From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Taking levothyroxine with food will likely result in elevated TSH levels because food significantly reduces the absorption of levothyroxine. For optimal results, levothyroxine should be taken on an empty stomach, ideally 30-60 minutes before breakfast or the first meal of the day 1. When taken with food, particularly those containing calcium, iron, fiber, or fat, the medication's absorption can be reduced by up to 40-80% 2. This decreased absorption means less thyroid hormone enters the bloodstream, causing the pituitary gland to produce more TSH in an attempt to stimulate additional thyroid hormone production. Consistently taking levothyroxine with food may lead to inadequate treatment of hypothyroidism, with patients experiencing persistent symptoms despite being on an appropriate dose. If morning administration is difficult, taking levothyroxine at bedtime (at least 3-4 hours after the last meal) is an acceptable alternative that may provide even better absorption for some patients.
Some key points to consider:
- The effect of food on levothyroxine absorption is significant, and patients should be advised to take their medication on an empty stomach 1.
- Certain foods, such as those containing calcium, iron, fiber, or fat, can reduce levothyroxine absorption by up to 40-80% 2.
- Taking levothyroxine with food may lead to inadequate treatment of hypothyroidism, resulting in persistent symptoms despite appropriate dosing.
- Alternative administration times, such as bedtime, may be considered for patients who have difficulty taking their medication in the morning 1.
It is essential to prioritize the patient's morbidity, mortality, and quality of life when making decisions about levothyroxine administration, and to consider the potential impact of food on medication absorption 3. By taking levothyroxine on an empty stomach, patients can help ensure optimal absorption and minimize the risk of inadequate treatment.