Can Levothyroxine Be Taken as Evening Dose? Comparative Evaluation of Morning versus Evening Dose of Levothyroxine in Treatment of Hypothyroidism
Open accessAbstract
152 drug naïve primary hypothyroid patients were divided into morning (Group 1) and evening (Group 2) dosing group and evaluated for change in biochemical profile, physical functioning and Quality of Life during the course of 12 weeks of study. At the end of 12 weeks 70 (90.90%) subjects in Group 1 and 72 (96%) in Group 2 achieved euthyroidism. On evaluation clinical symptoms and total clinical scores improved in both the groups at the end of 6 and 12 weeks. Significant improvement in thyroid profile was seen in both the groups at the end of 6 and 12 weeks (Pvalue <.0001). On intergroup comparison, no significant difference in thyroid profile was seen at 6 and 12 weeks between the morning and the evening dose group. Similar dose of levothyroxine was required to achieve euthyroidism in both the groups. Though an early restoration of euthyroidism was seen in evening group, the difference when compared to the morning group was not statistically significant. On assessment of QoL, statistically significant improvement in various parameters was seen in both the groups. Hence, from the study we inferred that evening dose is as efficacious as morning dose and provides an alternate dosing regimen.
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Four of six studies examining timing of LT4 administration showed that timing influences serum TSH values in hypothyroid patients receiving treatment.
“Four studies (121,126,128,129), out of the six studies examining this issue (121,128-131), have shown that the timing of LT4 administration influences the serum TSH values of hypothyroid patients receiving treatment.”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [131]
The paper examines morning versus evening LT4 dosing, but its Results (Section 4; page unavailable) report no significant difference in TSH between the groups at 6 or 12 weeks. It therefore does not support counting this study among those showing that administration timing influences serum TSH. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredA parallel design study in newly diagnosed hypothyroid patients showed achieved TSH at 12 weeks was 5.13 mIU/L with morning dosing versus 3.27 mIU/L with evening dosing, and these results were not statistically different.
“Another parallel design study, in which patients newly diagnosed with hypothyroidism were prescribed LT4 either 30 minutes before breakfast or in the evening, showed that at 12 weeks the achieved TSH was 5.13mIU/L (standard deviation 9.36) with morning dosing versus 3.27 mIU/L (standard deviation 4.19 mIU/L) with evening dosing (131). These two results were not statistically different.”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [131]
Materials and Methods describes newly diagnosed patients assigned to morning or evening levothyroxine for 12 weeks. Observations and Results reports no significant between-group difference in TSH at 12 weeks (P = .31). The passages in our copy do not give the claimed TSH means of 5.13 and 3.27 mIU/L or their standard deviations, so those figures cannot be verified. (LLM, conf=0.84)
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References 22 · Cited by 52
Research works printed but not linked: 1
- [18]Bolk N Visser TJ Nijman J Jongste IJ Tijssen JGP Berghout A Effects of evening vs morning levothyroxine intake Archives of Internal Medicine 2010 170 22 1996 2003 21149757
- Authors
- Rajput, R., Chatterjee, S., & Rajput, M.
- Affiliations
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (IN)
- Corresponding author
- Rajput, Rajesh
- ORCID
- Rajput, Rajesh
- Venue
- Journal of Thyroid Research
- Publisher
- Hindawi Limited
- Published
- 2011
- Volume
- 2011
- Pages
- 1-5
- ISSN
- 2042-0072 (ISSN-L)
- PMC
- PMC3139142
- OpenAlex
- W2035746775
- Cited by
- 52
- References
- 22
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 7 · 2019: 8 · 2018: 4 · 2017: 2 · 2016: 2 · 2015: 8 · 2014: 4 · 2013: 3 · 2012: 1
- FWCI
- 2.36
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Thyroid Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- levothyroxine, timing of drug administration, primary hypothyroidism, thyroid hormone replacement, euthyroidism, quality of life, physical function, drug-naive patients
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