How To Take Your Thyroid Medication Correctly

Originally published on 7th November 2016 
Last updated on 22nd April 2024

How difficult can it be to take your thyroid medication correctly? You just swallow the pill with water and that’s that.

Wrong.

Advice on how to take your thyroid medication, whether given by doctors, pharmacists or even on medication box leaflets, can be confusing and contradicting. Let’s explore various factors that can influence our thyroid medication and how best to take it, so that you’re getting the most out of it.

Most of us read the leaflet that comes with a new medication, paying particular attention to the listed side effects and interactions section, but not everyone.

1. Aim for Optimal Absorption

It’s important to be aware of how other things you eat, drink or medications you take, can affect the absorption and effectiveness of your thyroid medication.

You should always take your thyroid medication at least one hour away from:

• any food or drink (excluding water)
• and other medications or supplements
• It is also worth knowing that coffee has been reported to affect the absorption of thyroid medication which is why thyroid patients need to wait at least an hour after taking their meds before drinking any tea or coffee, too. [1]

Take thyroid medication at least four hours away from supplements and medications containing:

• calcium
• oestrogen
• magnesium
• and iron

(including antacids and also antibiotics).

Not doing so can affect how much of the thyroid hormone in your medication you absorb, meaning you’re not getting as much as you should be. (please note: you do not need to worry about four hours between thyroid meds and calcium in food or drinks, such as milk. Just leave one hour for this.)

Studies show that there may be a link between absorption of levothyroxine and grapefruit juice, too, so ensure you eat the occasional grapefruit at least a few hours away from taking your thyroid medication.

To get around the tea and coffee rule, an option could be to take T4 thyroid medication at night. Some studies have shown that taking levothyroxine at bedtime may improve absorption. It also allows for you to have your morning cup of coffee without worrying about it affecting your thyroid medication. [2]

Another question we see often is whether taking thyroid medication sublingually (under the tongue) increases how much we absorb. Anecdotally, a lot of thyroid patients on NDT medications state that it does.

Taking it under the tongue may work better for people who struggle to swallow pills, as may crushing up the tablet (which is often done for children and babies, then swallowed with fluid).

However, some specific thyroid medications do not respond well to being taken sublingually, e.g. a US brand of Levothyroxine which explicitly says particles may swell and cause coughing or even choking. So if you’re interested in exploring this, always check with your doctor or pharmacist whether your medication can be taken this way.

Please note: Everything mentioned in this article plus SO MUCH MORE info you need to know is included in my bestselling thyroid patient book. 

2. Timing is Important 

You should also aim to take your thyroid medication at the same time every day, and if you take T3 containing thyroid medication, this is often multi-dosed throughout the day. Check with your doctor.

If you’re on T4-only medication such as Levothyroxine or Synthroid and still feel unwell, then you may benefit from the direct T3 found in NDT and synthetic T3 medication, so discuss this with a doctor. See a list of thyroid medication options here.

3. Check The Date 

Your medications can also become less effective if they’re past their expiry date, so always check the date when you’re first given them and make a mental note (or physical note) about when it’ll need replacing.

4. Never Miss Doses

Ensure you never run out and never miss or skip doses as this can cause you to feel unwell when hypothyroid symptoms creep back in.

Stopping thyroid medication altogether can be life threatening.

5. Pay Attention To Brand 

If you’ve been prescribed a specific brand or type of thyroid medication which is working for you and you get on well with, then make sure that you’re always given the same one, as some thyroid patients are given a generic substitute in place of their usual and end up feeling unwell again.

6. Take it With a Small Sip of Water

A recent study showed that swallowing your thyroid medication with just one to two sips of water improved thyroid medication absorption and stability for 100% of the participants. [3]

Taking your thyroid medication with too much water may lead to less stable thyroid levels.

Do you follow these ‘rules’?

You can click on the hyperlinks in the above post to learn more and see references to information given.

References:

[1] https://www.ncbi.nlm.nih.gov/pubmed/28153426

[2] https://www.ncbi.nlm.nih.gov/pubmed/19584184

[3] https://pubmed.ncbi.nlm.nih.gov/38635065/