When should I take my Synthroid?
September 12, 2011 1:59 PM   Subscribe

Please help me figure out when to take my daily dose of Synthroid. I know it shouldn't be this hard, but none of the options I come up with are working.

I am supposed to take the generic version of Synthroid every day. I am supposed to take it on an empty stomach, meaning one hour before meals or two hours after meals. So three hours with no food + medication. Um, what?

I have successfully gotten down to fighting weight by eating very first thing in the morning and eating small high-protein mini-meals throughout the day, usually every...drumroll please...three hours. This works for me and has made me a happier, healthier person. It was a long road to get here and I am not all that interested in changing this routine.

So how can I integrate this medication into what I am currently doing? I have so far tried and failed at:

-leaving a pill on the bedside table and taking it during one of my many middle of the night wake-up-and-look-at-the-clock episodes. Fails more often than not.

-taking a pill at night before bed when I wash my face and brush my teeth. This often works, but usually goes out the window when I am visiting the beau or am having otherwise social periods of life.

-just taking the pill with food, figuring that not taking it is worse than taking it with food.

Logically, I know that taking this medication will (in theory) help me feel better and will be good for my health. Practically, it's been a huge PITA and ends up making me feel guilty for not taking better care of myself. My medical experts have not been able to suggest options other than the "take first thing in the morning", which doesn't work for me.

So I turn to you, hivemind. Any ideas? I am not on any other medication (other than Nuvaring, if that tells you anything about my past success at taking a pill every day), and feel very blessed indeed that this is the case. I can't imagine how difficult it must be to do this, x20, for multiple medications each with their own special set of snowflake instructions.
posted by stellaluna to Health & Fitness (22 answers total) 4 users marked this as a favorite
Best answer: ...one hour before meals or two hours after meals.

You eat every three hours, why can't you just take it two hours after your morning meal, which would be one hour before your next meal?
posted by Floydd at 2:04 PM on September 12, 2011 [4 favorites]

I use your option 2. I take a pill at night before going to bed.

You say it only "often" works but thats all it really has to do. Carry a pill case with you - as I do - when traveling. Sometimes there'll be late night dinners. Thats fine, if they're excpetional.
posted by vacapinta at 2:05 PM on September 12, 2011 [1 favorite]

I have an alarm set for 5:30am. I wake up, roll over, grab my pill and water, chug and promptly fall back to sleep until my real alarm goes off. It sucked at first, but it's now habit and I feel much better than I did back in the days when I didn't take it on a consistent schedule.
posted by Cat Pie Hurts at 2:08 PM on September 12, 2011

Best answer: I'm on some meds that tell me to [fishes around for pill bottle] "take with food," "not lie down for 30 minutes after taking," and "avoid prolonged exposure to sunlight." I'm really good about remembering to take my various drugs, but that's because I don't get too bogged down with all their rules.

Now, obviously, you should *try* to follow your dosing instructions as best as possible, but sometimes that's just not how reality works. If I'm about to go to bed and haven't taken the one that tells me not to lie down for 30 minutes after taking yet, I'm going to take it and go ahead and lie down anyway. Because if I don't take it, it will seriously Fuck My Shit Up, and that's worse.

Find a time in the middle of the day (maybe between breakfast and lunch? between lunch and dinner?) where there's a stretch of not eating. If it's not three whole hours, don't worry about it. Maybe it'll only be a half hour after you ate breakfast, and an hour before you eat lunch. Or whatever. It's more important to get into the habit of taking your meds on a regular schedule than it is to make sure that it's been exactly such-and-such minutes since you last ate.

Also, make sure you always ALWAYS have your drugs on your person, so if your schedule gets messed up and you're stuck in traffic or decide to stay at your boyfriend's or something, you don't miss a dose.
posted by phunniemee at 2:10 PM on September 12, 2011 [1 favorite]

I have been taking Synthroid for about 6 years and nobody has ever told me to take my pills on an empty stomach. Seriously. And my father is a well-regarded endocrinologist. I asked him about this once and he rolled his eyes.

Just take the pill once a day every day. Do your best to take it on an empty stomach - probably first thing in the morning sounds best for you. And if you miss a dose make it up the next day. You need to take it on a regular basis but it's not one of those drugs that is going to mess you up terribly if it's not taken exactly the same time every day.

And congrats on getting your weight down and sticking with it!
posted by radioamy at 2:18 PM on September 12, 2011 [1 favorite]

Best answer: Do you eat your meals at roughly the same time each day? If so, just pick a time that's 2 hours after one of your meals. Based on what you said, that would also be 1 hour before the next meal. So, for example:
- Meal at 2pm
- Pill at 4pm
- Meal at 5pm

Still 3 hours between meals, still within the prescribed guidelines.

If it's too tough to pick a time during the day, take it just before you go to bed (I assume you don't each within 2 hours of going to bed - is this correct?) That seems to be easy for many people to remember. Keep a pillbox in your purse with several doses and that way you'll always have one handy, even if you're not sleeping at home.
posted by pecanpies at 2:18 PM on September 12, 2011

It is important to take synthroid at the same time every day, so switching back and forth from bedtime one day to after breakfast the next is probably not a great solution. But - it can be more important to take it at the same time each day than to strictly observe the no-food rule. Maybe your doctor can advise about this? The solution I've adopted is swilling it just after morning tooth-brushing, before shower, etc. This builds in a window of time with an empty stomach before I even make it to the kitchen. My THS levels have been similar over time with this method.

You say you're going to take the generic version. Thyroid replacement is one of the few meds where the generic v. name brand is actually important. Synthroid (the brand) is significantly more consistent from pill to pill in its dosage than generics. This might sound strange, but it is true. Insurers actually know this, and will frequently allow Synthroid on request from either patient or physician. If finances do force you to use generics, it's probably worth it to akd your pharmacist about having them dispense a consistent generic brand from month to month, rather than whatever the warehouse sends them each time they get a resupply.
posted by citygirl at 2:21 PM on September 12, 2011

I've been on Synthroid for years and take it first thing in the morning, then eat at least an hour later. Yay for me. But here's the thing: Once you start taking thyroid medication, your doctor will run a thyroid panel (a blood draw, basically) on you about six weeks later to make sure the dosage is correct. If you don't take the pills on an empty stomach, the worst that will happen is that you won't absorb all of it so your thyroid panel will show you as needing a higher dosage. Your doctor will increase the dosage and repeat the thyroid panel six weeks later.

AFAIK, it's more important to take it under relatively-controlled conditions. So if you eat roughly the same breakfast first thing every morning, take the pill with your breakfast so you don't forget and let your dosage get adjusted to accommodate that pattern.

I know you didn't ask about this, but if you take a multi-vitamin with minerals or just minerals by themselves (especially iron or calcium), take those at a different time than your Synthroid.
posted by DrGail at 3:11 PM on September 12, 2011 [2 favorites]

Response by poster: I'm so relieved to find out that I am capable of beanplating something as minor as medication timing :)

Sounds like the best option is for me to try to take this mid-morning, after breakfast and before morning snack. I'm also very relieved to hear that it is not, in fact, as difficult as I am making it, and that taking it consistently is probably good enough, even if it's not "correctly" as directed on the label. I am ashamed to admit that I have not done a very good job of this so far but I am sure your words of encouragement and suggestions will help going forward. Thank you all for your reassurance and advice!
posted by stellaluna at 3:16 PM on September 12, 2011

I take synthroid first thing in the morning, when I wake up. Then I shower, go to work, and eat breakfast at my desk. That works for me.

If you like taking it at night but forget when you are staying overnight elsewhere, get one of the mini altoid tins and put a few extra pills in it. Pop it in your purse and when you are out and about - you have them. If you have trouble remembering, set a reminder alarm on your phone.

Good luck!
posted by bunderful at 4:53 PM on September 12, 2011 [1 favorite]

It's okay to take your thyroxine (that's the name of the substance that is in Synthroid) with food, as long as it's always exactly the same kind of food every single time. It will lower your absorption of the thyroxine, but then your dosage will be adjusted to make up for it. This does not work for people like me who will eat one food for breakfast for a month, and then switch to something else, but it works fine if you don't go changing what you eat. The foods that will have the greatest effect on how much of the drug you absorb are those that contain soy or which are fortified with iron or with calcium.

Synthroid is not better or more consistent than other brands. In fact, for several years, Unithroid and Levoxyl were more consistent than Synthroid, from one batch to another (though not to each other). However, the different brands are of slightly different strengths from one another. Don't switch from one brand to another. Pick one brand and always buy that one. Switching brands is like switching dosages.
posted by Ery at 5:20 PM on September 12, 2011 [1 favorite]

I also take Synthroid (brand). I have the bottle (next to my alarm -- hard to forget about it there!) on my bedside table along with a bottle of water. I make sure the water bottle is full every night before I go to bed. When I wake up in the morning, I take the pill first thing. I eat breakfast about an hour later at my desk.
posted by imalaowai at 7:04 PM on September 12, 2011

Synthroid (the brand) is significantly more consistent from pill to pill in its dosage than generics.

I disagree. and I'm not alone. I take Levoxyl, as a generic, and take it every night before I go to sleep. If I'm not home, I take a pill case along with me.

This isn't rocket/brain science. Get in the habit, and after 21 days, it will become routine.
posted by Ideefixe at 7:31 PM on September 12, 2011

What Ery said, on both counts. Generic is fine and don't buy the Synthroid marketing hype.

Second, be consistent about when and how you take it with food so that your absorption levels are constant and adjust your dose so that you're getting the right amount. I take mine every morning with my coffee, using the same approach. No, it's not a completely empty stomach, but I'm not functional without my coffee, and I take it the same way every time, and I'm on the right dose for me. It sounds like finding a routine to ensure you take the pill is a higher priority than an empty stomach, so work with that.

Also (this was helpful for me to know when I was first prescribed it), levothyroxine has a long half-life in the body so once your levels have stabilized, missing a pill and then doubling up isn't the worst thing in the world. They even did studies showing you could take your total weekly dose once a week and be fine. Unlike, say, birth control or antibiotics, there's less to lose if you skip a dose and then take 2. That is NOT a recommendation to get crazy with your pill-taking, but intended to be a comfort if you miss one.
posted by gingerbeer at 9:28 PM on September 12, 2011 [1 favorite]

Best answer: Per gingerbeer above, my doc also said you can probably get away with taking the weekly dose all at once. Since then, I've taken my six pills every Monday morning, and I don't stress if I'm traveling and it turns out to be Tuesday one week and Sunday the next. I've had no problems as a result. One nice thing about it is there are far fewer days I need to worry about when I eat. Good luck!
posted by sapere aude at 10:16 PM on September 12, 2011

Best answer: This often works, but usually goes out the window when I am visiting the beau or am having otherwise social periods of life.

I started taking taking my medication reliably when I started keeping a blister pack in my wallet. Not my handbag, which I don't use every day, but in a spare pocket of the wallet in which I keep my cards and money. It works really well for me because I never go anywhere without it. And if you're out with friends and you'd prefer to take your pills in private, it's easy enough to excuse yourself to buy a drink and duck into the bathroom on the way. If your synthroid doesn't come in blister packs, your pharmacist can re-package it for you.
posted by embrangled at 1:49 AM on September 13, 2011

The best way to take it is RIGHT when you wake up. I take levoxyl and if i do not take it in the morning i feel horrible. Also for me it KILLS my stomach and taking it in the morning is the best time to take it with the least amount of stomach pain for me.

PS My endocrinologist told me something that helps a lot. If you take levoxyl you can put the pill in water and drink it.

PS I was told specifically that some peoples bodies do not absorb synthroid well. Some people take better to levoxyl. I was one of those people. My body is doing much better on levoxyl vs synthroid.

I suggest taking it right when you get up. First thing you wake up take it with a glass of water. This way whenyour done with your morning routine it should be an hour later.
posted by majortom1981 at 4:37 AM on September 13, 2011

Also first thing in the morning is the best because your only stuck not eating for 1 hour vs 3.
posted by majortom1981 at 4:39 AM on September 13, 2011

I was told to take it when I wake up, and not eat for half an hour. I am experiencing no issues.
posted by troywestfield at 9:02 AM on September 13, 2011

I take my Synthroid in pretty much the same manner as bunderful, first thing upon getting out of bed in the morning with at least 4 oz. of water. I eat a morning snack that is more protein than carb when I get to work, which ends up being at least 3 hours later.
posted by Lynsey at 9:49 AM on September 13, 2011

Response by poster: Sapere aude! Embrangled! GENIUS! I will ask my doc about taking them all once a week, and will also ask my pharmacist about a blister pack for my wallet, because you're right--the wallet always makes it from one handbag to another, but not so much the other stuff.

Thanks again, all! So glad I checked back in!
posted by stellaluna at 5:26 PM on September 13, 2011

the generic version of Synthroid
You say you're going to take the generic version. Thyroid replacement is one of the few meds where the generic v. name brand is actually important.
Generic is fine and don't buy the Synthroid marketing hype.
Synthroid is not better or more consistent than other brands. In fact, for several years, Unithroid and Levoxyl were more consistent than Synthroid, from one batch to another (though not to each other). However, the different brands are of slightly different strengths from one another. Don't switch from one brand to another.

LOTS of misinformation in this thread!

Ery is right in that the important issue here is not brand vs brand. Anyone who says that it does not matter which BRAND of thyroid medication you take is absolutely correct. You can take Synthroid, Unithroid or Levoquel. The important issue is that once you find the brand that works for you, you stick with that brand and you're fine.

BUT you are not taking a brand name, you are taking a generic form. And the concern is that GENERIC versions of any of the brand names are not consistent from dose to dose. This is not a pharmaceutical industry issue, this is a clinical issue.

According to a joint statement issued by American Thyroid Association, The Endocrine Society, and American Association of Clinical Endocrinologists in 2005, clinicians petitioned to the FDA that they be consulted on the best methods of testing generic thyroid medications that were being considered for approval in the future.

But the FDA did not take their concerns into account, so

"TSH levels, the widely accepted best single laboratory tool for establishing thyroid status, are not part of the FDA’s determinations of equivalence.

“Uncorrected,” the FDA’s methodology may lead to the conclusion that preparations that
differ by as much as 33% are equivalent. “Correcting” for baseline values may reduce the
difference detected to less than 25% but greater than 12.5%."

And those differences are clinically significant, because, "Levothyroxine is a drug recognized to have a narrow toxic to therapeutic ratio with significant clinical consequences of excessive or inadequate treatment."

And that led to a lot of problems when the generics came onto the market, because patients started noticing some serious differences in their medications, and a lot of them didn't know that it was because they had been switched from brand to generic, not by their doctors but by insurance companies who insist that pharmacies substitute cheaper generic brands for brand names when available.

So while the BRAND names are fine for some and the GENERIC versions may be fine for those who never had a brand name prescribed to begin with, switching between brands or generics or both is going to introduce inconsistency in the levothyroxine dosage. And the most important issue when treating thyroid problems is consistency.

Which has led to the the physicians' recommended best practices for thyroid patients: "Patients should be maintained on the same brand name of levothyroxine product. If the brand of levothyroxine medication is changed, either from one brand to another brand, from a brand to a generic product, or from a generic product to another generic product, patients should be reevaluated, retested by measuring serum TSH in six (6) weeks, and the drug retitrated as needed."

So, if you were diagnosed to take "the generic version of Synthroid," to begin with, and you have taken nothing but that, you should be fine. But you do NOT want your pharmacy or your insurance company to just substitute a generic version (or even a different brand version) of levothyroxine, because it could mess with your TSH levels, and if you do switch, you are going to need to be evaluated after 6 weeks, and maybe have your dosage changed.

To avoid this, anyone who takes the brand name needs to make sure their doctor makes the prescription out for the brand name only and notes on the prescription that generic substitutions are not clinically authorized.

Synthroid (the brand) is significantly more consistent from pill to pill in its dosage than generics.

I disagree. and I'm not alone.

The letter in your link, despite the fact that the website says it was updated in October of this year, is over ten years old. Synthroid may have its own consistency problems, but more generics have been introduced since then (many in 2004), and they are not comparable with Synthroid, either. See the concerns I listed above.
posted by misha at 3:01 PM on October 19, 2011 [3 favorites]

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