EFL074 - Taking Levothyroxine Fasting vs. With Breakfast

For our 74th episode, recorded live at ENDO 2026 in Chicago, we review a recent JCEM study that addresses a common clinical question: does levothyroxine need to be taken on an empty stomach? This randomized clinical trial evaluates a dose-adjusted, non-fasting regimen and finds that a 15% increase with breakfast ingestion achieves TSH stability similar to that with standard fasting dosing. The results also suggest potential improvements in adherence and patient-reported well-being, while highlighting variability in dose adjustments and limitations in generalizability. Host Chase Hendrickson, MD, MPH, MHCC, from Vanderbilt University, is joined by regular contributor Andy Crawford, MD, from Dartmouth-Hitchcock Medical Center, and guest expert Matt Edelson, MD, from the University of Chicago. Together, they discuss “Fasting versus non-fasting dose-adjusted levothyroxine ingestion in hypothyroidism,” published in the April 2026 issue of JCEM, and consider how these findings may inform patient-centered approaches to medication timing and management.