Ladd McNamara, M.D discusses the future of medicine both as it relates to health, supplementation, and how health professionals are finding new ways to increase income in an ever evolving world!

When Should You Take Your Thyroid Medication?

bedtime blog

If you are taking thyroid hormone medication you’re doctor may have told you to not take them with vitamins.   Some doctors may have recommended you separate them by an hour, 3 hours, and I’ve even heard a doctor suggest you need 12 hours inbetween.   So, why the confusion, and what’s the conflict with taking nutritional supplements with thyroid medication?

Synthroid (levothyroxine, or synthetic thyroid hormone) is the most commonly prescribed thryoid medication.  The concern with thyroid medication and nutritional supplements is that they compete for absorption in the gut.   Calcium and iron are the main elements that compete for absorption and may reduce the effectiveness thyroid medication.   However, not only can calcium and iron interfere with absorption, but so too can food, coffee, fiber, and certain medications, such as some antidepressants, Evista, and antacids.

If your nutritional supplement does not contain iron the issue is moot.  However, most nutritional supplements provide calcium; and pregnant women, nursing mothers, and menopausal women absolutely need to take an additional 1000- 1500 mg of calcium (balanced with magnesium, of course).    Supplements, particularly minerals, are better absorbed if taken with food or soon after eating.  Thyroid hormone is better absorbed on an empty stomach.

One solution, though it may not be the best answer, is to take thyroid hormone in the morning on empty stomach at least an hour before eating, and then taking nutritional supplements and other medication an hour after eating.   That would separate the medication from the supplements by at least two hours, which should be sufficient.

However, two studies, one published in the journal Clinical Endocrinology in 2007, and a larger randomized study published in the Archives of Internal Medicine in 2010 found that it may be better to take the thyroid medication, levothyroxine (Synthroid), at bedtime than in the morning on an empty stomach.   Patients were found to have improved thyroid hormone profiles on blood work, because the thyroid hormone was found to be more effective (lower TSH levels, and higher free T4).

Taking thyroid hormone at night would work as long as it is separated by 2 to 3 hours from taking nutritional supplements, particularly those containing iron or more than 400 mg of calcium.    Therefore, if you decide to take thyroid hormone at bedtime, take your evening nutritional supplements at dinner, and then at least 3 hours later (if not 4 hours) take the medication.   (Melatonin does NOT interfere with thyroid hormone absorption, particularly if you use melatonin that is absorbed beneath your tongue, i.e., sublingual formulations.)

The benefits of taking your thyroid hormone at bedtime is that it appears to increase the absorption, and one does not have to wait to have breakfast or morning coffee.

Comments

Posted On
Mar 05, 2012
Posted By
David Delevante

I have a lady that is on Synthroid for hypothyroid. I want to put her on the protocol for hypo. She is also going through menapause. When she heard about USANA’s Phytoestrin, she was concerned that Black Cohosh would not react well with synthroid. Is that true in your experience?

Posted On
Mar 05, 2012
Posted By
Ladd McNamara, M.D.

Dave, good question. No, there’s no indication, studies, or reports that black cohosh interferes with the absorption of thyroid medication. She should be good to go. PhytoEstrin is a good product. Have her read this blog post if she hasn’t already. Thanks.

Posted On
Mar 06, 2012
Posted By
Debbie Beyer

You mention, Melatonin under the tongue …would this be the recommended usage for the Usana melatonin?

Posted On
Mar 06, 2012
Posted By
Ladd McNamara, M.D.

The best way to take melatonin is the type provided by USANA Health Sciences, which is a pure melatonin that is BEST dissolved under the tongue. By allowing it to be absorbed under the tongue it bypasses the liver effect, and directly enters the blood stream. It can be taken within 30 minutes of bedtime. Other forms of melatonin (the type you swallow) would need to be taken 60 to 90 minutes before bedtime. Thanks Debbie.

Posted On
Mar 21, 2012
Posted By
Edda Dulce Johnston

Dr. McNamara,
Hi again. I try to sneak Usana melatonin to my 10 y/o autistic boy, but he swallow it. I know it’s best to dissolve under the tongue but that’s impossible for him. Does he gets any benefits from just swallowing it? and do I have to give it to him an hour before? Thank you again.
Edda

Posted On
Mar 23, 2012
Posted By
Ladd McNamara, M.D.

Edda, yes … he will still get the benefits of melatonin if he swallows it vs. dissolving under his tongue. You’re doing great. :)

Posted On
Jun 01, 2012
Posted By
amoy joyce

Dr McNarmara I have a friend who had two miscarriges, her doctor claimed her Thyroid was a bit high and it needs to be lowered from TSH 3 to Tsh2, she is on Eltroxin 25 mg. I would like to suggest essentials, biomega, calcium proflav, Coq100 and vit D. she also suffers from lack of sleep. do you have any suggestions what best to recommend
Thank you so much.
kind regards Amoy

Posted On
Nov 19, 2012
Posted By
Ladd McNamara, M.D.

This is not the total answer, but I might suggest she take additional iodine/iodide complex. I used to recommend Iodoral (a iodine/iodide complex supplement). Take 1 per day. I’m not sure if that will make the difference for her, but it is a good health suggestion for the thyroid.

Posted On
May 18, 2013
Posted By
Samantha

I’m thinking of switching to bedtime to take my thyroid medicine. I assume I should still take it on an empty stomach. How long after eating should I wait to take the medicine?

Posted On
Jun 10, 2013
Posted By
Sharon Tobby

I was born with out a working thyroid glad. I am on armor thyroid meds now. Would it be safe for me to take my meds at night, knowing that armor is a more natural supplement than the other synthetic meds for thyroid? Phrase let me know what you think. Thanks

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