1. About levothyroxine
Levothyroxine is a medicine used to treat an underactive thyroid gland (hypothyroidism).
The thyroid gland makes thyroid hormone which helps to control energy levels and growth. Levothyroxine is taken to replace the missing thyroid hormone.
Levothyroxine is only available on prescription. It comes as tablets or as a liquid that you drink.
2. Key facts
- Levothyroxine starts working straight away, but it may be several weeks before your symptoms start to improve.
- The most common side effects of levothyroxine are caused by taking a bigger dose than you need. Your doctor can lower your dose to help reduce any side effects.
- Before you start taking levothyroxine, your doctor will do a blood test to see what dose you need. Once you start taking the medicine you'll have regular blood tests to see how well it's working.
- Levothyroxine doses need to be carefully monitored during pregnancy. If you're planning to become pregnant or think you may be pregnant while taking levothyroxine, it's important to visit your doctor to make sure you get the correct care for you and your baby.
3. Who can and cannot take levothyroxine
Levothyroxine can be taken by adults and children. However, levothyroxine is not suitable for some people.
Do not take levothyroxine and go back to your doctor to discuss your treatment if you have:
- had an allergic reaction to levothyroxine or any other medicines in the past
- an overactive thyroid (hyperthyroidism)
- a health problem that affects your adrenal glands (your doctor will be able to tell you if you're not sure)
Check with your doctor before taking levothyroxine if you have:
4. How and when to take levothyroxine
Take levothyroxine once a day in the morning, ideally at least 30 minutes before having breakfast or a drink containing caffeine, like tea or coffee.
Food and caffeinated drinks can both stop your body taking in levothyroxine properly so it does not work as well.
If you stop taking levothyroxine your symptoms are likely to come back.
You may need to take several different tablets to make up your dose.
Levothyroxine comes in 25 microgram, 50 microgram and 100 microgram tablets. The word microgram is sometimes written with the Greek symbol μ followed by the letter g (μg). A microgram is 1,000 times smaller than a milligram (mg).
Your doctor will tell you how many tablets to take each day.
The dose of levothyroxine varies from person to person.
Although starting doses are usually the same, the dose of levothyroxine you end up taking, or how quickly the dose is increased, depends on your symptoms, hormone levels, age and whether you have any other health problems.
Adults usually start with a dose between 50 micrograms and 100 micrograms taken once a day. This may be increased gradually over a few weeks to between 100 micrograms and 200 micrograms taken once a day.
Some people, such as over-50s or people with heart disease, may start on a lower dose. If you're taking levothyroxine as a liquid, 5mls has 25 micrograms, 50 micrograms or 100 micrograms in it.
How to take it
Swallow the tablets whole with a drink of water.
Levothyroxine is available as a liquid for children and people who find it difficult to swallow tablets.
If you or your child are taking levothyroxine as a liquid, it will usually be made up for you by the pharmacist. It will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have a syringe or measuring spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount.
What if I forget to take it?
If you forget to take a dose, take it as soon as you remember, unless it's almost time for your next dose. In which case just skip the forgotten dose. Do not take 2 doses together to make up for a missed dose.
If you forget often doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
What if I take too much?
Taking an extra dose of levothyroxine by accident is unlikely to harm you.
Speak to your doctor if:
- you accidentally take more than 1 extra dose
- you get side effects such as a racing heart beat or chest pain – these may not happen straight away, it can be several days before they come on
Your doctor will do regular blood tests to check the levels of thyroid hormones in your body before and after starting levothyroxine.
These will allow your doctor to adjust the dose to suit you.
At the start of treatment you can expect to have blood tests often. Once your hormone levels are stable, you'll usually have a blood test after 4 to 6 months, and after that once a year.
You may need blood tests more often if you:
- are pregnant
- start or stop a medicine that can interfere with levothyroxine
- have any symptoms that could mean your dose is not quite right
5. Side effects
Like all medicines, levothyroxine can cause side effects, although not everyone gets them. Once you are on the right dose of levothyroxine, side effects should go away.
Common side effects and self-help advice
The common side effects of levothyroxine usually happen because the dose you're taking is more than you need. These side effects usually go away after you go on to a lower dose of levothyroxine or stop treatment.
Common side effects are the same as the symptoms of an overactive thyroid. Talk to your doctor or pharmacist if these side effects bother you or do not go away.
Stick to simple meals and do not eat rich or spicy food.
Being sick (vomiting) or diarrhoea
Drink plenty of water to prevent dehydration. If you're being sick try small, frequent sips. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. If you get severe diarrhoea or vomiting from a stomach bug or illness, tell your doctor.
Make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Headaches should usually go away after the first week of taking levothyroxine. Talk to your doctor if they last longer than a week or are severe.
Feeling restless or excitable, or problems sleeping
These symptoms should improve as your body gets used to levothyroxine. If it does not go away, or if it's causing you problems, contact your doctor.
Flushing or sweating
Try cutting down on coffee, tea and alcohol. It might help to keep the room cool and use a fan. You could also spray your face with cool water or sip cold or iced drinks. The flushing should go away after a few days. If it does not go away, or if it's causing you problems, contact your doctor.
If you get unusual muscle ache, which is not from exercise or hard work, talk to your doctor. You may need a blood test to find the cause.
Shaking, usually of the hands
Talk to your doctor as you may need to have your dose reduced.
Serious side effects
It happens rarely, but some people may have serious side effects when taking levothyroxine.
Call a doctor straight away if you get:
- chest pain
- fast or irregular heartbeats, or palpitations
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to levothyroxine.
Immediate action required: Call 999 or go to A&E now if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of levothyroxine. For a full list see the leaflet inside your medicines packet.
You can report any suspected side effect using the Yellow Card safety scheme.
6. Pregnancy and breastfeeding
Levothyroxine and pregnancy
Levothyroxine is usually safe to take in pregnancy.
It's important to carry on taking levothyroxine throughout your pregnancy. Having too low or too high levels of thyroid hormone in pregnancy can cause problems for you and your baby.
You'll need to have regular blood tests during pregnancy to make sure you're on the right dose of levothyroxine for you and your baby. Most women need to take a higher dose of levothyroxine than usual while they're pregnant.
Levothyroxine and breastfeeding
It's usually safe to breastfeed while you're on levothyroxine. Thyroid hormones pass into breast milk in very low levels that are too small to affect the baby.
If you're breastfeeding, it's important that you continue to take levothyroxine. Your body needs good levels of thyroid hormones to make enough breast milk to feed your baby.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
7. Cautions with other medicines
Some medicines can interfere with thyroid hormones, so the dose of levothyroxine may need to be changed. They include:
- medicines for fits or seizures – such as carbamazepine and phenytoin
- oestrogens – such as in combined contraceptive pills or hormone replacement therapy (HRT)
Levothyroxine can change how other medicines work, so their doses may need to be altered. These medicines include:
- medicines for diabetes – either insulin or tablets
- the blood thinning medicine, warfarin
Some medicines should not be taken at the same time of day as levothyroxine as they can reduce the amount of levothyroxine your body takes in, including:
- calcium salts
- iron salts
- orlistat, a medicine used for weight loss
- sucralfate, a medicine used to treat stomach ulcers
- some cholesterol-lowering medicines such as colestyramine, colestipol or colesevelem
Read the information leaflet supplied with these medicines or speak to your pharmacist for advice on how much time to leave between taking these medicines and taking levothyroxine.
Mixing levothyroxine with herbal remedies and supplements
There's very little information about taking herbal remedies and supplements with levothyroxine.
Important: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
8. Common questions about levothyroxine
How does levothyroxine work?
The thyroid gland in your neck makes a hormone called thyroxine. Thyroxine controls how much energy your body uses (the metabolic rate). It's also involved in digestion, how your heart and muscles work, brain development and bone health.
When the thyroid gland does not make enough thyroxine (called hypothyroidism), many of the body's functions slow down. Some of the most common symptoms of an underactive thyroid gland are:
- feeling cold
- difficulty concentrating
- weight gain
- feeling depressed
Levothyroxine is a synthetic version of thyroxine. You take levothyroxine tablets to replace the thyroxine that your thyroid gland cannot produce and prevent the symptoms of hypothyroidism.
How long does levothyroxine take to work?
Levothyroxine starts working straight away, but it may be several weeks before your symptoms start to improve and you feel any different.
How long will I take levothyroxine for?
Treatment with levothyroxine is usually lifelong. If you stop taking levothyroxine your symptoms are likely to come back.
Is levothyroxine safe to take for a long time?
Yes, it's safe to take levothyroxine for a long time, even many years. High doses of levothyroxine over a long time can sometimes cause weakening of the bones (osteoporosis).
This should not happen if you are on the right dose. It's important to have regular blood tests to make sure your dose is not too high.
Will it affect my fertility?
There's no clear evidence to suggest that taking levothyroxine will reduce fertility in either men or women.
However, speak to a pharmacist or your doctor if you're trying to get pregnant. They may want to review your treatment.
Can I drink alcohol with it?
Yes, you can drink alcohol while taking levothyroxine. Alcohol does not affect how this medicine works.
Will it make me lose weight?
One of the symptoms of an underactive thyroid gland is weight gain. So, once you start taking levothyroxine, you may lose weight as your body's hormones rebalance. Losing weight can also be a sign that your dose of levothyroxine is too high.
Once your thyroid hormone levels have returned to normal, your tendency to gain or lose weight is the same as for people who do not have thyroid problems.
Can I drive or ride a bike with it?
Yes, levothyroxine should not affect your ability to drive or ride a bike.
Is there any food or drink I need to avoid?
There are some foods and drinks that do not mix well with levothyroxine:
- drinks containing caffeine, like coffee, tea and some fizzy drinks, can reduce the amount of levothyroxine your body takes in. Leave at least 30 minutes after taking levothyroxine before you drink them.
- calcium-rich foods, such as milk, cheese, yoghurt and broccoli, can reduce the amount of levothyroxine your body takes in. Leave at least 4 hours between taking levothyroxine and eating calcium-rich foods.
- soya in food and supplements may stop levothyroxine working properly. If you regularly eat soya or take soya supplements your doctor might need to do extra blood tests to make sure you're getting enough levothyroxine.
- kelp (a type of seaweed) can contain high levels of iodine, which sometimes makes an underactive thyroid worse. Do not take supplements containing kelp if you're taking levothyroxine.
Can I get thyroid medicines for free?
If you have an underactive thyroid, you're entitled to free prescriptions for all of your medicines (not just your levothyroxine). To claim your free prescriptions you'll need to have a medical exemption certificate.
The application form for the medical exemption certificate is called FP92A. You can get this from your doctor's surgery. You will need to fill in the form, then your doctor will sign it and send it off.
Will it affect my contraception?
Contraceptive pills that contain oestrogen (combined contraceptive pills) can reduce the amount of levothyroxine in your body.
Speak to your doctor if you start or stop taking the Pill – your dose of levothyroxine may need to change.
Will I lose my hair?
It's having an underactive thyroid that causes hair loss – not treatment with levothyroxine.
Because the natural hair growth cycle takes several months, hair loss related to thyroid disease might only be seen months after the illness has begun. If treatment with levothyroxine has already started, it may seem like the medicine – rather than the underlying illness – is causing the hair loss.
Hair usually regrows after treatment with levothyroxine, but it may take many months.