The treatment of thyroid disease has a long and rich history that spans a century.
Natural desiccated thyroid (NDT) medicine is made from the thyroid glands of pigs, termed porcine. This thyroid medicine was first developed in the late 1800s which was a good thing because, at the time, doctors were transplanting thyroid glands from animals into humans via surgery, which in and of itself was dangerous!
The advent of pills – even those extracted from pig glands – grew in popularity for good reason until the 1950s when synthetic (T4 drugs) became available.
Today, both synthetic thyroid hormones and natural NDT drugs remain popular today, however, I have 5 important warnings for you if you take any type of thyroid medication.
They are as follows:
1. Don’t Drink Coffee with Your Thyroid Medicine
Coffee can especially interact with thyroid medication in two major ways. Coffee contains compounds called tannins that can interfere with the absorption of thyroid hormone in the gut. The tannins bind to the medication like metabolic ‘glue’ and prevent it from being absorbed properly so it doesn’t do its job or obtain proper blood levels. This is especially true for T4 medications such as levothyroxine because it is a T4 drug, although interactions may occur with other T3/T4 combo drugs aka NDT medications like Armour.
You can find studies to prove this on reputable sites, and here is one PAPER that you can read right now.
The other major way coffee interacts with thyroid medicine is that it speeds the transit of everything in your gut, that’s why some people get diarrhea from coffee. It’s also why other people drink coffee in the morning (because they have constipation and the drink makes them go). Anyway, coffee will speed the transit of medication out of the gut and you may not absorb it properly, therefore you may not achieve therapeutic blood levels of your thyroid medicine.
If you take thyroid medication, it’s generally recommended to wait at least 60 minutes after taking your medication before drinking coffee or other beverage like black tea or matcha tea because they also contain these tannins.
2. Don’t Take Calcium Supplements with Your Thyroid Medicine
Calcium can interfere with the absorption of thyroid medicine. Like coffee, calcium can bind to your medication and block it from getting properly absorbed properly from your intestines. Both levothyroxine (T4) drugs and Armour Thyroid (NDT drugs) need to be absorbed fully in the gastrointestinal tract to be effective in treating an underactive thyroid, and calcium inhibits absorption by forming a complex in the gut that doesn’t dissolve and get into the bloodstream.
There are studies to confirm this phenomenon, here is one that was published in JAMA.
I recommend you wait for at least 3 to 4 hours after taking your thyroid medication before consuming any calcium supplements. This allows the medication enough time to be fully absorbed before the calcium is consumed.
If you need to take calcium supplements for other health reasons like a parathyroid condition, osteoporosis, or hypocalcemia, just schedule your thyroid medicine and supplement intake accordingly to avoid any potential interactions. For example, one option is to take the thyroid medication when you wake up around 7 or 8 am and take the calcium supplements at lunchtime.
Calcium can bind to thyroid medicine and form insoluble complexes in the gut, which prevents levothyroxine from being absorbed properly. This can lead to lower levels of levothyroxine in the bloodstream, which can cause symptoms of an underactive thyroid.
3. Don’t Eat Yogurt with Your Thyroid Medicine
Just like calcium supplements, eating calcium-rich foods right after you take your thyroid medication will interfere with absorption. So don’t take your pill and then eat a bowl of yogurt, or have a glass of milk! Wait about 3 – 4 hours after you take your thyroid medicine to consume these foods especially if you take T4 drugs like levothyroxine, but also T3/T4 combo drugs. You don’t have to avoid the foods altogether, you just need to be mindful of the time between the administration of your thyroid medicine and with consumption of dairy-rich foods/beverages.
4. Don’t Drink Green Juice with Your Thyroid Medicine
Goitrogenic foods and fruits suppress thyroid hormone production. They don’t interfere with medications as a classic interaction though. Some people like to take their thyroid medication, then drink a green juice smoothie. This is almost always going to be a huge problem for you!
Goitrogens like kale or spinach are popular juicing veggies. But they are bad for your thyroid in such high quantities and may trigger autoimmune flare-ups if you have Hashimoto’s (but not Graves’ disease).
Goitrogens are compounds that are well known to interfere with the uptake of iodine by your thyroid gland, which is an essential nutrient in the production of thyroid hormone. If the thyroid gland doesn’t receive enough iodine, it cannot produce enough thyroid hormones, which can lead to an enlarged thyroid gland (called a goiter) as well as symptoms of hypothyroidism, what I call “thyroid sick” in my BOOK.
My literary agent is a friend. We were chatting over email one day and I found out she was juicing her greens for a smoothie every morning. She has Hashimoto’s thyroiditis which means her thyroid isn’t always working up to snuff, and here she was consuming handfuls of goitrogens every morning! Thus suppressing her natural ability to produce thyroid hormone which explained why she wasn’t feeling her best anymore. She’d been doing this for months. So I sent her a copy of my Hashi No-No book, which you can download HERE, and a bottle of HashiScript. About a month later I received this glowing email from her:
Hey Suzy I woke up feeling so good today I had to write! i have not had heartburn or low energy since starting HASHIScript!! Thank you again for helping me feel younger! You are the thyroid queen. I am so grateful. Now I Hashi know know!”
Some examples of goitrogenic foods that people eat include cruciferous vegetables such as broccoli, cauliflower, and cabbage, as well as soy products, millet, and some fruits such as peaches and strawberries. I just cringe when I see superfood green powder drinks loaded with goitrogenic ingredients! It can smash thyroid hormone production over time. That’s why I formulated Yummy Greens – it is safe for your thyroid because it does not have any goitrogens.
That’s also why it’s the only pharmacist-formulated, fully patented superfood green drink mix in the world!
However, I think it’s important to note that goitrogenic foods and fruits are very healthy, especially if they are not raw, but cooked. They have anti-carcinogenic properties and are generally not a concern for anyone who consumes them in normal amounts and has a healthy thyroid gland. Again, many of these goitrogenic foods have important health benefits and should be included in a balanced diet.
To be clear, people who have an underactive thyroid or are taking thyroid medicine may need to be more cautious about consuming goitrogenic foods, as they can interfere with iodine uptake and the effectiveness of thyroid medication. Feel free to talk to your healthcare practitioner before making any changes to your diet or medication regimen.
5. Don’t Take Thyroid Medication at Night
Thyroid medication works by increasing the levels of thyroid hormones in the body, which are stimulating. This means that it will speed up your metabolism, burn fat, increase energy levels, and improve hair and nail growth. Thyroid medicine will also warm you up, so if you’re always cold, that could be a sign that you have hypothyroidism.
The best time to take thyroid medication is in the morning on an empty stomach, at least 30 minutes before eating.
The reason for taking thyroid medication in the morning is that it can produce insomnia if you take it at night, especially if you’re also reading your device in bed at night adding one more factor for insomnia. For sure, taking it in the morning is easy to remember, and my recommendation! Taking thyroid medicine FIRST thing in the morning is ideal so you can separate it from other medications, foods, or calcium-rich supplements that interact with it.
However, some people may prefer to take their medication at night, I hear that every once in a while. It’s unusual but certainly doable. This is the case if you find that it causes nausea or stomach upset, and you just want to sleep through it. But again, it could cause restlessness or insomnia – just be aware of that.
Ultimately, the best time to take thyroid medication is up to you. There’s no hard, fast rule for this. I’d say 99% of people take it in the morning though. Perhaps your response to it is more dose-dependent.
If the dose of your thyroid medication is too high for your individual needs, it will absolutely cause high levels, of hyperthyroidism, the opposite of hypothyroidism. This problem occurs in people who are just starting out on the medication and finding the correct dose for them. Hyperthyroidism can cause symptoms such as anxiety, restlessness, tremors, sweating, diarrhea, and difficulty sleeping. If you’re just starting out on thyroid medication, definitely take it in the morning.
It’s important to follow the dosing instructions provided by your healthcare provider and to have regular thyroid function tests to ensure that the medication is working properly and not causing any adverse effects.
Here are some common sense DO’s for people who take thyroid medication:
✅ Follow dosing instructions carefully: It’s important to take your thyroid medication exactly as prescribed by your healthcare provider. Taking too much or too little medication can lead to side effects or interfere with your thyroid function.
✅ Don’t skip doses: Consistency is key when it comes to thyroid medication. If you skip a dose, it can affect your hormone levels and lead to symptoms such as fatigue, weight gain, and depression.
✅ Be mindful of other medications: Some medications can interact with thyroid medication, so it’s important to let your healthcare provider know about all the medicines you’re taking. This includes over-the-counter drugs and supplements.
✅ Monitor your symptoms: Even if you’re taking your thyroid medication as prescribed, it’s essential to pay attention to your symptoms. If you experience any new or worsening symptoms, let your healthcare provider know right away. Adjustments to your medication may be necessary.
In Summary
Today I’ve discussed several aspects of thyroid medicine and its potential interactions and side effects. This is a very important topic so please forward it to anyone who might help.
I can’t emphasize enough the importance of taking thyroid medication as prescribed and avoiding skipping doses or taking too much thyroid medicine. I also discussed how drinking coffee and/or taking calcium supplements can interfere with the absorption of thyroid medication. Please wait the appropriate times before consuming these substances if you take thyroid medication.
Next, I addressed the potential for goitrogenic foods to interfere with thyroid hormone production. Healthy foods like kale or strawberries are fine in normal, moderate consumption, but it’s easy to overdo these if you take a scoopful every day in a typical superfood drink mix, or you put big wads in your blender for your morning juice! Learn more about that in my article, The Case Against Kale.
Finally, I discussed the best time of day to take thyroid medicine and how it can adversely affect sleep and cause restlessness. It’s important to work with your doctor to determine the best dosing schedule and to monitor any adverse effects of the medication if you are just starting out.
Overall, it’s important to be aware of the DO’s and DON’Ts of thyroid medicine. By working together with your practitioner, and knowing the information I’ve shared today, you can be safe on your medication and improve the quality of your life.
Suzy Cohen, has been a licensed pharmacist for over 30 years and believes the best approach to chronic illness is a combination of natural medicine and conventional. She founded her own dietary supplement company specializing in custom-formulas, some of which have patents. With a special focus on functional medicine, thyroid health and drug nutrient depletion, Suzy is the author of several related books including Thyroid Healthy, Drug Muggers, Diabetes Without Drugs, and a nationally syndicated column.
