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.
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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?
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?
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!