How to take Levothyroxine & Other Thyroid Medication (NDT/T3) Correctly

*This post was most recently updated on January 25th, 2019 with more information*

Did you know that changing the time of day you take your thyroid medication may impact your thyroid function?

Beyond the time of day, there are several factors that YOU can change which may result in an increase thyroid function and conversion in your body.

These changes have helped hundreds of patients of mine in the past and I'd like to share these strategies with you.

Let's jump in: 

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The Importance of Taking Thyroid Medication Correctly

Believe it or not, taking your thyroid medication correctly matters quite a bit.

In the current treatment paradigm (where your total dose is based on your TSH) it becomes very important to ensure that you are getting enough thyroid hormone to your tissues.

And that's where taking your thyroid medication correctly comes into play:

It turns out that the time of day you take your medication may influence how much of it is actually absorbed, how much enters into your body and how much thyroid hormone is converted.

Conventionally you (and most thyroid patients) are told to take your medication first thing in the morning, on an empty stomach and wait at least 60 minutes before you eat any food.

Sound familiar?

Well, it turns out that there are several factors at play here that may change how much thyroid hormone you absorb and how your body interacts with that thyroid hormone.

As we've established in other posts, thyroid hormone interacts with many other hormones in your body including cortisol levels (1).

One thing you might also be familiar with is that cortisol levels are supposed to peak at 8am each morning (2).

​Since we know that both of these hormones interface with one another (and alter the effects of each other) taking your thyroid medication in the morning may be increased demand on adrenal and thyroid function. 

Unfortunately, many hypothyroid patients also suffer from debilitating fatigue which may be due to dysregulated cortisol levels.

tips for improving thyroid hormone absorption

In addition, it turns out that your GI tract and how quickly it moves throughout the day also may influence thyroid absorption. 

We know that approximately 70% of thyroid hormone is absorbed (assuming you have no GI issues).

We also know that GI function slows down at night (3) and speeds up in the morning (explaining why most people have bowel movements in the morning).

​Therefore it just makes sense that taking thyroid medication at night may be better for some individuals based on these two factors alone. 

For patients who have cortisol related issues (meaning high or low cortisol) or who suffer from GI-related problems - it may actually be better to take your thyroid medication at night. 

Does this mean that you should take your thyroid medication at night?

Not necessarily, but we can use it as a guide to determine if this might be an option for you: 

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The Best Time to Take Thyroid Medication & Why it Matters

It turns out that some studies have shown that simply taking your thyroid medication at night (4) may improve all of your thyroid serum tests. 

Total T3 levels of levothyroxine if taken at night

​What's really interesting about this study is that it showed not only do T4 levels increase but T3 levels also increase. 

If you've been reading my blog you know that the most important marker for thyroid function is your T3 level. ​

In fact, we really only care about T3 levels because T3 is the ACTIVE thyroid hormone.

So why does taking your thyroid medication at night seem to result in an increase in T3 levels for some patients?

Again, this probably comes back to hormonal rhythms and changes that you undergo on a daily basis. 

In a world where most physicians are reluctant to increase your dose of thyroid hormone, it's helpful to understand what you can be doing to help improve your thyroid absorption and function whenever possible. 

In fact, simply changing the time of day you take thyroid medication and adding in some T4 to T3 conversion boosters may improve your quality of life drastically. ​

If you are symptomatic despite taking thyroid medication and despite "normal" thyroid labs, you can consider these rules for taking thyroid medication which may improve your symptoms. ​

Always remember:

If you are planning to make any changes to your thyroid medication it is best to consult with a physician first - each situation is unique and should be treated as such. ​

Rules for Taking Thyroid Medication:

  • To ensure proper absorption make sure to take your thyroid medication away from meals, supplements and anything else by mouth.
  • If taking your medication in the morning doesn't work well for your schedule then consider taking your medication prior to bedtime.
  • Avoid taking thyroid medication anywhere near iron or calcium as these may further reduce absorption of thyroid medication.
  • If you have any gastrointestinal issues make sure to manage those appropriately, that means any of the following conditions: GERD (or reflux), SIBO/SIFO, constipation, gas/bloating, IBS, IBD or abdominal pain. 
  • Remember that certain forms of thyroid hormone are absorbed better than others: the fewer fillers that the medication has the better it will be both tolerated and absorbed. 
  • NDT may be more difficult to absorb for some patients with GI-related problems. 

Use these rules as guidelines for taking your thyroid medication. 

Now on to more pressing questions: ​

Will this change result in weight loss? ​

Will Changing How you Take Levothyroxine Help with Weight Loss?

The answer to this question isn't necessarily an easy one, but we will talk about how it might help you.

Obviously, the value of increasing your T3 + T4 levels simply by changing when you take your thyroid medication is very promising.

But, does this effect change your metabolism?

The answer is that it might...

Several issues are involved in why some thyroid patients lose weight and others don't and I've written about it in detail here

Basically, as long as your body is converting T4 to T3 adequately then increasing your absorption may improve your metabolism and lead to weight loss. 

When we talk about thyroid function and weight gain you need to understand that the majority of the benefit from taking thyroid medication comes from its influence on your basal metabolic rate (5) and other hormones.

​So for some of you, increasing your thyroid medication may result in an increase in T3 which may result in an increase in metabolism. 

For others increasing your T4 may result in an increase in reverse T3 and may not have any impact on your weight. ​

​The good news is that making this change is relatively easy to do. 

Tips for Taking Levothyroxine & Other T4 Containing Medications

When it comes ​to taking T4 only thyroid medication there are a couple of other factors you can consider to increase absorption and improve thyroid function. 

Since T4 (levothyroxine & Synthroid) are the most commonly prescribed thyroid medications it's important to put emphasis on these medications.

This is particularly true if you are experiencing any negative symptoms.

Consider these tips if you are using any of the T4 only medications: ​

1) Change levothyroxine dosing to 50mcg increments

Believe it or not, levothyroxine is filled with inactive fillers and dyes.

These fillers and dyes can reduce the absorption of thyroid hormone (by making it harder to break down) and they can also cause negative reactions by themselves.

levothyroxine added dyes and fillers

Many patients experiencing persistent hypothyroid patients may actually be reacting to fillers or dyes inside of their thyroid medication.

This is where the 50mcg tablet of levothyroxine steps in.

​The 50mcg tablet of levothyroxine has no additives or fillers which means it can potentially help hypothyroid patients. 

Something as simple as switching your dose may influence your absorption and reaction to thyroid hormone...

The best way to do this is to supplement up to your current dose of levothyroxine using 50mcg increments.

So if you are taking 150mcg of levothyroxine you would simply switch to 3 tablets of the 50mcg levothyroxine dosage for a total of 150mcg.

Note:

This doesn't change your total dose, it just changes how you get to it.

2) Consider switching to Tirosint

I've written in the past how Tirosint may be the best T4 only thyroid medication and for good reason.

​Tirosint is a T4 only thyroid medication that contains 3 inactive ingredients and 1 active ingredient (levothyroxine or T4). 

Many patients report that switching from levothyroxine/Synthroid to Tirosint has significantly reduced their symptoms and has helped with weight loss.

This likely has to do with the increased absorption (due to reduced fillers) and therefore more thyroid hormone in the body.

Switching to Tirosint is an option for many patients because most endocrinologists and PCP's are willing to prescribe T4 only medications over T3 preparations and Tirosint is a T4 only medication. 

3) ​Make sure your dose is correct

Another big downfall to T4 only thyroid medication is dosing.

Many hypothyroid patients are treated based on their TSH which is inaccurate for many reasons.

This results in sub-optimal thyroid levels in the body and persistent symptoms of hypothyroidism

To ensure that you are getting the right amount of thyroid medication in your body you may actually need to increase your dose. 

This is especially true if you have concurrent GI-related issues that may be reducing absorption. 

You can use this levothyroxine dosage guide to help you determine if you are indeed on the right dose. 

4) Consider taking thyroid medication at night​

Another consideration is simply changing your dosing schedule of thyroid hormone.

Switching to a nighttime dosing schedule of your current thyroid medication may result in an improvement in symptoms for the reasons mentioned above.

This can be done with all forms of thyroid medication, by the way, and is still helpful for those on NDT and T3. ​

Tips for Taking Natural Desiccated Thyroid Medication (Armour Thyroid, Nature-throid, WP thyroid, & NP Thyroid)

​Natural desiccated thyroid includes a combination of T4 and T3 thyroid hormone (in addition to other thyroid hormones). 

Many patients report feeling better when switching from T4 only thyroid medication to NDT (6) and this likely has to do with the addition of the T3 in this medication.

This doesn't make NDT a perfect thyroid medication, however, so if you are taking this medication and still experiencing hypothyroid symptoms you can consider these tips: ​

1) Consider using WP thyroid (fewer fillers)

NDT, like other thyroid medications, contains additives and fillers.

Your symptoms may be due to reduced absorption or an interaction with some of these fillers.

If you are experiencing these symptoms you might consider switching from whichever NDT you are currently taking to WP thyroid.

Naturethroid comparison table

WP thyroid contains the fewest inactive ingredients when compared to other thyroid hormone formulations.

​Increasing absorption of T3 is particularly important for weight loss and you can read a case study here about how using WP thyroid can help with weight loss

It has been more difficult to get both WP Thyroid and Nature-throid lately, so switching to an alternative like NP thyroid may be your only option. 

2) Treat any GI-related issues you may have

NDT​ may be difficult for your body to break down which means that you need a proper functioning GI tract to increase absorption. 

If you are experiencing any of the GI-related symptoms (listed above) make sure to get your GI tract evaluated and treated if necessary.

Treating your GI tract will not only improve your absorption it will also increase your T4 to T3 conversion as well (7).

3) Be careful if you have autoimmune thyroiditis

Patients with a known diagnosis of Hashimoto's or autoimmune thyroiditis should be mindful when taking NDT.

NDT is porcine sourced which means that inactive parts of this medication may have antigenic properties in the body. 

thyroid daily essentials insert

What this means for you is that you may react negatively to the medication, especially if your immune system is compromised. 

Your body may react negatively to the thyroid medication and you may feel worse (in addition your antibodies may increase as a result). 

If this happens to you make sure that you cool off the inflammation and treat any GI-related issues prior to attempting the medication again. 

4) You may need to split your dose throughout the day​

Like other forms of medication containing T3, you may benefit from splitting your dose throughout the day. 

This is not because of serum T3 levels, but instead, it's because of how your heart tissue interacts with T3.

T3 directly activates calcium channels in your heart tissue that may result in an increase in contractility and heart rate. ​

Slowing down the absorption or spacing out how you take your medication may help to reduce these symptoms. ​

Tips for Taking Cytomel and Other T3 Containing Medications

T3 is the strongest thyroid medication which means it is also potentially the more dangerous of thyroid medications.

Many patients taking T3 containing medications like Liothyronine and Cytomel tend to experience heart palpitations and or tachycardia (rapid heart rate).

These symptoms are concerning and if you experience these symptoms you should see your physician. ​

1) Immediate release T3 (liothyronine + Cytomel)

Immediate release forms of T3 like liothyronine and Cytomel tend to have the most symptoms associated with their use but they are also the strongest medications. 

Part of this reason has to do with the rapid absorption of T3 in the body and the rise in serum T3 levels about 2-3 hours after taking the medication.

This immediate release usually results in better tissue levels throughout the body but can also come with many side effects.

If you experience heart palpitations and a rapid heart rate, then switching to sustained release T3 may be a better option for you. 

2) Treat any GI issues you may have if switching to SR T3​

The reason SR T3 is sustained release is due to the methylcellulose fillers (8). 

This acts as a glue which slows down absorption in the GI tract and therefore reduces the spike in serum levels after ingestion.

The problem with potentially switching to SR T3 is that you need a functioning GI tract to properly absorb this medication.

Conditions like low stomach acid or SIBO will reduce absorption and potentially cause problems.

If you are taking SR T3, make sure that you have your GI tract evaluated properly, especially if your dose doesn't seem to be working. 

Moral of the Story

There are many tips and tricks that you can use to improve your symptoms of hypothyroidism and improve your thyroid function. 

Some tips are intuitive like making sure you take "cleaner" thyroid medications, and others are less intuitive like taking your thyroid medication at night. 

The bottom line is this:

Whatever thyroid medication you are using you want to make sure that you are absorbing and converting your thyroid hormone properly. 

Use the tips in this article to help guide you but realize that each person is different. 

Now it's your turn:

Have you changed the way you take your thyroid medication?

Has it helped?

Why or why not?

Leave your comments below!

References (Click to Expand)

This post was most recently updated on June 12th, 2019

Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders.He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances.You can read more about his own personal journey here.

111 thoughts on “How to take Levothyroxine & Other Thyroid Medication (NDT/T3) Correctly”

  1. Hello Dr. Childs! I have been taking Synthroid at night for the last 6 years. I noticed some improvement in my symptoms when I started taking it at night instead of the morning. That was unfortunately short lived. I am in the process of adding a T3 to my regime, as well as switching from Synthroid to Tirosint. Based on the information above, it sounds like it may be better to take T3 medication in the morning. Can I take T3 in the morning and continue taking T4 at night? Or should these medications be taken together? Thank you! Ryan

    • Hey Ryan,

      It’s not necessarily better one way or the other, but you can experiment to find out what works best for you.

  2. Hi Dr. Childs, I want to start by giving you a little of my background. About 17 years ago I had thyroid storm and went into hyperthyroidism. It resolved and my lab values were fine for many years without any problems. But about seven years ago I switched doctors, and my new doctor wanted to look into my thyroid more because she said my thyroid was enlarged upon examination. Long story short, after having ultrasounds and biopsies I had a complete thyroidectomy, as I was told I had probable thyroid cancer. As it turned out, I did not have thyroid cancer and my thyroid was removed unnecessarily. Since that time I have only been on levothyroxine. I have gained about 25 pounds and my energy level has tanked. Because my doctor would not work with me and try one of the natural desiccated hormones, I found a nurse practitioner in my area who specialized in hormone therapy and sought her out. I was taking levothyroxine 137 much prior to seeing her. She added Armour Thyroid 60 mg to my current medication. This was about four months ago. The first couple of days after taking the Armour Thyroid I felt amazing, with energy that I have not felt in years and even lost about 4 pounds! Unfortunately, this did not last but a few days and then I gain the weight back and my energy level once again tanked. Additionally, I began developing severe bone and joint pain especially in my legs and specifically in my knees. My TSH level is now critically low. She has now decided to increase my Armour Thyroid to 120 mg a day and cut my levothyroxine dose in half in hopes of increasing my energy level. My T3 and T4 levels are normal. She thinks that maybe my bone and joint pain is a side effect from the Armour Thyroid. She said that in a week or two if my bones are still hurting that she thinks we should stop the Armour Thyroid and just add Cytomel to my levothyroxine 137 mcg. I am writing to you in hopes that maybe you have something else to suggest for me. Do you think that my bone and joint pain is a side effect from the Armour Thyroid? If so, do you think I should try a different one like naturethroid? I am a little concerned that maybe my bone and joint pain are indications of osteoporosis. I would so appreciate any feedback that you have for me. God bless you and thank you for all of your knowledge that you have shared.

    • I can relate 100% Angela… I have the exact same bone joint pain and only began when I started medications…. you wrote this last year so I’m hoping things are better for you and that they get better for me…
      Dr Child’s what is your comments to this?

  3. Thanks Dr. Child’s! I am going to try to switch my medication to nighttime and hope maybe it has a positive effect on my fatigue levels and weight gain. I eat a fairly clean diet and avoid food triggers like gluten, dairy and soy and I work out regularly and try to maintain balance but fatigue has become overwhelming. I will try my Synthroid and Cytomel at night and see if I feel better. Are there signs that I might notice that it has made a difference or any timelines for changes to happen?

  4. Hi I am currently taking armour 60mcg,

    I wanted to know how I can take the medication at night?

    How long after food/dinner do I have to wait?

    Can I still have water after I have taken the medication?

    • Hey Neha,

      The article above should answer most of your questions. If there is any concern you should always address dosing issues with your current doctor (some patients take medications that HAVE to be taken at night that may interfere with absorption). Several other conditions may also make it unwise to use thyroid medication at night (untreated GI issues, etc.).

  5. The wonderful results I used to have are reversing rapidly. How about if I take other supplements at night such as 5HTP. Can I take that with my thyroid meds? Perhaps an hour apart?

  6. Hi Dr. Childs
    I came across your wonderful site today. I live in Sydney Australia and I really need your advice.
    9 years ago I had my thyroid removed as they found early stages of thyroid cancer, I started taking 100 mpg of synthetic thyroxine ( here its called Eutroxsig). I stayed on that dose for some 4 plus years and felt ok ( sometimes a little hyper so Id go for a long walk to walk it off). Then my endocrinologist reduced my levels to 75mcg because my blood results showed I was on too much thyroxine and he was worried about heart and bone health. I seemed ok on this level for a few months then started getting other symptoms. I little weight gain and feeling like I was off balance when I walked. I went to many doctors who kept saying that I had all sorts of things including depression. I did develop anxiety but that was because I always felt off balance ( a little like you have had a bit of alcohol on an empty stomach). While on 100 mpg i had pretty much consistent blood results. On 75 mcg my blood results were all over the place. About 1 year ago my doctor put my back up to 100mcg. Then my bloods showed my levels were too high and dropped my to a combination of 4days x 100mcg and 3days x 75 mpg,. When that came back too high, the meds were dropped to 5 x 75 mpg and 2 x 100 mpg and when the blood tests results came back still a little high back down to 75 mpg every day!! I have not been able to shake the off balance feeling and the anxiety so I saw another doctor who put me on 65mg of porcine thyroid instead. I felt a bit better day 1-3 then come day 4, 5, 6 and now 7 get the most awful feelings ( all the ones listed in your blog including feeling agitated and feeling like my heart is racing, lightheaded, feeling totally unwell etc). I have asked my doctor about this and she has suggested since my porcine is compounded into a capsule form that I take it every second day and see how I feel ( I can’t cut it in half and take twice a day as your blog suggests). I will start that tomorrow. I just wanted your thoughts on this Dr. Childs. Instead of getting better I seem to be going backwards. I have a young family and I need to get better. I have lost all my confidence and never feel well and Ive been like this now 3 years.
    Nadia

  7. So I have been on Synthroid, Tirosint, Armour, Naturethroid and on my 4th endocrinologist in the last 11 years. Suffered through lots and lots of side effects along the way. Needless to say when I was on the NDT it was not administered or monitored correctly. Along the way the one severe side effect was 60 pound weight gain. Besides the weight gain not one dr listened to me about my heat intolerance. So out of control, and I live in Fla. If I heard it one time I heard several times….hot flashes. NO, that is not what it was. Weight gain of course didn’t help. My close friends and family couldn’t believe how I would sweat and couldn’t even wear make up. Make a long story short, I abruptly took myself off Naturethroid (the last thyroid med I was on) this past July and if anything I’m a little chilly and I’m ok with that. Lol! Now going to 4th endo ran 4 current tests on me this past Jan, 2 of the tests I have already have had several in the past. Of course Free T3, Free T4 & TSH bloodwork, & ultrasound . Cortisol and swallow test was a new test. Seems to be okay.. Blood work was bad but I have not been hot, lol! Now doc is wanting me to get a biopsy on left thyroid. Medicine started back on is Armour15 Mg.
    Now reading your comments on this post, Are you saying it’s okay to take it at night before I go to bed? I have been taking it when I wake up, then I have my 1cup of coffee for the day. I already take HBP medicine at night Atenolol. And couple of hours after I take Armour in the AM I have breakfast and take 2nd HBP Potassium Hydrenol. I would whether take my thyroid medicine at night, would make it easier. Thanks, Donna!

    • Hey Donna,

      If you are taking multiple medications then it can be difficult to find the right time of the day when other medications won’t interfere with absorption. I wouldn’t make changes to your regimen until you talk to the doctor prescribing your medication to avoid issues.

  8. This information is greatly appreciated and I will talk to my naturopath about taking the Synthroid at night. I plan on asking him for slow release Cytomel this time so I dont have to take them 3 times a day

  9. What thyroid medication do you recommend for severe adrenal fatigue sufferers ? I tried slow release T3 at a very low dose and My adrenals could not handle it.

  10. About four years ago, my doctor prescribed 75mg of levothyroxine. I have a known allergy to contrast dye used for CT scans and thought it best to switch to 50 mg. with no dyes or fillers. I haven’t noticed any difference in weight loss and my hair is still thinning on top, which is very worrisome for me. What are the correct T3 numbers to look at and what do they mean?

    Thank you

    • Hey Jean,

      I haven’t written about how to evaluate lab tests when already on thyroid hormones, I may in the future however.

      • I am on Naturethroid and have thyroid tests scheduled next week to see if my dosage is optimal. I was going to compare my test results to your recommended ranges; I don’t see why the optimal test ranges would change based on whether the patient is medicated. I would be very interested in your take, since it appears you think there should be a difference. I’d also like to know what you mean when you say that a result should be 1/3 of the range. Is that the top third, the middle third, the bottom third, or something else.

  11. Hi, should I take T3 at night too or will it influence my sleep? Insomia is the reason why I can’t use T4. I could’t sleep at all, no matter what time I took it.

    • Hey Krista,

      I can’t make any recommendations because I don’t know anything about your history, etc. If you have questions about your current dosing schedule it’s best to take them to your physician who understands your case.

  12. Great article full of helpful information. I switched my Synthroid to night dosing 10 years ago and it worked so much better for me. Past summer acute health event sent me Hyper for a bit and had a dose reduction. Have felt awful, super cold mostly and way more than my typical. Felt the Synthroid change had a role but new Endo brushed me off. I see the fillers are very different and more in current dose. I’ve avoid any medication, supplement, vitamin possible as decades ago figured out fillers bother me. Avoid the typical American diet for same reason. I’ve never had the weight struggles most people do.

  13. I was instructed to take levothyroxine first thing in the morning before breakfast. As I did more research found that it should be well before breakfast and no tea or coffee. This meant I had to set my alarm for 5am to take my medication and go back to sleep for another hour. Needless to say that this didn’t help my chronic fatigue symptoms. I decided to take the levo last thing at night. Within 2 weeks I noticed a difference. My weight stabilised and then started to go down. Very slowly, but at least it’s stopped going up. More importantly, my tsh is finally below 2 (taken 2 years).
    The one thing no one seems to have an answer for is: why are my antibodies still above 700?

  14. I heard about taking Armour Thyroid sublingual, Armour (sublingually) gets absorbed directly into the system through the mouth tissue without being weakened by stomach acids as when you swallow it. Taking it sublingually minimizes the chance that the thyroid will bind to other things like calcium or iron.

    I am on Armour 120mg, I split my dosage in half, one in the morning and one mid afternoon. I am biting it a bit and then placing the half portion between my gum and my lower teeth or below my tongue. I started trying it about 30 days ago. Other than the bad taste, In the past 2 weeks, I notice that I had more alertness in the evenings, not exhausted when I get home.

    There are mixed comments on if it was designed to take sublingual, and they results when doing so.
    Can you share your professional thoughts on Armour used sublingual? Is it truth, hype, have you tried this with your patients to test the results by swallowing the pill vs sublingual?

    • Hi Kat You are doing all that us required to get the best absorption in Armour Thyroid medications. Dont swallow and take your medications sublingually as this gives the body the highest concentration into the blood stream of the thyroid medication…… Baby I have been doing it for over 10 years and it is the way to go !!!
      Love David xxx

  15. Hello Dr. Childs please write an article about hashimoto and pregnancy with all tips including diet treatment doses special advices and check ups and i wanted to know abt relation between hypothyroidism and facial hair for females with normal testosterone and no pcos

  16. Dear Dr. Child’s,
    I am a mess. Gained 30 lbs. I have had hypothyroidism for 15 years. Just got diagnosed with Hashimoto’s. i was told I was taking too much synthesis. Dr changed my dose from .175 to .150. Convinced my dr to test T3 levels. A month ago at 60 ng/dl. Taking 50 mcg liothyroxine. Now month later I am at 98 for T3. Still no weight loss. Have taken temp every am for a month. Still can’t get above 97 degrees. Consistently at 96.4 to 96.9. New blood work last week was : tsh-0.03…T3-98…T3 reverse -17…T4-1.1…thyroid peroxidase antibodies was 127. Cortisol levels were cortisol free1.32 mcg/dl and cortisol total 22.8. Because of weight glucose was at 112 mg/dl. My dr needs guidance. She is a gp willing to work with me but she needs help. I try to let her know your info from your articles. Can you help please! I am 62 female. Can I become a patient. Live in Fl. No dr like you near by. I trust you.

  17. Dear Dr. Childs,
    I underwent total thyroidectomy 5 yrs ago. Tried a lot of dosages. I am besteht with 125 t4 at morning and 25 t4 at bedside (improved energy and sleep).Additionally, I habe 4-5 times 5 MCG of cytomel,depending a bit on activity level. Its not perfect, but the besteht I could reach AG this time. Maybe I am going to shift More t4 to bedtime in future.
    Thanks for sharing all this!

  18. Well I am taking .75mcg but I think I can go down to the .50 as I am also on .30 of Tertroxin which I split during the day, one 20 and half a one and have no heart palpitations at all so it must be working well but had no idea about the .50 not having anything in it so I think I will go down to .50mcg, I will certainly know if I have slowed down..have no weight issues so nothing to talk about there but I am also going to start taking at night and am looking at iron overload issues and looking at root cause protocol to try and reverse Hashimoto’s – will let you know if I do cheers Sheryl Levell

  19. I have hashimottos hypothyroid. i also had gastric bypass which causes malabsorption. I recently found out not absorbing thyroid pill. I take nature thyroid. So I now take at night at bedtime & chew it Do not swallow it. Been reading ur articles a lot of info. Slowly digesting it all. Glucose high levels sounds like me. I would eat & get tired & have to have sugar. Excellent articles. Wish u were in Florida.

  20. hello Dr Childs
    I have hashimotos on 150 mg levothyroxine ,will try no and take med at night as I am on two allergy tablets in the morning ,so fingers crossed it will help, its such a debilitating condition one day your tip top next you are flat as a pancake,i can cope with most of the ailments that hashi throws at me except the brain fog and my hair loss which is thinning around forehead and temples ,do you have any suggestions for the hair ?….loving your articles …
    regards
    Sharon x

      • Hey Dr Childs,

        I am so happy to hear you are working on hair loss ,can not wait to read and try your recommendations..

        thank you for replying Its very much appreciated.

        kind regards

        sharon

  21. Sir i am a patient of hypothyroidism nd iam also taking thyroxine 4 tablets in the morning.but my weight is stuck even i am putting alot efforts like clean eating.running.cardio.but no progress.my tsh test aftr medication is normal.pl give me some nice suggestion

  22. Hi Dr.,
    You said to take thyroid medication on empty stomach and without other supplements. What about taking thyroid meds (levoxyl and compounded T3) at night at the same time as bioidentical compounded progesterone capsules and dhea tablet??’ Thanks. Sarah

  23. Hi Dr Childs, If taking iron supplements interferes with thyroid medications, would having iron injections be causing me to feel as though I am becoming more hypothyroid? I have had 3 of 5 injections so far and don’t feel any better. I have Hashimoto’s and take NDTH.

  24. Is this for people who still have their thyroid or for people who have had it removed. My pathology report said malignant and full blown Hashimoto thyroiditis

  25. I have been hypothyroid for 388 yrs. I am currently on 175 synthroid. My tsh was 9.907. T4 was 4.8 t3 was 35.2. So Dr upped me from 150.I have been eating cleaner and staying active and no weight loss. I am also type one tight control diabetic a1c is 6.5 Would armour thyroid and taking meds at night help me with weight loss?

  26. Hey doc,

    How do you usually treat people that have done RAI? I have been on levothyroxine for a few months and haven’t really felt any better even when increasing my dosage. Thank you.

  27. This is very interesting to me as I’ve heard it but never learned why. So I take many supplents at night before bed. I can change that to earlier. I do take ambian when needed how close in time can I take it if I take my half dose at night? I have Hashi so normally I split my dose morning and 3. Sometimes I take my morning dose at 2:30 a.m. as I’m up at the gym. I’d like to try this based on your explanation. So if I take half dose at night how much time in between supplements and food. Thank you 🙂

  28. Dr. Childs,

    I’ve dealt with hypothyroidism well over 10 years now, and I always felt pretty normal and well, in general, until last year when I was fired from my job and a close relative died, then it all started feeling strange in my body, I guess because I was under a lot of stress. I gained a little weight and felt “chubby” without any change to my diet or regular exercise. I did the usual tests and my doctor said I now had Hashimoto’s. I’ve been reading, researching and desperate to find out how to go back to feeling normal, again, for the last year and months, and until now I found your site. I am thrilled with the comprehensive information on why it’s been so hard to go back to my normal weight. I now see that my usual dose of levo might not be enough. I’m 32 and feel like age might also be playing an essential role in this whole ordeal.
    I truly appreciate all the information. Wonderful job. What a way to help thos of us that are feeling desperate.

  29. I was prescribed 50mcg of tirosint my TSH is 5.7 and my TPO is 357. My RT3 is high and my homecystine was 15.2 which indicates inflammation. I quit eating Gluten, Dairy, Eggs, Caffeine and sugar. I am terrified to take this medication due to side effects. I don’t want to feel worse!

    • Hey Rachael-mae,

      It doesn’t make everyone who takes it feel worse, just a certain sub group of patients who take it.

  30. Good Evening Dr. I had been taking my thyroid meds (levothyroxin) 88 in the morning with my prozac and amlopidin (?) and come to find out i was taking it all at the same time as my multivitimens and calcium tablets! I also took them with my morrning coffee and never had any problem untill i found out NOT to take them with calcium and also with a empty stomach. I prob. knew this but had forgotten. So, I started taking my levo- at night while getting up to go to the loo, the problem started then. I have started gaining weight and it started when i switched to middle of the night! I am concidering taking them right before bed after reading your blog and also would like to add zinc to see if that will help boost me back to losing weight. I am a full time housekeeper and do approx 9 homes a day at a retirement center and also work out at planet fitness on the weekends for a hour each day. so i seem to be getting enough excersize but can’t lose this weight! What do you think? please help! Thank you. and thank you for your awesome blogs!

  31. Hey Dr. Childs, I was taking 137mcg levothyroxine and my TSH went down to .42 and my t4 went to 2.6. I was still feeling a little off so my doctor and I decided to add T3. He reduced my levothyroxine to 100mcg and added 5mcg cytomel. He said that’s equivalent to taking about 130mcg levothyroxine. Is this true? I feel like bringing levothyroxine down to 100mcg is a little too much.

  32. Hi Dr Childs last week the doctor lowered me from 90 to 60 armour thyroid. I’ve been having light headed and having anxiety what can I do

    • Hi Sherry,

      It’s best to consult with the Doctor who made that change to help understand the logic behind the decision.

  33. HI Dr. Childs,
    I have a teen ager that has panhypopituitarism due to a germenoma. He does take 150 dose of Levothyroxine, Cortisol 3x a day and DDAVP for diabetis insipidis. And although his Free T4 is within range, overall he still appears lethargic and has trouble focusing on school work. Due to the pituitary damage, his thryroid no longer works as well. Would it be possible that he may feel better with other medicine that contains T3? Is there something else we could explore with his Doctor?

  34. Hi Dr. Childs,

    I had a thyroidectomy 32 years ago due to multinodule goiter. I have been taking synthroid ever since up until March of this year. On the Synthroid, my RT3 was 24.8 with the top of the range being 27. I have tried to switch to 1 grain nature throid and 15 mcg T3 split into 3 doses. I have a rapid heart rate and chest pain on these medications so I am going to have to move on to something else. Do you have any suggestions on how to keep my RT3 from going high if I return to Synthroid or try Tirosint?

    • Hi Shirley,

      If you can find the source of inflammation or whatever is causing the high reverse T3 then it shouldn’t be an issue when you switch medications.

  35. HI Dr. Childs- I am being seen by a very good Naturopath and have been taking 1.5 grain Naturthoid for about 4 months now. Feel so much better but my numbers are really wacked out and I haven’t lost a bit of weight- about 40 lbs over. Initially in january my t3 was 2.8, t4 .79 and tsh 1.7. Felt horrible and like I was going to die. He put me on B12 shots and CBD oil for a couple months to bring me down because I was going to blow like a volcano over every minimally stressful issue that arose. Thyroid numbers didn’t budge. anyway since medication, my numbers now are t3 4.7, t4 .89 and tsh is 0.007! I feel pretty good despite the numbers, but really wonder why I haven’t dropped any weight because I know my metabolism is better due to my body temperature adjustment since the meds. My testosterone was at 14 and he monitored it for months then asked if i’d like to see how it made me feel…I’ve had two shots of .03 in the last month and a half and now my testosterone is 155! Big difference but I wonder if it’s causing me a lack of patience with my husband and kids. Not sure if I want to continue testosterone injections at this point but he said it would help me build muscle with working out, which I have honestly not been doing like I should. I take one grain naturthroid in the am usually around 530 am and then I take my half grain (which he reduced from one grain) before bed around 8. I keep wondering why my t4 won’t go up and if this is connected to my inability to lose weight. Should I try adjusting my times? Your thoughts are appreciated.

    • Hi Melissa,

      Yes, high doses of testosterone can cause irritability so that may be contributing. Most hormone specialists tend to give high doses of testosterone to try and brute force weight loss but it rarely ever works.

      • Do you have any input on my thyroid numbers or do they not seem all that bad? Also, any suggestions on what I should do? I am contemplating HCG but I am fearful it will hurt my metabolism. I did it a few years before diagnosis, and I did lose 20 lbs but after about a year gained it back. I hope that wasn’t what put my thyroid over the brink, i am certain it was sluggish all my life really.

        • Hi Melissa,

          I can’t comment on your labs, but even so labs aren’t the best representation of what is happening hormonally in your body. HCG will cause temporary weight loss but at the cost of significant metabolic damage and you will regain whatever weight you lose within a few months and be at a worse place than when you started.

          You can find more info about my weight loss recommendations here: https://www.restartmed.com/hormone-mastery/

  36. Hi Dr. Childs!

    I found this article to be very informative. I am on 90mcg Armour Thyroid. I have been for some time. After switching to this med, my next blood work showed my TSH very high–like VERY high. (Can’t remember the number right now.) My GP bumped my dose up to 120mcg. My TSH dropped to 0.2 and my GP flipped out and bumped me back to 90 immediately, despite the fact that I felt better than I had in 10 years, I was no longer symptomatic, my digestive issues went away, and I was losing weight. My GP works solely on TSH, and doesn’t care how I feel. She refuses to read any info I pass along. Her only comment is, “I can refer you to an endocrinologist.” I have no insurance and I struggle to keep my bill paid at her office as it is. So, not only am I fighting a sluggish thyroid, but a GP who is unwilling to expand her knowledge on the topic or even listen to me. Do you have any advice for me? I just read this article today and I am going to try switching my time schedule to taking the med at night. I already eat gluten-free, dairy and soy-free and anything else I can do to help. Help please!

    Melody Montgomery

    • Hi Melody,

      You won’t have much luck in terms of feeling better if you play whack-a-mole with your TSH like your current physician is doing.

  37. Hi again, great articles!! I’m going to start taking Naturthroid at night, I just need a pointer!! I took my pill this a.m. at 7:00 a.m., should I take my dose as late as possible tonight?

  38. Hi. I’m on both NT (81.25mg) and levo (50mcg). I’ve tried taking them at night, but within a week I’m tired in the late afternoon and I get this weird tightness in my chest. I also tried splitting the NT in a morning and afternoon dose, with levo taken with the afternoon dose, but same problems as taking them at night. I have gone back to taking them both in the morning. The reason I started looking for other timing options is because since I started this combo (went from 65mg NT/88mcg levo) I’ve been incredibly anxious.

    Have you encountered these symptoms in your practice? I see a regular endo and is less than thrilled about prescribing the NT, but I fight him every time because I know it works best for my body. I’d love to be on all NDT, but he refuses.

    Have you ever heard that anxiety and other symptoms (like feeling lightheaded) can mean the patient needs to actually go up on the NT?

    Thanks!
    Jodey

  39. I am presently taking the smallest does of thyroxin for Hashimotos in the morning and it seems to be going quite well except for the fact I am not sleeping well so may try your suggestion of taking it at night, thank you.

    Is it possible to take adrenal support/rebuild supplements(eg Dr Wilson’s) at the same time as taking Thyroxin?

  40. I had a full thyroidectomy 10 yrs ago. I did have cancer I had radiation. I take 150mg of levothyroxine in the morning. I feel really fatigued and constantly tired no matter how much I sleep. I go up and down on weight difficult losing it and keeping it off. My Dr. Says he can’t raise my medication because I had cancer could affect it again. My question can I switch the 150mg at night. And how should we take it. Since in the morning it has to be an hour prior fasting.

    • Hi Sandra,

      You will need to discuss your specific case with your Doctor but in general you take it the same way you would in the morning, but just at night. All the same rules apply regardless of the time of day that you take it.

  41. I generally take magnesium, preservision, probiotic and fiber at night. Some nights I take a pain med and muscle relaxer. Would it be ok to take my levothyroxin at the same time?

  42. When I take any thyroid medication for my hypothyroid my body fills up with water within a week. It is so bad I can hardly bend over. I feel like I am 6 months pregnant. I have been to many doctors/endocrinologists and no one knows why this happens. Do you have any idea what may be causing this swelling? I tried just taking t3 and still the same thing happens. I go off my meds and it goes away. Either way I am miserable on or off the thyroid medication.
    HELP

    • Hi Dani,

      Some people do experience those side effects, you may have luck with different combinations such as NDT or T4 as Tirosint or some other combination.

  43. Greetings Dr. Childs,

    Thanks for writing the helpful article. I have a better perception how hypothyroidism functions.
    I reside in MD. Can you email me any referrals of Endocrinologist, who may have the same interests and/or education studies as yourself?
    Look forward to hearing your reply.
    Bless you.

  44. Dr. Childs, my Dr. won’t prescribe Thyroid medication because my lab results show it as being normal. I’m 54, in menopause but it’s very mild at this point. I finally went to a Naturopath Dr who has me taking Iodine and a supplement called Ortho Thyroid. I have noticed some improvements but still not losing weight. Any suggestions? Thank you.

  45. Dr Childs
    If you take Nature Throid at night will it make me more active and affect my sleep?
    Can I take it with melatonin PR and or progesterone tablets?

    thank you
    Diane

    • Hi Diane,

      Most people don’t have trouble taking Nature throid in the evening but it does energize some people.

  46. Dr. Childs,

    I am on Cytomel only 5mg twice a day. The first day I felt fantastic and was hopeful. The second day felt like I was in a coma and haven’t felt energy since the first day. Is it normal to feel even worse fatigue from Cytomel and from such a low dose? I will say my sleep quality is better and I have tried taking Cytomel before bed and setting a timer as was suggested by someone two to three hours before normal waking and that works the best but I am still tired. I have had a hard time finding much on fatigue from Cytomel only. Thanks for your help in advance.

  47. Dr. Childs, I was diagnosed hypothyroid 8 years ago and have taken NatureThroid 65mg (1 gr) for the last 3 years, obtained through a mail-order pharmacy, ExpressScripts, in 90-day batches. For some reason, the May 2018 90-day batch gave me very strange symptoms (a mixture of some hypothyroid and some hyperthyroid). My PC insisted I was over-medicated and asked me to skip medication one day out of 7. That was in the middle of the 90-days. When that batch was finished, ExpressScripts couldn’t fill the next one, because of a source-shortage, so I had to fill locally, and they only had a one-month supply. While I was on this batch, the strange symptoms abated, though hypothyroid symptoms worsened (I was still skipping one day a week). The next batch was again from ExpressScripts, and I’ve been on it about 2 weeks. The strange symptoms have come back. Is it possible that the recent batches of Nature Throid could be different than before? I read they had problems getting ingredients which caused a temporary shortage since last October, but they have recently begun catching up with demand. I’m wondering if these new pills are different in some way than before the ingredient shortage. My body is telling me it is. Have you heard of anyone having issues recently with Nature Throid’s formulation?

    • Hi JHansen,

      Yes, several people have reported issues with the new formulation. Thyroid medications are constantly changing, though, so this has been part of the game of treating your thyroid for quite some time. You should be able to find what works for you with some trial and error.

  48. I had a total Thyroidectomy July 27th 2018 due to severe Hyperthyroidism and Graves Disease. I really wish you would address Graves Disease. After Surgery was put on levothyroxine 100mcg. My hair loss was so scary.It finally slowed down. 5 days ago changed to levothyroxine 88mcg and added liothyronine 5mcg. My TSH is 0.015. I wasn’t feeling well and wanted to sleep all the time. I know it’s going to take a while to get meds tweaked. My concern also is that my left eye is swelling more. Haven’t seen opthomologist yet. Will this go away? I realize there is no cure for Graves disease. Can you or anyone address this disease some? Labs every 4 to 6 weeks now.

  49. Hi Dr. Childs!

    In 2015 I had a miscarriage and months later felt sick and tired ALL the time. My doctor did blood tests noticed my thyroid levels were off and after a ultrasound of my thyroid diagnosed Hashimotos. Less than a month after starting medication I was pregnant again, but with an empty egg. From there on out my treatment was generally stable and my T4 levothyroxine helped me get energy and lose weight again. After I was feeling the best I felt in a long time, I got pregnant again. My lovely little boy is now 16 months and doing great, but I’m back to sluggish and putting on weight.

    My last blood tests showed no change in my medication necessary, but I don’t feel like the dosage is right. Your comments about absorption and GI issues make me wonder if my irregular recurring diarrhea can be related/influence my medication absorption – but you don’t mention this end of GI issues in your entry. We are looking at an ultrasound again soon, but I will bring this up with my doctor as well.

  50. I have bought some Tiromel I am taking Thyroxine but never feel well, can you tell me what dose I should take please? I don’t want to do anything stupid. I am having problems because Dr here reduced my thyroxine on the TSH results and feel,dreadful

    • Hi Lynn,

      Unfortunately, I cannot give you specific medical advice in that way. It would be similar to a lawyer giving legal advice online without someone being their client. If I do then I become responsible for any problems that may arise.

  51. Hello Dr. Childes,

    I just found your website. Understand that you can not give medical advise, however I am just looking for what are the optimal labs when on NDT. Looking for TSH, rT3, Ft3, FT4, Total T4 and Total T3. I was on NP 1.5gr with additional 25mcg of T3 daily.

    My primary and new Endo d/c’d the T3. Hopefully my symptoms don’t return.

    Thank you,
    Cathy

  52. I’ve learned so much on the in this article since diagnosed with Hashimoto’s over 15yrs ago. Been going thru horrible med changes and ridiculous fluctuations in test levels. You give me hope.
    You are truly a blessing.

  53. I am so confused- I am taking nature throid. Went to get my blood checked at an endocrinologist who wants me to change to Levothyro….I’m afraid because of the horrible anxiety I have had in the last and don’t want to go there again even though I do have smaller bouts throughout the day. I have Hashimoto’s and I don’t believe she understands how some natural products and vitamins have helped me along with adrenals. I have gained weight in the last 15 years and it seems that is what she concentrates on. I am not a big eater-never have been. I need to know if I should try the levo….or stay on what I am on or can you alternate at all?

    • Hi Kathy,

      Endocrinologists don’t like NDT (they have a bias against using it) whether it’s working for you or not. So just be sure to keep this in mind as you consider switching. Sometimes it’s necessary to switch, but I have seen many patients do worse once they switch.

  54. Hi Dr. Childs,

    My apologies if this question has been answered somewhere else. I’m on both Levothyroxine and Cytomel. It never occurred to me to ask if I can take these at the same time? I follow all the other guidelines, but take them together for at least one of my cytomel doses. (150 mg T4 and 30 mcg T3).

    As an aside, I did look into Tirosint, which is unfortunately on the list of explicitly excluded meds not covered by my insurance.
    Thanks so much

    • I recently was put on Liothyronine due to Free T3 low. I’ve really not felt any increased energy or wt. Loss since starting the med. I also had two NEW nodules show up on my ultrasound that was not there 2 years ago on my thyroid. Hx: My sister and mom both had thyroid cancer. The radiologist read results saying I didn’t need further follow up, but looking up the rad code reference it was considered a concern. My sister suggested I see a specialist for further review. What might you suggest as the best course of action I take?

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