When do i take levothyroxine

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Back to Healio. Read more about levothyroxine. Related Content. When overall changes were compared between the 2 groups, bedtime levothyroxine intake was found to have a direct treatment effect, with a decrease in thyrotropin level of 1.

The mean SD FT 4 level in the group that received morning levothyroxine first increased from 1. In the group that received bedtime levothyroxine first, the mean SD FT 4 level decreased from 1.

Therefore, bedtime levothyroxine intake resulted in a direct treatment effect, with an increase in FT 4 level of 0. Changes in TT 3 levels were similar to changes in FT 4 levels. In the group that received morning levothyroxine first, the mean SD TT 3 level increased from In the group that received bedtime levothyroxine first, the mean SD TT 3 level decreased from In this case, the direct treatment effect of bedtime levothyroxine was an increase in TT 3 level of 6.

No first-order carryover effect was found for thyrotropin, FT 4 , or TT 3 levels. There were no differences between the 2 study groups in serum creatinine or lipid levels, blood pressure, body mass index, or heart rate. These results are summarized in Table 2.

Hypothyroidism symptoms were unchanged between the 2 periods, despite improved thyroid hormone profiles, nor was there a difference in hyperthyroidism symptoms. When asked at the end of the trial before the randomization code was broken , 34 of 90 patients said that they felt better during the period of morning intake of levothyroxine, 31 patients preferred the period of bedtime intake, and 25 patients indicated no preference. At 1 year after completion of the trial, more than half of the patients still preferred bedtime intake of levothyroxine.

We performed this large, randomized, double-blind crossover trial among 90 patients to address whether levothyroxine taken at bedtime instead of in the morning improves thyroid hormone levels. The primary outcomes show a decrease in thyrotropin level of 1. Despite the change in thyroid hormone levels, the patient QOL did not differ.

Bedtime levothyroxine intake could be more convenient for patients, as they do not have to postpone breakfast. After our study was completed, more than half of the patients decided to continue with bedtime intake of levothyroxine. How can the bioavailability effects of levothyroxine be explained?

An interval of 30 minutes between taking levothyroxine and eating breakfast may be too short to prevent interference with gastrointestinal absorption of levothyroxine. Moreover, many patients drink coffee in the morning, often instead of eating breakfast, 6 or may take other medications that interfere with levothyroxine absorption.

In contrast, most patients in our study stated that they had eaten no food or snacks for several hours before bedtime, this being their usual routine. Bowel motility is slower at night, resulting in more prolonged exposure of levothyroxine to the intestinal wall and, consequently, in better bioavailability.

Thyroid hormone level changes did not translate into QOL changes. There are various explanations for this observation. Patients with hypothyroidism taking adequate doses of levothyroxine ie, those whose thyrotropin level is in the reference range can still have significant impairment in psychological well-being and cognitive function compared with control subjects. Weight gain and inability to lose weight are known to occur in patients with treated hypothyroidism and hyperthyroidism.

A trial investigating T 3 supplementation showed that improved QOL was limited to a subgroup of patients with suppressed thyrotropin levels who had lost weight. In contrast, plasma thyroid hormone levels may not be representative of thyroid hormone levels at the tissue level eg, in the brain ; therefore, they would be unrelated to QOL.

Primary outcomes of this study are consistent with results of an earlier pilot study. In a retrospective medical record review of 15 nursing home residents, Elliott 35 observed a nonsignificant decrease in thyrotropin levels when levothyroxine intake was switched from after breakfast to midnight. The findings in that nonrandomized trial confirm the results of our study. A 3-period crossover design study 36 showed higher thyrotropin levels when levothyroxine was taken at bedtime instead of before breakfast, but there was no change in FT 4 or TT 3 levels, as in our study.

The study also included patients with thyroid cancer, whose thyrotropin levels were maintained at lower levels than those of the rest of the population. Therefore, we believe that the findings in that study extend the generalizability of our study results to the treatment of primary hypothyroidism. Lower thyrotropin levels associated with levothyroxine intake before breakfast vs at bedtime intake in that study could be explained by the longer interval between levothyroxine intake and breakfast 60 minutes vs 30 minutes in our study.

Also, most patients in our study stated that they had nothing to eat or only a small snack for several hours before bedtime, which differs across cultures. In all studies performed on the timing of levothyroxine ingestion, intake on an empty stomach seems to result in maximal absorption of levothyroxine.

Our study shows that if this fasting regimen can be achieved at bedtime, then resulting thyroid hormone levels are better than those associated with levothyroxine intake 30 minutes before breakfast.

The crossover design of our study has the advantage that each patient served as his or her own control. Therefore, a statistical difference in thyrotropin values at baseline will not influence primary and secondary outcomes of the study. The study design has potential limitations, including order and sequence effects.

We found no first-order carryover effect between the 2 periods, but we looked at no other order or sequence effects. It should also be noted that this was a single-site study in the Netherlands, where eating habits might be different from those in other countries or cultures.

Based on the results of our study, clinicians should inform patients with hypothyroidism that levothyroxine intake at bedtime is a good alternative to levothyroxine intake in the morning, provided that levothyroxine is taken on an empty stomach. For patients who do not attain normal thyrotropin or FT 4 levels with morning levothyroxine intake, a switch to bedtime is recommended.

Recommendations on timing of levothyroxine intake and on uptake interference by food are found in few guidelines about the management of hypothyroidism. In conclusion, bedtime intake of levothyroxine in our study significantly improved thyroid hormone levels.

This may be explained by better gastrointestinal bioavailability at night or by less uptake interference by food or medications.

As shown in this study, bedtime administration is more convenient for many patients. Clinicians should inform their patients about the possibility of taking levothyroxine at bedtime. A prolonged period of bedtime levothyroxine therapy may be required for a change in QOL to occur. Authors Contributions: Dr Bolk had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design : Bolk, Visser, and Berghout. Acquisition of data : Bolk, Jongste, and Berghout. Critical revision of the manuscript for important intellectual content : Visser, Tijssen, and Berghout. Statistical analysis : Nijman and Tijssen.

Administrative, technical or material support : Nijman and Jongste. Study supervision : Berghout. Additional Contributions: Liesbeth Ruygrok, PhD, oversaw preparation of the levothyroxine and placebo capsules and randomization of the patients.

Maasstad Hospital Rotterdam laboratory technicians processed the blood samples, and employees of the Department of Internal Medicine assisted with patient assessment. We thank the patients who participated in this study for their cooperation. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Download PDF Comment. Figure 1. View Large Download. Table 1. The spectrum of thyroid disease in a community: the Whickham Survey.

Liel YHarman-Boehm IShany S Evidence for a clinically important adverse effect of fiber-enriched diet on the bioavailability of levothyroxine in adult hypothyroid patients.

For people with heart problems: Levothyroxine can increase your risk of serious heart problems, such as heart attack , abnormal heart rhythm, and heart failure. Tell your doctor if you have heart problems or a history of heart problems.

Your doctor may decide to start you on a lower dosage of levothyroxine. For people with diabetes: Let your doctor know if you have diabetes. Taking levothyroxine can make your diabetes worse. Your doctor may monitor your blood sugar level more closely while you take this drug and adjust your diabetes drugs if needed. For people with osteoporosis : Using levothyroxine for a long time can cause decreases in your bone mineral density and put you at higher risk of bone fractures.

For people with adrenal or pituitary gland problems: Let your doctor know if you have any adrenal or pituitary gland problems. Using levothyroxine can cause changes to your levels of thyroid hormone that could make these problems worse.

For people with blood clotting disorders: Let your doctor know if you have any blood clotting disorders. Taking levothyroxine may make it more difficult for your blood to clot and make bleeding more likely. It appears unlikely that this drug will harm a pregnancy. Not treating hypothyroidism could cause problems for both you and your pregnancy.

You should not stop taking this drug during pregnancy. For women who are breastfeeding: Small amounts of levothyroxine may pass into breast milk, but this drug is usually safe to take while breastfeeding. Talk to your doctor about the best way to feed your child while taking levothyroxine. Your doctor may choose to start you on a lower dosage. For children: Levothyroxine has only been approved for use in children for the treatment of hypothyroidism.

The tablet can be used safely in children of all ages. Levothyroxine oral tablet is used for long-term treatment. It may even lead to coma. For this drug to work well, a certain amount needs to be in your body at all times. If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose can include:. If your symptoms are severe, call or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose.

Never try to catch up by taking two doses at once. This could result in dangerous side effects. How to tell if the drug is working: You should feel your symptoms of low thyroid hormone decrease. For instance, you should have more energy, less tiredness, and less weakness. A prescription for this medication is refillable.

You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription. Your doctor will monitor your thyroid hormone levels during your treatment with this drug. Your doctor will have blood tests done to make sure your thyroid hormone level is within the range they feel is best for you. The tests will tell if your medication is working.

Certain foods such as soybean flour, cotton seed meal, walnuts, and other dietary fibers may affect how well your body absorbs levothyroxine. Talk to your doctor about whether you should make any changes to your diet. Many insurance companies require a prior authorization for certain brand-name forms of this drug.