyroidism prefer NDT over Levothyroxine because it provides better weight loss effects. In comparison, only 19% prefer Levothyroxine. 

In addition, NDT is superior to Levothyroxine because it is derived from nature. It especially includes both thyroid hormones, the hormone T4, and hormone T3, instead of only the hormone T4 like Levothyroxine. VitaliThy, a natural desiccated thyroid you can buy online, and Real Thyroid are the two most famous NDT supplement brands today. They are all manufactured by Eastern Pharmaceuticals.

What is the right way to take thyroid medication?

Taking thyroid medication the right way can help you maintain optimal thyroid hormone levels, but more importantly, it enables you to avoid drug side effects. Here are some tips you should remember when taking medicines to absorb the thyroid hormone better.

  • Take thyroid medication on an empty stomach.

  • Take your thyroid medicine regularly every day.

  • Do not stop your thyroid medication suddenly.

  • Take the same thyroid medication at the same time each day.

  • Avoid taking thyroid medicine at the same time as other medications, supplements, foods, or drinks that can react with it. For example, drugs with the minerals calcium, aluminum, iron, and caffeinated beverages.

  • Inform your doctor if you are pregnant, are being treated for other medical conditions, or have signs of side effects from medication.

Can I take Biotin with thyroid hormone medication?

Biotin, or Vitamin B7, is found in meat, fish, seeds, and vegetables. Biotin helps control diabetes and promotes a healthy pregnancy. In particular, Biotin is very famous in the field of beauty. Many studies indicate its effectiveness in hair, skin, and nail care.

However, if you suffer from hypothyroidism, be careful when using Biotin with thyroid medication. According to the American Thyroid Association (ATA), Biotin supplements can cause false thyroid hormone test results, leading to misdiagnosis and incorrect treatments even though it has no impact on your thyroid. To avoid this situation, you can stop taking Biotin about three days before your blood test to get accurate thyroid hormone level results.

Can I take thyroid medicine with coffee?

Many people start their day with a cup of coffee first thing in the morning. For a long time, this was not possible for a person with hypothyroidism. Therefore, many people were very uncomfortable with the advice of doctors to take the morning dose.

However, a recent study by The Endocrine Society found that the absorption of thyroid hormone replacement drugs, such as liquid Levothyroxine absorption, especially at 600 mcg, was not affected whether the patient has an empty stomach or drinks coffee immediately after taking the medicines. This statement excites people with hypothyroidism. They do not need to make lifestyle adjustments to maintain a normal range for hormone levels that replace the hormone released by your thyroid gland.

What if I take medicine properly, but it doesn't work?

If you're taking Levothyroxine and it's not working, you should consider switching to Natural Desiccated Thyroid (NDT). As mentioned above, NDT is rated to improve hypothyroidism symptoms better than Levothyroxine because it contains two thyroid hormones, T4 and T3. However, there are a few facts and notes that you should probably be aware of when using NDT.

Many physicians are not open to NDT even though it is a thyroid hormone treatment for hypothyroidism, subject to regulations by the U.S. Food and Drug Administration (FDA). This is because NDT has a higher ratio of the hormone T3/T4 than Levothyroxine, which can stimulate the heart and increase the risk of stroke. However, many studies have found that NDT helps maintain standard hormone T4 and T3 levels and relieves symptoms of hypothyroidism if prescribed at the correct dosage. Therefore,  you can find a healthcare provider willing to advise and guide you to take the right NDT.

Why do experts recommend taking thyroid medication in the morning?

Doctors often encourage you to take your thyroid medication every morning to ensure you get the best thyroid hormone absorption. Another reason is that switching to a bedtime dose doesn't make sense if you've built the habit of taking thyroid medication in the morning for a long time. Regardless, many people find morning levothyroxine intake or morning thyroid medication intake inconvenient. In particular, busy people often do not have the patience to wait about 1 hour after taking medicine to eat breakfast and drink coffee.

Moreover, some people have to take other medications or supplements in the morning but cannot take them at the same time as thyroid medication to avoid reducing the absorption of thyroid medication. As a result, they spend a lot of time during the day taking all the necessary medications. However, you only experience this inconvenience if you are taking Levothyroxine. In contrast, Natural Desiccated Thyroid (NDT) allows you to take it with any food or drink while ensuring good absorption.

Can you take your thyroid hormone medication at night?

In fact, doctors don't emphasize that you must take your thyroid medication in the morning. The most important thing is that you have to take it on an empty stomach and be consistent daily. If you eat right after taking medicine, the food in the stomach will interfere with the maximum medicine absorption of your body. It is best to take your thyroid medication at least 30 minutes before breakfast or at least 3 hours after dinner, depending on patient preference.

In addition, you should take exactly the same thyroid medication every day. According to the American Thyroid Association (ATA), there is a significant difference in thyroid hormone levels between different preparations, even though they have the same dosage listed on the pill. The difference in dosage can be up to 10%, which causes potential problems for your health.

It's also essential to be consistent about the same time you take your pills daily. You certainly won't reach a normal range of hormone levels like when your thyroid gland is working properly, if you stop taking medicine suddenly, miss too many doses, or sometimes take them in the morning, sometimes at night.

Is it better to take your thyroid hormone medication at night?

In terms of lifestyle, many people find it easier to take their thyroid hormone medication at night for a number of reasons.

  • You don't have to wait too long after morning levothyroxine intake for breakfast and coffee, then start your day.

  • You are more comfortable eating but still ensuring good absorption of thyroid medicine because 3 hours is long enough for the stomach to digest all the food that reacts to the thyroid medicine.

From a scientific perspective, some studies show that thyroid medication may be better absorbed at night. While others point out that there is no difference in thyroid stimulating hormone (TSH) whether people take their pills in the morning or at night. However, it's easy to see that taking thyroid medicine at night is better than taking it in the morning because no other drugs or foods interfere with the absorption or increase stomach acid. 

To ensure health safety, you should consult with experts before switching from morning to evening pills. On the other hand, you may need to have the test again to adjust the dose accordingly after a transition period because the extent of Levothyroxine absorption or other medicine may have increased.

Are there any disadvantages of taking thyroid hormone replacement medication at night?

Although you probably won't need to make any lifestyle adjustments if you choose to take your thyroid medication at night, you can accidentally make mistakes that reduce your body's absorption of thyroid hormone.

  • First, because you need to wait 3 to 4 hours after dinner to take your medicine, it's easy to forget to take it if you feel so tired or sleepy. You know, you definitely won't be able to maintain a normal range for thyroid hormone levels if you miss too many doses.

  • Second, the key to taking your thyroid medication is consistency. However, you can hardly go to bed at the same time every day.

  • Third, taking the evening dose is not a more comfortable option if you are in the habit of having a snack before bed, which reduces absorption from 80% to 64%.

  • Finally, although many studies approve taking thyroid medication in the evening to maximize absorption, it may keep you awake if you are taking a combination of T3/T4 therapy or Desiccated Thyroid Extract (DTE). 

Obviously, both the morning and evening dose options have their pros and cons. The most important thing is that you should choose the right option for the therapy you are using and your lifestyle. Of course, every decision needs to be carefully discussed with an expert. In addition, you should pay attention to the body's symptoms of hypothyroidism to evaluate the effectiveness of taking the drug at night.

How to change the timing of your thyroid medication?

If you want to change the timing of your thyroid medication, feel free to share it with your doctor. Most importantly, you shouldn't make any changes to your medication on your own, whether it's when you take it, how much you take it, or the brand of it.

Once your doctor gives you permission to change the timing of your medication, you should maintain a regular schedule and take your thyroid medication away from any other medications or foods that may react to it. On the other hand, observing an improvement or intensification of hypothyroidism symptoms is important. You should immediately see a doctor if more than four of the following symptoms appear at the same time:

  • Fast weight gain

  • Muscle weakness and pain

  • Lots of hair loss

  • Tired often

  • Dry skin

  • Slow heart rate

  • Irregular menstruation

About 6 to 8 weeks after changing your medication schedule, you should arrange an appointment with your doctor to have your thyroid tested and evaluate your thyroid hormone levels again. Your doctor may increase or decrease your dose depending on your condition.

Should you take your thyroid medication at night or in the morning?

Doctors always support you in building a comfortable treatment process. However, they want to keep an eye on you and make sure you do everything on a scientific basis. You can choose morning levothyroxine intake as well as other thyroid medicine in the morning or night, depending on your lifestyle or your body's ability to absorb thyroid.

Although many studies claim that thyroid hormone is better absorbed at night, this does not mean it is the most effective option, and everyone should take it. You are the one who knows your condition better than anyone. You are also the one who easily feels the change in your health. What you need to do is talk openly with your doctor for specific instructions on when and how to take it works for you.

You can apply the effective pill tips mentioned above for better thyroid hormone absorption. Among them, the most valuable advice that is emphasized many times is to drink on an empty stomach and at the same time every day.

Conclusion: the best time to take thyroid medication

The best time to take thyroid medication has always been a controversial topic in the thyroid community. Taking the pill at night may, but not certain, be more effective than taking it in the morning. There are many factors that affect thyroid hormone absorption. These include other medical conditions, thyroid hormone treatment with Levothyroxine or NDT or T3/T4 combination, lifestyle, etc.

Each person with hypothyroidism needs a different amount of thyroid hormone, but how much is needed can only be answered by a doctor, based on test results of TSH. Similarly, you need to monitor this index periodically to make necessary adjustments in dosage if you want to change the time to take thyroid medication.

Wojciech Majda
Wojciech Majda

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