Are you taking your thyroid hormone replacement medication correctly? Did you know that how and when you take your thyroid medication can affect your ability to absorb the necessary hormone properly? In the article below, I investigate the factors that contribute to correctly (or incorrectly) taking thyroid replacement hormone and on how thyroid patients can get the most out of their medication.
Have you suffered from brain fog, unusual fatigue, unexplained weight gain and severe hair loss, and ended up being diagnosed with hypothyroidism? Are you at your doctor’s mercy now to take your thyroid medication correctly?
If yes, you are not alone.
1 in 20 individuals in the United States have hypothyroidism and are on thyroid medication for their condition.  Further research reveals that 14 million individuals in the U.S. have Hashimoto’s thyroiditis, making it the top cause of hypothyroidism in America. 
The statistics clearly indicate how prevalent hypothyroidism is in our society and how many people are likely taking medication for it.
But did you know that as many as 50% of hypothyroid patients don’t take their thyroid medication properly? And did you know that many practitioners fail to educate their patients on how to take their thyroid medication?
This article delves into eleven important tips on how to take your thyroid medication correctly that often go overlooked.
First, let’s discuss common types of thyroid medication. Thyroid medication comes in 4 different types in various brand names and generic forms.
Types of thyroid medication include the following:
Depending on a patient’s unique thyroid needs of thyroid hormone replacement, any one or combination can be prescribed. If a patient is having difficulty converting the T4 into the more active T3, natural desiccated thyroid medication and T3/T4 combination methods are often used 
There may also be underlying conditions preventing some patients from properly absorbing or converting thyroid hormone.
If you believe you are on the correct dose of levothyroxine, liothyronine, or natural desiccated thyroid medication, there are certain things you can do to maximize the results. Read on.
The thyroid is a small gland in your neck, but it has enormous effects on your body. A hypo-functioning thyroid has an effect on every organ, tissue, and cell of your body. So, not taking thyroid replacement therapy properly can impose serious consequences. What could this result in?
Therefore, taking thyroid replacement is of utmost importance in order for your body to function properly. Following the tips below can help you get the most out of your medication.
Thyroid patients can be extremely sensitive to their medication changes, and not all thyroid medication is created equal.
Changing your thyroid medication type or brand might lead to a change in your symptoms, for better or for worse. Healthcare providers recommend using the same brand for your thyroid therapy if that provides a resolution of your hypothyroid symptoms.
For example, T4 (levothyroxine) is not an equal replacement for natural desiccated thyroid medication.
Additionally, if given a generic as a replacement for a brand name drug, there may be different inactive ingredients or fillers that you may be sensitive to which can affect how your body utilizes the thyroid hormone.
Ask your healthcare professional to write the prescription as “brand necessary,” or “no substitutions“, or “dispense as written”.
Furthermore, be sure to thoroughly read the label of your medicine when you receive it. When you are at the pharmacy, double-check these items:
✓ Check that you are getting the correct prescription and dose that your doctor ordered (no substitutions)
✓ Be sure that you are getting the right number of tablets for the month
✓ Be sure that the medicine is well within its expiration date
✓ Check to see if it’s generic or name brand. If you’re not already getting a generic drug, you may want to avoid a generic form if you were previously taking name brand. The medication may contain other components or fillers in the generic that are dissimilar and can affect the rate of absorption. [4,5]
Drugs should be kept in proper storage so that they remain effective. After you bring your thyroid hormone replacement medication home, be vigilant to store it properly.
Keep them at the right temperature. Generally speaking, thyroid medicine should be stored at room temperature.
They should not be exposed to sunlight and they should be kept away from heat.
Finally, do not place your medication in damp areas, such as a shower room or bathroom, as the tablets might dissolve and affect your dosage. 
Take your medicine daily on time, without forgetting.
Many people miss their dose which is to be taken at the same time daily, and then decide to just take it the next day.
Don’t do this. Missing a thyroid dose for even for one or two days can drastically change how you are feeling. 
It’s best to take it as soon as you remember that you missed your dose.
To solve this potential problem, take your medication with some other activity that you do every day (except for eating and drinking coffee).
For example, you can make a habit of taking your dose first thing when you wake up in the morning. Perhaps, keep the medication bottle next to your nightstand. You may also want to set the alarm or reminder on your phone, or buy a daily pill sorter.
The absorption rate of thyroid hormone may be affected by food as it may bind with the drug, leading to decreased access to intestinal absorption sites. This alters the rate of thyroid hormone dissolution. 
Take your thyroid medication with a full glass of water and take it either in the morning without eating anything, or just before going to bed on an empty stomach, at least 30-60 minutes away from eating.
Some people take it immediately before they go to bed because of the possibility of better absorption at night (ie. no interference of food or other supplements). On the other hand, others may not do well with this option as they may feel more awake at bedtime and prefer to take it in the morning.
Taking it with enough water is important because you want your thyroid medication to fully dissolve and not get lodged and moved out with your next bowel movement!
Keep in mind that certain food, supplements, and medications have special considerations and should be taken 4 hours or more from thyroid medication.  More on that below.
You should pay particular attention to the following foods when taking thyroid hormone replacement medication since their minerals, ingredients, or content could affect the hormone absorption:
You should avoid taking thyroid hormone replacement before or after supplementation.
The general rule of thumb is to take most supplements about 30 to 60 minutes away from thyroid medication. However, be extra cautious when taking calcium, iron, and magnesium, in addition to multivitamins and fortified cereals.
These supplements should be taken a minimum of 4 hours apart from thyroid medication:
Here are other supplements to be mindful of:
Several over-the-counter and prescription drugs can affect thyroid hormone absorption. Therefore, it is essential to inform your doctor if you are taking any medications to avoid potential problems, and aim to take them at least 4 hours from your thyroid medication.
Common drugs that can impact absorption or have negative interactions when taken with thyroid medication:
Several other drugs can also interact with thyroid hormone, including Welchol (colesevelam) for heart problems, and Fosrenol (lanthanum) and Renagel (sevelamer) for kidney disease. [12, 13]
There are many other drugs that could interact. Always consult with your pharmacist regarding the medications you are taking.
Several medical conditions affecting the gut and liver may also impact thyroid hormone absorption. Some common examples are as follows:
In such cases, thyroid hormone medication may be prescribed at a higher dose.
Also, a liquid or gel cap form of T4 thyroid medication (e.g. Tirosint) is usually absorbed more quickly than standard tablets. Ask your doctor or pharmacist about this option. 
You may be sensitive to certain fillers or inactive ingredients used in thyroid medication. Avicel, acacia, and microcrystalline cellulose can be issues for some sensitive thyroid patients.
Options for those who are very sensitive are to look into getting the thyroid medication through a compounding pharmacy and ask for a simple, well-tolerated filler such as rice flour or sucrose.
Consider this analogy: Think of thyroid hormone as the “gas” to a car and cortisol from the adrenal glands as the “oil”. If there is not an optimal amount of “oil” (cortisol), and you give the car “the gas” (thyroid hormone), you will only rev the car and not go anywhere. [14,15]
This is how it may feel when you have unresolved adrenal fatigue while attempting to take thyroid medication.
You could feel more “wired and tired” or have symptoms of feeling revved or agitated, without feeling the benefits of thyroid replacement hormone.
If you feel these symptoms and suspect adrenal fatigue (cortisol levels that are not optimal throughout the day), consider the help of an integrative practitioner listed on this site and discuss the possibility of adrenal fatigue.
Also, remember these following points when on thyroid hormone replacement:
When you have a thyroid condition, it is essential that you visit your doctor regularly to get a full thyroid panel to ensure that your thyroid hormones are in check.
If you still don’t feel well and need assistance with your thyroid journey, or if you’re looking to find a new doctor, I have several recommendations:
Finally, check out the video below from Dr. Westin Childs, DO where he explains many of the tips above in further detail.
Denise Roguz is the owner and co-founder of ThyroidChange, a thyroid health and wellness website. Through her blog and patient/physician cooperative approach, Denise uses her voice to educate for optimal care and to promote healthy lifestyle choices. Denise has collaborated with various companies, organizations, podcasts and media outlets around the world. With over 108K followers on Facebook, tens of thousands more on other social media platforms, over 32,000 newsletter subscribers, ThyroidChange is uniting a global audience.
I had the pleasure of speaking with Lisa Hunt, D.O., an integrative physician at Holtorf Medical Group (www.holtorfmed.com) in El Segundo, CA a short while ago. I polled my audience and your top thyroid-related questions are answered here by Dr. Hunt. Dr. Hunt is a board-certified integrative physician and has extensive experience in thyroid health, hormone replacement, immune dysfunction and chronic conditions.Read Article
Pursuing proper treatment and an overall healthy lifestyle that includes eating well and exercising can help you manage a thyroid condition. But what else can you do to live well with and thrive with your condition? The information can be overwhelming and Annabel Bateman, thyroid health advocate and author, has created this guide to walk you through essential lifestyle tips once you have been diagnosed.Read Article
Tune in and listen to Denise Roguz of ThyroidChange interview integrative practitioner and hormone expert, Dr. Tiffany Mullen, DO, FABFM, ABOIM, and Co-Founder of integrative telemedicine company, Vytal Health (www.vytalhealth.com). You will learn why functional medicine is essential for many thyroid patients and how can it make a difference for you. The audience’s pressing thyroid questions are answered by Dr. Mullen at the end of the talk. What would you like to know?Read Article