I think you're supposed to take it (L-thyroxine) first thing in the morning (on an empty stomach) and wait 30 minutes to eat. This is so it will be able to have the maximum absorption and to be able to work all day long to increase your energy. Still, you don't need to force yourself to wake up at a certain time to take them. Just get plenty of sleep and wake up and follow the routine.

If your energy levels are dropping and especially if you are sensitive to the cold still, maybe you need your labs done again. Hopefully the doctor checks the FT4 as well as the TSH, and preferably the FT3 also.

Levothyroxine has a 7-day half-life which means 1/2 of the dose is used up after 7 days.

Taking it at different hours really shouldn't be a problem as long as you don't eat/drink anything other than water for at least 30 minutes before you take it or 2 hours after.

A small study showed that levothyroxine is best absorbed at night. The thought behind this is that bowel motility is slower at night thus, giving the med more time to be absorbed.

It was because of this study and mostly because I didn't want to wait for my AM coffee that I've always taken my levothyroxine around 11PM......making sure it's at least two hours after my last food/drink other than water and 4 hours away from my calcium supplements (that spacing also applies to iron supplements)

My endo told me her patients set their alarms for 3:00 AM, get up & take their meds, then go back to sleep. Yeah, like THAT'S going to happen. I didn't think there WAS a 3:00 in the morning. Geeze!

I was told to take them first thing in the morning, and wait at least 1/2 before drinking coffee or eating.

I have enough trouble sleeping period. Not gonna set an alarm to get up and take meds cause i would never go back to sleep.

I take mine around 6:30 and wait an hour to eat anything. I don't think you have to wait that long but I think my doc originally said 40 minutes.

I take mine at midnight right before I go to sleep.

I take Levothyroxine and I always take it in the morning right before breakfast. I take it at different times and I never wait 30 minutes before breakfast. I just take it whenever I wake up. I have done this since I was 12 and I have never had any problems with my thyroid.

I take mine AT bedtime and started to feel 100% better. If I take it in the a.m. I feel like wilted lettuce throughout the day. Taking it at bedtime enables FULL absorption.

30 minutes AFTER any meal is an empty stomach.


When I was first diagnosed I was told to take it in the a.m. and NEVER felt any improvements. I was taking Levothyroxine when I made the switch to taking it at night. I am taking Armour and that was a smooth transition taking it at night.


Should you take your medication at night?
By Mary Shomon, About.com

Every thyroid patient has heard the advice that for best results, we should take our medication first thing in the morning, on an empty stomach, and wait at least 30 minutes to an hour before eating. (And also, that we should wait at least three to four hours before taking calcium or iron, which can interfere with thyroid hormone absorption.)

But two important studies -- a 2007 study published in the journal Clinical Endocrinology, and a follow-up larger randomized trial reported in the December 2010 issue of the Archives of Internal Medicine -- have found that taking the same dose of levothyroxine (i.e., Synthroid) at bedtime, as compared to first thing in the morning, may be better.

The studies were prompted by observation that some patients had improved thyroid hormone profiles improved after they switched from taking their levothyroxine in the morning, to bedtime.

In 2007, Clinical Endocrinology reported on a small pilot study, which looked at the impact on thyroid hormone profiles by changing the time levothyroxine was taken from early morning to bedtime. They also evaluated the impact of this change on the circadian rhythm of TSH and thyroid hormones and thyroid hormone metabolism. The study, while small (12 subjects), was fairly conclusive in its findings, which the researchers said were striking and which have important consequences for the millions of patients who take l-thyroxine daily.

Researchers reported that taking medication at bedtime, rather than the morning, results in higher thyroid hormone concentrations and lower TSH concentrations. TSH decreased and Free T4 levels rose in all patients by changing thyroxine ingestion from early morning to bedtime and T3 levels rose in all but one subject. And TSH decreased irrespective of the starting TSH levels, suggesting better absorption of the thyroid medication when taken in the evening. Interestingly, the researchers found that the circadian TSH rhythm -- the typical daily fluctuations of TSH that occur during a 24-hour period -- dids not vary.

The researchers suggested several explanations for the results:
Even when waiting at least 30 minutes to eat, breakfast may be interfering with the intestinal absorption of levothyroxine thyroxine.
Bowel motility is slower at night, which means that it takes longer for the levothyroxine tablet to transit through the intestinal system, resulting in longer exposure to the intestinal wall, and therefore, better uptake of the medication.
The conversion process of T4 to T3 may be more effective in the evening.
The researchers have suggested that given the results of this pilot study, a large double-blinded randomized study was needed to confirm their results.

That study was conducted between April 2007 through November 2008m, and the results were reported on in the 2010 Archives of Internal Medicine article. The study was a randomized double-blind crossover trial. Ninety patients completed the trial, which involved a six-month period of taking 1 capsule in the morning and 1 capsule at bedtime, with one capsule active levothyroxine, the other placebo, and a switch at the three-month point. The researchers evaluated thyroid hormone levels, as well as creatinine levels, lipid levels, body mass index, heart rate, and quality of life parameters.

The researchers found that the patients taking nighttime levothyroxine had a drop in TSH of 1.25 -- which is a significant change. They free thyroxine (Free T4) level went up by 0.07 ng/dL, and total triiodothyronine (Total T3) went up by 6.5 ng/dL. According to the researchers, there were no significant changes in the other factors.

The researchers concluded that, given the improvement in thyroid hormone levels, physicians should consider prescribing levothyroxine to be taken at bedtime.

From Mary Shomon: What are the Implications for Thyroid Patients?

Taking medication at bedtime instead of in the morning could have major implications for many thyroid patients. First, its easier, as you dont have to worry about when to eat breakfast.

Second, its easier to avoid medications, supplements and foods, like calcium, iron, and high-fiber foods that can interfere with thyroid medication absorption.

Third, coffee drinkers would not have to wait until an hour after their medication to enjoy their first cup.

Fourth, it might offer some improvement in symptoms to people who are just not getting optimal absorption by taking thyroid medication during the day.

While these are smaller studies, they confirm what many patients anecdotally have been reporting for years -- that they feel better if they take their thyroid medication in the evening, rather than the morning.

You may want to talk to your practitioner about changing the time you take your levothyroxine (i.e., Synthroid, Levoxyl, Levothroid, Unithroid, Eltroxin) to bedtime, versus morning. And if you decide to change to taking your thyroid medication in the evening, be sure to have your thyroid levels evaluated -- six to eight weeks is a reasonable timeframe -- after youve made the switch. The blood test results, along with any improvements or worsening of symptoms, will help you and your doctor to determine if you need to adjust the dosage or timing of your medication.



What About Natural Thyroid and T3 Medications?
This study was conducted with levothyroxine -- a synthetic form of the long acting T4/thyroxine thyroid hormone. This form of the hormone must first be converted in the body to the active form (T3), and this can take days. Thyroid drugs that contain T3 -- Cytomel, Thyrolar, and the natural desiccated thyroid drugs like Armour -- are used directly by the body within hours. These drugs were not evaluated in the study, and it's not known if medications containing T3, or natural desiccated thyroid drugs would be better absorbed at night.

Anecdotally, some thyroid patients have reported improvement in symptoms when taking some or all of their T3-based thyroid hormone replacement medications in the evening. But some thyroid patients also find that if they take a medication with T3 later in the day or in the evening, the slight stimulatory effect of the T3 medication can make it difficult to sleep.
So keep in mind that while it's very possible that if a similar study were conducted with T3 drugs, the results would be similar, there is some chance that it would impact sleep quality in some patients. Only make such a change after discussing it with your doctor.

Optimally, some doctors have suggested that patients who take medications use a time-released or sustained release formulation of T3, or T3 split their doses. This approach seems to minimize sleep interference.

Again, if you do make a change to how you take your T3 thyroid medication, you'll want to have a reevaluation of blood levels and symptoms after several weeks, to determine if you need to adjust the dosage or timing of your medication.

I take mine in the morning with water and have coffee right after. Have done it that way for years.

Thank you all for the great info! I am taking my meds as soon I get up. I've been too tired to set my alarm to take it at 7 am. I hope taking it at different morning hours will not disrupt my levels!

I have found if I take the Naturethroid, dessicated T3 and T4 in the PM, that I cannot sleep and feel quite agitated. That said, I now take both NT and an additional T4 supplement. Was wondering if its wise to take the NT in the early morning, and the T4 at night?????

Incidentally, even my stupidest Endos and MD's told me not to eat or drink anything but water one hour before and two hours after dosing for maximum absorption. I know there are varying opinions on this including Mary Shoman.

I don't have a thyroid to help secrete its own hormones, so every bit of thyroid hormones for me has to come from meds. And I treasure every teeny tiny bit. Hypothyroid symptoms are the worst!

Thanks for all the great info energylost..
I'll give it a try.. I especially like those stats on FT3 !

I would like to try taking it at night, would I need to ask my doctor if I can do this???