From the Guidelines
Yes, you can take thyroid medication at night, as taking levothyroxine at bedtime may lead to better absorption when the digestive system is empty. Although most doctors traditionally recommend taking it in the morning, studies have shown that nighttime dosing can be effective for some people 1. If you choose to take thyroid medication at night, it is essential to take it at least 3-4 hours after your last meal and avoid eating or taking other medications for at least 30-60 minutes afterward. Consistency is key—whatever time you choose, stick with it daily.
Key Considerations
- The most important factor is taking thyroid medication on an empty stomach, away from food, calcium, iron supplements, and certain medications that can interfere with absorption.
- If you're considering switching from morning to nighttime dosing, consult your healthcare provider first, as they may need to monitor your thyroid levels after the change to ensure your dose remains appropriate.
- It is crucial to prioritize taking thyroid medication consistently and at the same time every day to maintain optimal thyroid hormone levels and minimize potential side effects 1.
Potential Risks and Benefits
- Overtreatment with levothyroxine can lead to adverse effects on bone mineral density and the cardiovascular system, such as angina, arrhythmia, and increased cardiac wall thickness 1.
- However, five trials published since the previous review assessed the harms of treatment of hypothyroidism with levothyroxine and generally reported no indication of harms or no or minimal withdrawals from treatment due to adverse effects 1.
From the FDA Drug Label
• Instruct patients to take levothyroxine sodium tablets as a single dose, preferably on an empty stomach, one-half to one hour before breakfast with a full glass of water to avoid choking or gagging.
The recommended timing for taking levothyroxine is one-half to one hour before breakfast, which implies that it should be taken in the morning. There is no direct information in the drug label that supports taking thyroid medication at night. Therefore, based on the available information, it is recommended to take levothyroxine in the morning, as instructed, and not at night 2.
From the Research
Administration of Thyroid Medication
- The timing of thyroid medication administration can be flexible, with studies suggesting that taking levothyroxine in the morning and at bedtime are equally effective 3, 4.
- However, it is essential to maintain a proper time interval between levothyroxine and food intake, especially for coffee and calcium or iron supplements, to minimize interactions and ensure optimal absorption 3, 5.
Interactions with Food and Supplements
- Certain foods and supplements, such as calcium, iron, and coffee, can interfere with levothyroxine absorption, reducing its efficacy 3, 5, 6.
- Taking levothyroxine at bedtime may be an attractive option for patients with hypothyroidism, as it can help minimize interactions with food and supplements 4.
Alternative Formulations
- Liquid levothyroxine may be a suitable alternative for patients experiencing malabsorption due to calcium or iron supplementation, as it is resistant to sequestration by these substances 6.
- Novel formulations are being developed to address the issue of malabsorption caused by coffee, calcium, and iron 3.