Replaces a hormone your body should make. Simple in principle; the dose titration is where it goes wrong.
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Levothyroxine is synthetic thyroxine — chemically identical to the T4 hormone a healthy thyroid produces. It is replacement rather than treatment in the usual sense: you are topping up something the body has stopped making enough of.
Correctly dosed, it restores normal thyroid function completely and you should feel entirely well on it.
This is the section that matters most, because absorption is where levothyroxine usually goes wrong.
Take it once daily on an empty stomach, ideally 30 to 60 minutes before breakfast, with water.
Separate by at least four hours from: iron tablets, calcium supplements, indigestion remedies containing calcium or magnesium, and multivitamins. These bind levothyroxine in the gut and stop it being absorbed.
Coffee taken immediately with the tablet also reduces absorption. Leave a gap.
Take it at the same time every day. Erratic timing is one of the commonest reasons for results that bounce around and a dose that never seems to settle.
If you miss a dose, take it when you remember on the same day. If you only remember the next day, take that day's dose as normal.
At the correct dose, levothyroxine has no side effects, because it is replacing a hormone your body should be producing. Symptoms almost always mean the dose is wrong rather than that the drug disagrees with you — which is a genuinely important distinction.
Too much produces the symptoms of an overactive thyroid: palpitations, tremor, anxiety, heat intolerance, sweating, weight loss, loose stools and insomnia. Sustained over-replacement carries longer-term risks of atrial fibrillation and reduced bone density, which is why the dose is not simply pushed up to chase symptoms.
Too little and the original symptoms persist — fatigue, weight gain, cold intolerance, constipation, low mood.
Some people have a genuine reaction to the tablet fillers rather than the drug. Switching brand or to a liquid preparation resolves this.
Pregnancy is not a reason to stop — quite the opposite. Requirements rise by roughly 25 to 50% in early pregnancy and the dose usually needs increasing promptly. Tell us immediately if you are pregnant or trying to conceive.
TSH is checked 6 to 8 weeks after starting or changing a dose — not sooner. The level takes that long to reach a new steady state, and testing early produces a misleading result and an unnecessary dose change.
Once stable, annual bloods are usual.
Absorption interactions: iron, calcium, magnesium-containing antacids, proton pump inhibitors, sucralfate, and some cholesterol-binding drugs.
Other interactions: warfarin (levothyroxine potentiates it), amiodarone, lithium, and oestrogen — starting HRT or the combined pill can increase levothyroxine requirements.
Yes. Thyroid replacement is well suited to remote care because it is managed on blood results and symptoms rather than examination.
What that involves: a full thyroid profile including thyroid antibodies, which are frequently omitted elsewhere and which tell you whether this is autoimmune and likely to progress. We check ferritin, B12, folate and vitamin D alongside, because low iron and low B12 cause near-identical symptoms and commonly coexist — treating the thyroid alone then leaves you still exhausted.
We will titrate properly. That means rechecking at 6 to 8 weeks and adjusting until symptoms and bloods agree, rather than stopping once a number lands anywhere inside the reference range.
What we will not do is prescribe levothyroxine to someone with normal thyroid function for fatigue or weight loss. It does not work for that and it carries real cardiac and bone risk.
This page is information, not an offer to supply.
Levothyroxine is inexpensive, and on a private prescription the drug cost plus dispensing fee is usually comparable to or less than the England NHS prescription charge of around £10. NHS prescriptions are free in Wales.
Different manufacturers' levothyroxine tablets are not always identical in the way your body absorbs them. Most people notice nothing, but a minority are genuinely sensitive to a switch.
If your levels have been stable and then drift after a change of brand, that is worth mentioning rather than dismissing. Asking your pharmacy to keep you on the same make is reasonable and costs nothing.
Levothyroxine replaces a hormone your body should be making but is not. It is not a drug you stop because you feel better — feeling better is the drug working.
Stopping causes hypothyroidism to return gradually over weeks: fatigue, cold intolerance, weight gain, constipation and low mood, creeping back slowly enough that the connection is often missed.
There is no withdrawal syndrome and no taper. For most people with autoimmune thyroid disease, treatment is lifelong.
After any change, wait six to eight weeks before rechecking. Testing at three weeks produces a misleading number and leads to unnecessary further changes.
Pregnancy is the exception — requirements rise early, often by around a quarter, and this needs planning before conception rather than managing afterwards.
That is a real and common situation, and it deserves better than being told the numbers are fine.
Check ferritin, B12, folate and vitamin D, all of which cause identical fatigue and are frequently low alongside thyroid disease. Coeliac disease and sleep apnoea are also worth considering.
Liothyronine is occasionally used in specialist practice, but it is a hospital endocrinology decision, not a remote prescribing one.
Food, coffee and milk all reduce how much you absorb. Take it with water at least 30 minutes before breakfast, or at bedtime well after eating.
Consistency matters more than the specific time — the same routine every day gives an interpretable blood test.
Iron, calcium and indigestion remedies must be separated by at least four hours. They bind levothyroxine in the gut and are one of the commonest causes of an unexplained rise in TSH.
People often take iron and levothyroxine together with breakfast, which is exactly the wrong combination.
Two to four weeks for the first change, and full benefit takes longer. It is a gradual lift rather than a switch.
Because normal thyroid results do not exclude other causes. Low ferritin, B12 deficiency, vitamin D deficiency, coeliac disease and sleep apnoea all cause the same fatigue.
Being told "your thyroid is fine" and nothing else is not an answer, and checking those is straightforward.
Correcting a genuine deficiency removes the weight an underactive thyroid added — usually a modest amount, much of it fluid.
It is not a weight loss treatment, and taking more than you need to lose weight is unsafe: it causes bone thinning and heart rhythm problems.
Usually yes, where the cause is autoimmune. Some cases after pregnancy or a viral thyroiditis recover.
Tell someone straight away. Requirements rise early in pregnancy and adequate thyroid hormone matters for the baby's development.
Ideally plan this before conceiving rather than after a positive test.
For most people, no. For a minority, genuinely yes.
If your levels drift after a change of manufacturer, ask the pharmacy to keep you on one make.
Not much. Take it when you remember, or take two the next day if a whole day was missed.
Levothyroxine has a long half-life, so a single missed dose barely registers.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 24, 2026
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