Contrary to popular belief, you don’t have to take thyroid medication first thing in the morning.
I know, I know, a lot of you are probably getting ready to throw your thyroid medication at me for even suggesting such a thing but it is true.
The truth is that there is nothing magical about taking your thyroid medication first thing in the morning.
But if you were to ask your pharmacist or doctor when you should take your thyroid medication, they would most likely tell you that the only time of day that you can possibly take your medication is first thing in the morning.
But we know that isn’t true.
Studies like this one prove it (1).
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The Difference In Taking Thyroid Medication in the Morning vs. Night
This study looked at 152 drug-naive patients with hypothyroidism and divided them into two groups.
Drug naivety just means that these are people who have never used thyroid medication before.
Another important point worth mentioning here is that all of these hypothyroid patients had Hashimoto’s thyroiditis as well.
The first group was told to take their thyroid medication 30 minutes before breakfast and the other group was told to take their thyroid medication 2 hours after dinner.
The researchers then tested the thyroid lab test results (TSH) of both groups of patients at various times during the 12-week period and compared the results to both groups.
Do you know what they found?
Both groups of patients saw improvement in their symptoms, cholesterol levels, and quality of life, and both groups required roughly similar doses to obtain normal thyroid function.
In other words, regardless of when the thyroid medication was taken, both groups saw roughly the same benefit.
Now there are some differences that are worth pointing out here including:
- The fact that the number of patients being tested is relatively small (about 70 people in each group).
- The patients told to take their medication in the morning were told to take it within 30 minutes of their food instead of 2 hours like the group who took theirs in the evening.
- There’s no way to know for sure if the patients in this study were actually following directions each and every day.
Despite these limitations, there’s still solid evidence (even in the form of additional studies (2)) to suggest that the time of day that you take your thyroid medication really doesn’t matter.
What does matter is that you get your dose in each and every day and roughly around the same time of day.
Why does this matter?
Because not everyone who takes thyroid medication has a schedule that allows them to take it first thing in the morning!
People often lead busy lives and when you take into account the necessity of taking thyroid medication away from food, it can make fitting your thyroid medication dose into your schedule very difficult (3).
But this doesn’t have to be an issue because it’s viable to take your thyroid medication in the evening.
Even though this is the case, you still will probably see that your doctor recommends you take it in the morning for a few reasons:
Why Do Doctors Tell You To Take Your Thyroid Medication In The Morning
The first reason has to do with doctors and dogma (4).
Dogma just refers to a set of principles that have existed for a long time and they are often just accepted as true even though many of them have never been truly challenged.
I bet if you were to challenge your doctor on what time of day is best to take thyroid medication they really wouldn’t have a good answer for you.
The main reason this is recommended is just because it’s the way that it’s always been recommended.
But that isn’t really a good excuse, especially when we have evidence to suggest that this claim is incorrect.
If your doctor does have a response to your question it will probably be something like this:
“Well, you have to take your thyroid medication first thing in the morning because it needs to be taken on an empty stomach”.
And while this is definitely a true statement, there are plenty of times during the day when your stomach is empty so it still isn’t a reason that it MUST be taken first thing in the morning.
For those wondering, here’s how the physiology of the stomach works:
In an otherwise healthy adult, it takes approximately 2 to 4 hours for the food that you eat to leave your stomach (5) and enter into your small intestines.
So from the perspective of thyroid medication, as long as you take your medication at least 2 hours (which was the time interval used in the study above) away from your last meal then you can rest assured that whatever you ate before or after this time is no longer in your stomach.
And if the food you ate 2 hours ago is no longer in your stomach then it’s not going to cause absorption issues with your thyroid medication.
So the reality is that you can probably take your thyroid medication at just about any time during the day so long as it’s 2 hours away from food and at least 30-60 minutes away from supplements.
Is It Safe To Take Thyroid Medication at Night?
I can probably already guess what your next few objections are to this idea so let me try to debunk them before you even voice them.
The first biggest objection that I hear when I tell thyroid patients that they can take their thyroid medication is the evening has to do with sleep.
They say something like this:
“But what about my sleep?! Won’t taking thyroid medication at night cause me to lose sleep?”.
And the answer to that question is…
Most people have no issues taking thyroid medication in the evening but it definitely has the potential to cause issues with sleep for certain people.
You can kind of predict how it will impact your ability to sleep by observing how it impacts you when you take it in the morning.
If you are like most people then you probably don’t find your thyroid medication very stimulating.
It’s not as if thyroid medication provides you with a big boost of energy right after you take it.
It does for some people, but not for most.
If you are someone who doesn’t really notice any difference in how you feel after you take your thyroid meds in the morning then taking it in the evening will probably not cause any issues with your sleep.
But if you are someone that notices a big boost of energy or a rush when you take it in the morning then it may cause issues with sleep for you.
The next objection I hear is something like this:
“Well, it may be the case that someone can take a weak thyroid medication like levothyroxine in the morning but that will never work for me because I take T3“.
And, just like my response above, it’s not often that even thyroid medications that contain T3 will keep you up at night even if you take them right before bed.
Are they slightly more likely to cause issues with sleep compared to T4 medications?
Yes, but the percentages that they won’t cause issues are still in your favor.
How do I know?
Because when I was practicing medicine years ago and prescribing T3 thyroid medication I would always recommend that patients start taking it at night instead of in the morning.
And based on my personal experience prescribing it to hundreds of people, probably only around 5-10% or so of people had issues with sleep when taking it in the evening.
So this strategy of taking thyroid medication at night works for all types of thyroid medications and for all types of thyroid problems.
Whether or not it works for you is more dependent on you personally and not on what type of thyroid medication you are taking or your dose.
How To Transition To Taking Your Thyroid Medication At Night
One of the best things about changing up the time of day that you take your thyroid medication is that this is something that you have complete control over.
You can’t force your doctor to change your thyroid medication, but you can adjust when you take it, and making even a small adjustment to when you take it may have a big impact on how it makes you feel.
So if you are someone who wants to transition from taking your thyroid medication in the morning to the evening here’s how to do it:
- Option #1: The skip dose approach. When using this approach what you would do is take your thyroid medication normally one morning and then skip it the following morning and start it back up in the evening on the next day. So if you last took your thyroid medication on Monday morning, your next dose would be Tuesday evening. From there you’d just continue taking it every evening.
- Option #2: The non-skip dose approach: With this approach, you would take your morning dose of thyroid medication and then take another dose in the evening on the same day. So if you took your dose on Monday morning then you would take another dose Monday evening and then continue taking it every evening from there.
Both options can work but I would recommend going for the skip dose approach if you are someone who tends to be sensitive to small changes to your thyroid medication dose.
Most people shouldn’t have an issue just taking their dose in the morning and then again in the evening (The non-skip dose approach).
If there’s ever any question about how to take your thyroid medication, though, make sure you touch base with your doctor.
I’m not giving you medical advice here, I’m just sharing some basic guidelines.
What if Taking Your Thyroid Medication At Night Doesn’t Work For You?
Simple!
You just go right back to taking it in the morning.
You won’t have done any harm in making the change and you will have learned some important information about yourself that you can use going forward.
The most common reason that taking thyroid medication at night doesn’t work has to do with sleep problems but some people have also reported strange or unpleasant dreams as well.
Recap & Final Thoughts
Even though most doctors will tell you that you have to take your thyroid medication in the morning, taking it in the evening is a viable option.
Not only is it viable, but it may actually be preferred in many situations.
Don’t be afraid to play around with the time of day that you take your medication just be sure to keep in mind the important fact that it must always be taken on an empty stomach.
As long as you take it around 2 hours away from food, though, that won’t be an issue.
Now I want to hear from you:
Did you know that you could take your thyroid medication at night?
What time of day are you taking your thyroid medication right now?
Have you tried taking it in the evening?
If so, did it work for you? Why or why not?
Leave your comments below!
Scientific References
#1. ncbi.nlm.nih.gov/pmc/articles/PMC3139142/
#2. ncbi.nlm.nih.gov/pmc/articles/PMC9261378/
#3. ncbi.nlm.nih.gov/pmc/articles/PMC6615580/
#4. pubmed.ncbi.nlm.nih.gov/35303116/
#5. ncbi.nlm.nih.gov/pmc/articles/PMC6850045/
Dr. Westin… just wanted to let you know that I take my medication at night and I have never felt better. I decided to do this because I couldn’t take my medication for arthritis until 2 hours after in the morning. I also take your multiple vitamins that have made a difference with how I feel. I’m 68 years old and I do feel better and my labs are better too. Thank you for all your help.
Hi Susana,
Glad to hear that taking it at night is working well for you! Thanks for sharing.
I’ve been taking my Nature Thyroid at bedtime for years. The reason is that I take my supplements with my breakfast, so taking my thyroid medication in the morning is not an option unless I change when I take my supplements.
Dr. Childs,
I work odd hours sometimes and taking my med in the morning and having to wait for coffee/breakfast is often inconvenient. I asked my physician about taking it in the morning and her response was along the lines of it “giving energy and why would one want that at night”? I do think I am going to try taking it at night for a couple of weeks (unless I have immediate issues) and see how I do. I typically eat dinner about 6-6:30 and go to bed about 10-10:30. I think I will try taking it about 9. I am going to try the “no skip” starting tonight. Thank you for educating me and others.
Hi Kelly,
That sounds like a good plan and you’ll know pretty quick if taking it at night works for you or not.
Hi! I just watched your video on getting the perfect lab tests (posted a few years ago) where you talked about the timing for thyroid meds. If I take thyroid meds at night and do a draw at 8 am, should I skip the dose the night before? Thanks for all the resources!
Hi Jinny,
It depends on your doctor and there preference, really. I generally would recommend that my patients avoid taking their evening dose but I would always take this into account during interpretation of the results. If your doctor isn’t aware and you do it, then you may confuse them.
I have learned so much. I’ve had three doctors and each Gave me a different mg of 150 ,137& 127. said it was effecting my heart. I will be doing the night taking.
Hi Yolanda,
Sounds good! Let me know how it goes.
I take mine whatever time of night I get up to go to the bathroom. Sometimes 330 sometimes 530, most of the time 530 or six. Tirosint and then T3. Then I go right back to sleep for however long and when I get up, I can have coffee eat, etc. with no thoughts or worries.
Hi Lisa,
That definitely works! Just make sure you consistently take your thyroid medication at the same time every day (or at least as close to it as possible).
I have been taking my Levo 100mg at night for about a year now. Love it. On occasion, it can get messy if I have a late night sweet tooth post taking my meds but we will pretend that doesnt happen (wink). I try to take it at the same time every night or within 30-45 min of the same time each night. Would I be able to simultaneously take the Essential T2 supplement at night or should that be taken during the day only?
Hi Megan,
Do you mean simultaneously take T2 at the same time as your levothyroxine? If so, the answer is yes, they can be taken at the same time.
Hey! I was thinking about shifting my med routine to night routine. I usually go workout in the gym 11pm and during that i drink alot of water. Will it affect the absorbtion if i take my thyroxine meds at 1am everynight? I will also have my last meal at 9-10pm.
Hi Karzan,
Yes, it will likely affect their absorption but most likely for the better.
I am taking a compound T3/T4 porcine derived in Australia – with the shorter life of T3, is it still ok to take one time per day in the evening only? Will the T3 last for the following day?
Hi Sarah,
For most people, yes, but some people benefit from multi-dosing T3 several times throughout the day.
Hello,
I have been following you on Pinterest for a while and I have learned a lot and thank you for sharing your knowledge with Hashimoto’s.
I take 88mcg of Synthroid and I was taking it in the morning for years. I would feel like I was going very fast. Then, I would sweat really bad during the day, and I was always thirsty. There are other things also. I talked to my Endocrinologist about what was going on and she said that I was sensitive to the medication but my labs looked great and to keep me on my prescription dosage.
I did some research about people taken thyroid medication at night and how it helped them so, I tried it for a few weeks and I get up about 2:00-2:30 in the morning to take my thyroid medicine.
I am better taking it this way now.
On my last visit to my Endocrinologist I told her I was still taking my thyroid medicine at that time and she said okay, whatever.
Thank you, again Dr. Childs for all the great advice.
Hi Dr. Childs,
I’m currently on NP Thyroid, 2 pills daily (I do one in the morning and the other in the afternoon). I feel like my life revolves around taking it twice a day. Is it feasible to take both doses at night? Or maybe one in the morning and one at night? Thanks!
Hi Nicole,
Absolutely, many people can take all of their daily dose at once.
Hello Dr. Childs!
I have actually thought about taking my thyroid medicine at night before. For one reason, I have found that I always seem to get my best sleep after I have taken my Armour around 4 am in the morning and then go back to sleep!
Does it make a difference in taking it at night if you take Armour or another type of medication?
Hi Joni,
All thyroid hormones and thyroid medications can be taken in the evening, this is not specific to levothyroxine or T4.
I have always taken my NDT with food and my other supplements mainly because if I don’t they don’t get taken.
I had the left side of my thyroid removed and it was thought the right side of the thyroid would continue to wither away (it’s still partially there). What are the ramifications of not taking thyroid on an empty stomach?
Hi Kathy,
Decreased absorption of thyroid hormones typically leading to persisent thyroid-related symptoms.
Hi Dr. Childs,
I weaned myself off my thyroid meds. ( I know I wasn’t suppose to do that without a physicians guidance) but it worked for me. My question is this, I am taking your hypothyroid bundle including the Thyroid Glandular. Currently, I take the thyroid glandular before breakfast and the rest after breakfast. Would I get a bigger benefit taking them at night?
Hi Trudy,
Thyroid Glandular, Thyroid Adrenal Reset Complex, and T3 Conversion Booster contain ingredients that may be stimulating so its best to take those in the morning. Essential T2 and T2 Cream can be taken at night, however, provided they don’t keep you up.
I thought I read that any dairy or minerals should be four hours from taking your thyroid medicine. If taking your meds at night is too much of a rush. Can you divide it between night and morning or would there be any benefit to that? I take 75 levo and 60 armor.
Hi Sarita,
You can learn more about the calcium in dairy impacting thyroid medication absorption here: https://www.restartmed.com/calcium-and-thyroid/
And, yes, you can split your dose if you’d like, you just have to make sure you take it correctly twice which can be ornerous for some.
I’m interested in switching to taking of NP thyroid in the evening. Can I take it with my LDN? Thanks for your articles. It’s helped me a lot.
Hi Margie,
I do not recommend taking thyroid medication with any other prescription medication except other thyroid medications.
I was taking levothyroxine at night for a while. I think I stopped because drinking a glass of water close to bed would cause me to get up to urinate. Is it necessary to drink a full glass of water?
Hi Robert,
No, it is not.
Hi, Dr. Childs.
I took my thyroid medication at night for at least 25 years without any problems. Then one day, my PC doctor decided that he didn’t like my TSH test results and upped my prescription for levothyroxine to the next higher dosage. The first night I took the higher dose, I woke up about two hours after I went to bed feeling terrible. I took my blood pressure, and it was very, very high. I experienced strange sensations in my arms. The BP would stay high like that for a while, then it would drop back down to normal. I know that it has been said that high blood pressure causes no real symptoms, but I could actually tell when it went up – I could FEEL it as it went up, then dropped. It did that again and again for hours. I was terrified. It eventually stopped and I fell asleep. I did not make a connection to the higher dose until after I had taken it for several days and the same thing happened every night. I called the doctor’s office and left a message. When the nurse called me back, she said “the doctor thinks you were just having an anxiety attack” (in my sleep?) and told me to try taking the medication first thing in the morning instead.
I followed his advice and began taking the thyroid med in the morning. The same thing happened with my blood pressure spiking extremely high, then dropping low, except this time it was happening in the daytime. So, this time I made an appointment to go in and see the doctor. During my appointment, the doctor told me that it could NOT possibly be the thyroid med causing the problems. He then proceeded to diagnose me with Hypertension and prescribed a blood pressure medication. I was frustrated by that because I didn’t think I developed the BP condition overnight. It was obvious (to me) that the problems coincided with my taking the higher dose of levothyroxine.
So, I made an appointment with a cardiologist who ran multiple tests, determined that I was NOT hypertensive and told me that it was likely that the higher dose of my thyroid med was causing the fluctuation of my blood pressure. He advised me to stop taking the blood pressure medication that I had been prescribed. I went back to taking the lower dosage of levothyroxine and my blood pressure went back to within a normal range and stayed that way.
Sorry for the long post, but what I’m saying is that it has been my experience that taking it at night CAN disrupt sleep if you have an adverse reaction to taking too high of a dose.
Thanks for listening.
Hi Jamie,
It certainly can impact sleep, I’ve seen it many times, but it seems like the issue in your case was primarily dose related as it was working well prior to increasing your dose for 25 years.
There are some people who can’t take any dose, even small doses, though, because it interferes with sleep even at very low levels. Why this occurs in some and not others is not clear to me. But I can say from experience that about ~80% of people have no issues taking their meds at night.
Does this hold true if one takes a combination of levo and lio?
I see the study only refers to levo and I know lio has a different half life and absorption rate.
Hi Jody,
It applies to all thyroid medications, including those that contain T3.
My young teen son switched from his 6am dose time to just before bed.
It did not bid well with him. He often forgot to take his daily vitamins until dinner, and often ate dinner late. His physician was supportive of the evening dose but wanted to make sure he took it four hours away from any supplements. I think with the combination of taking supplements and digestive aids with many late dinners, he was doomed! His labs showed that even though he had increased his dose, his TSH and T4 fell. Lots of factors but definitely couldn’t have seen it until we tried to do it. NP Thyroid
Hi Theresa,
This strategy may not work well for people who are accustomed to eating right before bed. But for most people who eat several hours before they go to bed, it can work great.
Hi Dr Child’s,
I had my thyroid removed in 2008 as it was enlarged (goiter) am regretting it now as I didn’t do research, just trusted the consultant. After many years I decided it would be more convenient to take it at night, as I was a care assistant coping with shift work.
It was easier to take, I felt fine, when I had a Dr’s appointment and mentioned that I take it at night, he said to go back to the morning time, wasn’t happy with me.
I do blame the system as they go through medical training and all come out brainwashed the same. They are not encouraged to treat people holistically or as an individual, they treat the illnesses not the person. Sorry to tar everyone with the same brush, but the good ones are hard to find in the UK.
Hi Dr Childs,
Just to say I started out on 100mg of Levothyroxin, going up to 150mg once my levels were tested and adjusted, was on that larger dose for many years, now I’m older that has changed and an now on 75mg, I did ask the Doctor why that was and was told that even though I had all my thyroid removed, my brain was still making T4.
I just want to say, isn’t the body amazing.
Hi Teresa,
It sure is!
Believe it or not, my Lyme doctor changed taking my thyroid med to twice a day. Once in the morning (usually about 6:00am) and another cap also in the evening. This seems to be working great for me. I take T4/T3 0.5gr porc Caps, two in the morning and one in the evening. Seems to work for me. That was quite a few years ago, and I no longer see that doctor but still take my thyroid med twice a day.
Hi Mary,
If it works for you then stick with it! Dose splitting can be beneficial, it just has the potential to cause more problems because you need to take your dose twice per day giving you another chance for interference.
Dr. Childs,
As a senior adult who has had no thyroid gland since the age of 28 yrs old, having been on thyroid medication for many years, I find that the perfect time for me to take my Levothyroxine is in the early morning hours.
I usually wake around 4 am to go to the bathroom.
Since I am up, I take my thyroid med.s and usually lie back down for a couple more hours.
I take supplements and or any other med.s about an hour after finally getting up.
Since I do not eat after 7pm at night, or before 10am in the morning, and am retired, I don’t have any issues with timing.
At one time I did try taking my Thyroid med.s at night , but since I have had insomnia for years , I found It inconvenient to take sleep supplements and thyroids med.s both at night….however, that being said, I did not feel any different when I took it at night.
Hi Charlene,
Taking it early in the morning is also another option that can work. It’s just no ideal because, well, ideally you’d be asleep during that time. But if it works for you, then stick with it. Just make sure you don’t accidentally miss any doses.
I have experimented with taking thyroid medication at night in the past. The only problem is I want to take magnesium at night as well. The magnesium helps me so much. I’ve always been concerned about it affecting my sleep. I seem to go from exhausted, could fall asleep anywhere to being exhausted but unable to calm my brain to sleep.
Currently I take the levo usually in the middle of the night, but I forget a lot. The T3 is usually around noon to 2 PM. I have a very bad 3-5 PM crash, I often feel like I am going to fall asleep on my feet. Taking the T3 in the afternoon seems to help. I seem to have issues with my heart rate increasing when taking the T3. Can’t seem to get the balance there. I also take adrenal glandular. Does it matter if I take them with thyroid medications?
Hi Sher,
I do not recommend taking thyroid medication at the same time as any other supplement or medication. It’s always better to separate them to ensure there’s no issue with absorption.
Hi Dr Childs,
I love your articles! I’m considering switching to the night dose for my armour. I also take melatonin, magnesium and another calm supplement for sleep. Would this dosing interfere with supplements ?
Thank you!
Hi Lindsay,
It’s best to take thyroid medication away from all supplements and all medication. 30-60 minutes away is usually okay with a few exceptions which you can learn more about here: https://www.restartmed.com/how-to-take-your-thyroid-medication/
Hi Lindsay,
Yes, all supplements and medications have the potential to interfere with thyroid medication absorptin which is why it should be taken on an empty stomach. You can learn more here: https://www.restartmed.com/how-to-take-your-thyroid-medication/
What about splitting the dosage between morning and night as my doctor advised?
Hi Julie,
There’s definitely some benefits to dose splitting, but it can become ornerous too, so it depends on the person and the situation as to whether or not it’s really needed.
I take 88 mcg of Levothyroxine along with 10 mcg of T3 in the morning. I would love to switch to taking them at bedtime but I also take Progesterone at night and a magnesium supplement. Any suggestions on the best way to take these without interfering with absorption?
Hi Vonda,
Thyroid medications should be taken 30-60 minutes away from other medications and supplements and this applies regardless of what time a day you take it. You can learn more here: https://www.restartmed.com/how-to-take-your-thyroid-medication/
Did you know that you could take your thyroid medication at night?
– No, but discussed it with my GP who saw no problem, I was wanting to see if it made any difference.
What time of day are you taking your thyroid medication right now?
Back to taking it in the mornings, I am too tired to remember at night, so that went out the window.
Have you tried taking it in the evening?
Yes. It did not seem to make any significant difference to how I felt. I slept ok.
If so, did it work for you? Why or why not?
What did not work was that time frame – after dinner, I can just fall asleep/zone out and I forget. I am better at remembering the morning one.
Hi Dr. Childs, what a solid explanation! Thank you! Is it also safe to do the transition to the evening during pregnancy? Or better wait until after it?
Hi Stephanie,
It shouldn’t be an issue making the switch while pregnant, provided you do it correctly, but whenever a baby is involved, I always recommend touching base with your ob/gyn for safety reasons.