Dosing Thyroid Medication

The most common problem I see with patients on thyroid medication for hypothyroidism is how the medication is dosed. The symptoms of hypothyroidism are due to fluctuations in blood/tissue thyroid levels, rather than absolute levels. Therefore, dosing the medication properly becomes very important to keep blood levels consistent and smooth. Remember: do not change what you are doing until you talk to your prescribing doctor since it can greatly change the amount of thyroid medication absorbed into you system.

Synthroid, Levoxyl, Tirosint, Unithroid, Levothyroxine (T4) dosing:


in the morning on an empty stomach, wait at least 20-30 minutes before eating food in general. This is not a specific time. of day, just when you wake up. If you wake at noon, take at noon. If you wake at 8am, take at 8am


If you forget/miss a dose, don't take it in the middle of the day. Take your regular dose the next morning plus the dose you missed from the previous day. Don't make this a habit. The weekly dose of T4 matters more than the daily dosage. This does not apply to non-T4 medications for hypothyroidism


These medications/foods completely prevent the absorption of thyroid medication and should be separated by at least 4 hours (four hours prior and 4 hours after dosing thyroid medication): Any Vitamin pill, Any Supplement pill, Any Stomach medication, Calcium tablets / iron tablets /Soy products/ pepto bismol/ any vitamin / laxatives / prunes / walnuts.


Note: if you are taking T3 (liothyronine or cytomel) it is shorter acting than T4 so do not double dose (weekly dose rule does not apply), if dose missed then just take when you remember. Take it as directed

*If you develop chest pains, palpitations, shortness of breath while taking this medication please call our office.

*If you take the generic form (levothyroxine) please only refill the prescription at that exact same pharmacy location each time in order to get consistent drug levels

* If you take a supplement called BIOTIN, please stop this medication 5 days prior to your thyroid blood testing as it can affect the thyroid blood levels.


WOMEN: if you are PREGNANT you must message our office to get an appointment WITHIN 10 days since thyroid dosing changes a lot during pregnancy. Please message us with subjecy "pregnant". If there is significant change in your pregnancy (miscarriage, other pregnancy complications then please also see us within 10 days) and let us know via a portal message.

For more information see:

Generally hypothyroidism can be managed by a primary care doctor. If you would like to transfer care to a primarycare doctor, please ask them to start prescribing these medications for you. Otherwise if your prescription is coming from our clinic, you will need to follow up regularly with us.