Can levothyroxine (T4) be taken if missed in the morning?

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Last updated: April 21, 2025View editorial policy

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From the FDA Drug Label

Instruct patients to take levothyroxine sodium tablets only as directed by their healthcare provider 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 FDA drug label does not answer the question.

From the Research

If you miss your levothyroxine dose in the morning, you can still take it later that same day, as long as it's within 12 hours of your usual time, according to the most recent and highest quality study available 1.

Key Considerations

  • If you remember within 12 hours of your usual time, take it as soon as you remember.
  • However, if it's almost time for your next dose (the following day), skip the missed dose and resume your regular schedule.
  • Don't double up to make up for a missed dose.

Importance of Consistent Timing

Levothyroxine works best when taken consistently at the same time each day, preferably in the morning on an empty stomach, 30-60 minutes before eating.

  • This timing maximizes absorption since food, certain medications, and supplements can interfere with how well your body absorbs the medication.
  • Consistent timing is important because levothyroxine has a long half-life in your body and works to maintain steady thyroid hormone levels, which regulate your metabolism and many other bodily functions.

Adjusting Your Schedule

If you frequently miss morning doses, talk to your healthcare provider about potentially adjusting your schedule.

  • They can help you find a schedule that works best for you and ensures you're getting the most out of your medication.
  • It's also important to note that the evidence for combination therapy with levothyroxine and liothyronine is still being studied, and the current consensus is that there is equipoise for a new clinical trial of combination therapy 1.

References

Research

Evidence-Based Use of Levothyroxine/Liothyronine Combinations in Treating Hypothyroidism: A Consensus Document.

Thyroid : official journal of the American Thyroid Association, 2021

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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