Monday, March 5, 2012

Do I always have to take my medication on an empty stomach?

I was just asked this question again today and I've been meaning to post about this, but then I always forget.

Doctors and pharmacists always say you need to take your thyroid medication on an empty stomach. Why? Because food, especially foods with calcium or iron in them, will interfere with thyroid hormone absorption from your stomach. Also, some medications, like antacids, can bind to the thyroid medication and prevent absorption. (Caution: If you do take other medications along with thyroid meds, check with your pharmacist to see if there might be any interactions between drugs or any reason that you absolutely need to take them separately from your thyroid meds.)

Here's the scenario: You're newly diagnosed with thyroid disease and need to start taking medication. Upon hearing that you need to take it on an empty stomach, you realize that means you won't be able to eat breakfast in the morning for an hour even if you tke the pill first thing when you wake up. That disrupts your whole morning routine. So you get this great idea: you'll wake up an hour early, take your pill, and go back to sleep. Sounds great, right?

WRONG! Not fun. Plus, how many times do you wake up out of a sound sleep and have to do something, and then can go right back into a sound sleep for another hour? (If you can, then you're either lucky, or not perimenopausal)

One of the biggest fallacies about taking thyroid meds is the waiting an hour until you eat. If you always do the same thing, and are always consistent, the absorption thing will work itself out in the testing and dosing. I take mine every morning with my coffee (which has milk in it) and I eat breakfast soon after. You need your sleep more than you need to be woken up every morning just to take a pill. I know so many people who think they have to do it that way and really, it makes no sense.

Here's what I learned from my old endocrinologist in Arizona. She had her thyroid removed and took thyroid meds every day. She took hers with her morning latte. She explained it like this:
If you always have the latte, then the test will be based on your thyroid med absorption with the latte. So whatever your TSH comes out to be based on thyroid meds with latte, you can be medicated based on thyroid meds with latte.

I never worry about it, and I've never had a problem. In races, like I said, just do it when it's the same time of day. One day doesn't make all that much difference in your overall TSH if it's done slightly differently due to a race. Especially considering you'll only be getting tested every few months at the most.

Enjoy your sleep! (And your coffee)


  1. Thanks for the post! I like your endocrinologists example. Looking forward to a little more sleep....

  2. It doesn't make sense to encourage someone who is already exhausted to get even less sleep...

  3. I like this post, because when I was newly diagnosed I was that girl waking up an hour early before my workout, taking the meds and going back to sleep (if I was lucky enough). But now, after two years since my thyroid was removed, I take mine with my morning coffee always, and that seems to be working good. At first I was having issues and it turned out it was a vitamin D deficiency vice taking the meds on an empty stomach. It is amazing how many things we have yet to learn about thyroid meds and all the myths surrounding them.

  4. Thanks Maria! There is so much still not understood about thyroid disease. Again, there is not a lot of research into this because it is not generally considered a life-threatening condition and it's not a big money maker for drug companies or anyone in medicine. Vitamin D deficiency is very common, but a lot still remains to be learned about that too! I often wonder how many people who are struggling to get their thyroid meds to work right, have other undiagnosed or undetected deficiencies in other minerals or vitamins. That's why it's so important to find a doctor who will work with you- if you're not getting results despite a "normal" TSH and other thyroid labs, there could be something else going on and the doctor needs to help you solve it. Often endocrinologists won't put the effort into that because it's not their area of expertise. You need a team to help you get well, and the team has to work together!

  5. Who did you use for an Endo in Phoenix? I need someone who understands Arlene.

  6. I used Kristin Hanson for my endo in Phoenix. She left her practice a long time ago to go into research, I thought, but I just looked her up and found her, so maybe she is seeing patients again. She was in downtown Phoenix. Excellent doctor, very smart, and she has been there! Good luck, I hope she is back in practice.

  7. I found that as I don't have much time in the mornings generally, waiting an hour to eat after meds was not at all convenient and I end up leaving the house without breakfast more often than not. I now take my pills at night, just before bed, and its so much less hassle.

  8. Unfortunately there are two things incorrect with this post. One, you should Never take your meds with food. It does cause interference with absorption and binding to chemicals in your body, up to 49% of your meds!! Two, you should NEVER be dosing your meds off your TSH levels and if you have an endo that doses your meds off your TSH level and not your Free T4 and Free T3 levels, fire them quickly and get a new doctor. Your not near as well as you could be!! You could feel soooo much better even with less sleep! :)

  9. Resa, there are very few NEVERs in life. Read the post again. It's about consistency. If you always do the same thing, your lab values will reflect the level of absorption of your meds with your everyday routine. And as far as TSH vs. FT3 and FT4, I'll leave that to the physician to decide. I don't care what numbers they want to look at, as long as they listen to me. It's all about quality of life and how I feel, as the person living with the thyroid disease.

  10. I read somewhere that it could be more benificial to take it at night. At night your intestines slow down and the medication would stay longer in your GI track giving it more time for absorption. Any thoughts?

  11. Anonymous, there is no evidence for it being better to take your medication at night than during the day. Your GI tract will process whatever is in it regardless of the time of day. It is not true that it will absorb better at night. The only merit to that statement is that if you take it on an empty stomach, it does absorb better, but the point of my post is consistency. Whatever you do, do it all the time and your labs will reflect what you are absorbing and using on a regular basis and it will be easier to determine the amount of drug you need.

    1. There have been studies done that indicate that it is better for most people to take thyroid medicine at night.


Please feel free to leave a comment. Sharing your experience can help someone else who feels they are alone! (Note: I do not endorse anyone's product. ALL attempts to sell a product WILL BE DELETED- don't waste your time!)