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Should You Take Vitamin C with Levothyroxine?

Does thyroid medication work better if you take it with vitamin C? New research suggests it’s possible!
Should You Take Vitamin C with Levothyroxine?
Last updated:
7/15/2024
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Imagine feeling energetic from morning until night! For the millions grappling with hypothyroidism, this is rarely a reality, and each day brings the challenge of taking thyroid medication and managing their thyroid condition. But what if the secret to effective thyroid treatment lies in a simple, often overlooked vitamin? Recent buzz in the medical community suggests that taking vitamin C with your daily dose of thyroid medication might just be the game-changer you need. Could this dynamic duo be the key to optimizing your thyroid treatment and boosting your energy? Let’s explore the science and learn more about the potential benefits.

Understanding hypothyroidism treatment

When you are hypothyroid, your thyroid gland is unable to produce enough thyroid hormone. The treatment for hypothyroidism is thyroid hormone replacement medication. The most commonly prescribed drug is levothyroxine, a synthetic version of thyroxine (T4), a hormone produced by the thyroid gland.

Thyroid hormone is crucial for regulating your metabolism, energy production, and overall hormonal balance. When your thyroid gland is underactive, it leads to symptoms such as fatigue, weight gain, depression, and brain fog. Thyroid hormone replacement medications like levothyroxine help restore normal thyroid hormone levels in your bloodstream. By maintaining thyroid function, this medication relieves symptoms and helps prevent potential longer-term complications such as heart disease, infertility, and obesity.

It’s not always as easy as taking a pill, however. Thyroid hormone absorption is a delicate dance, easily disrupted by foods, certain supplements, other medications, and even your morning coffee. Typically, experts recommend that you take your levothyroxine on an empty stomach, about 30-60 minutes before breakfast, and away from other medications or supplements to optimize its absorption and uptake.

You may be aware of the list of dos and don’ts for thyroid medication. For example, experts recommend that you put at least one to four hours between coffee, milk, iron supplements, calcium, antacids, high-fiber foods, and your thyroid medication. It can be a frustrating game of trial and error to ensure that your body gets every bit of crucial thyroid medication.

Now, vitamin C—a powerful antioxidant found in fruits and vegetables—is garnering attention for its potential positive impact on levothyroxine absorption.

The role of vitamin C

Vitamin C is a powerful antioxidant crucial in maintaining overall health and well-being. This essential nutrient offers many benefits, making it a vital component of a balanced diet. Here are some key health benefits of vitamin C, as shown in research studies.

Immune support

One of the most well-known benefits of vitamin C is its ability to support the immune system. It helps stimulate the production and function of white blood cells, the body’s first line of defense against infections and illnesses. Vitamin C also aids in producing interferons, proteins that help fight off viruses. By boosting the immune system, vitamin C can help reduce the severity and duration of common colds and other respiratory infections.

Wound healing

Vitamin C is essential for the production of collagen, a protein that plays a vital role in wound healing. Collagen is a primary component of connective tissues, including skin, bones, and blood vessels. Adequate vitamin C intake can help promote faster healing of cuts, burns, and other injuries by supporting the body’s natural repair mechanisms.

Cardiovascular health

Vitamin C has been shown to have a positive impact on cardiovascular health. As an antioxidant, it helps neutralize harmful free radicals that can contribute to the development of heart disease. Additionally, vitamin C may help lower blood pressure levels and improve the function of blood vessels, reducing the risk of heart attacks and strokes.

Skin health

Vitamin C plays a crucial role in maintaining healthy skin. It is involved in producing collagen, which helps keep skin firm and elastic. Furthermore, vitamin C’s antioxidant properties can help protect the skin from damage caused by UV radiation and environmental pollutants, potentially reducing the risk of premature aging and wrinkles.

Eye health

Research suggests that vitamin C may help prevent or slow the progression of certain eye conditions, such as cataracts and age-related macular degeneration (AMD). The antioxidant properties of vitamin C can help protect the eyes from oxidative stress, which is a contributing factor in the development of these conditions.

Vitamin C and levothyroxine absorption

Low stomach acid, also known as hypochlorhydria, is a common issue in people with hypothyroidism and autoimmune Hashimoto’s thyroiditis. The thyroid hormones play a crucial role in regulating the production of hydrochloric acid (HCl) in the stomach. When thyroid hormone levels are low, as in hypothyroidism, it can lead to a decrease in stomach acid secretion. Levothyroxine’s bioavailability can be adversely affected by low stomach acidity, making thyroid hormone replacement treatment less effective.

Several recent research studies report that vitamin C acidifies the stomach and lowers the gastric pH level, enhancing the solubility of levothyroxine and its absorption.

In one study, patients with poor thyroid control had TSH, Free T4, and T3 levels evaluated while taking levothyroxine alone and then after a period of taking their medication with 500 mg of vitamin C (dissolved in water). The results showed that TSH decreased, and Free T4 and T3 levels increased in all the study subjects while on vitamin C, and the majority of patients achieved normalized TSH levels.

One study found that after two months of taking levothyroxine with 1 g (1000 mg) of vitamin C, the TSH levels of the study participants had fallen by an average of around 70% despite taking the same dose of levothyroxine.

Interestingly, the beneficial effects of vitamin C were seen even two months after discontinuing it, suggesting a sustained improvement in levothyroxine absorption.

Finally, a 2024 study from Turkish researchers reported on a patient who was taking increasingly higher doses of levothyroxine but was unable to get her TSH below 100, and testing showed that her T4 level only increased about 25% after taking the medication. She was given 1000 mg a day of vitamin C. On the third day of levothyroxine with vitamin C, her TSH increased by 60%, indicating a significant improvement in absorption.

Other benefits of vitamin C for hypothyroid patients

Reduction of oxidative stress

Hypothyroidism is often associated with increased oxidative stress, which can damage cells and tissues. Vitamin C, as an antioxidant, helps to neutralize free radicals, reducing oxidative stress and its associated complications. By lowering oxidative stress, vitamin C can improve overall cellular health and potentially relieve or reduce some symptoms of hypothyroidism.

Support for immune function

Vitamin C may also play a role in immune function for patients with autoimmune Hashimoto’s thyroiditis. Some studies have reported significant differences in blood vitamin C levels in patients with these conditions, suggesting a potential link between vitamin C and autoimmune thyroid disorders.

Vitamin C is well-known for its immune-boosting properties. It stimulates the production and function of white blood cells, enhances skin barriers, and promotes the activity of antioxidants in the body. Improved immune function can help patients with autoimmune hypothyroidism fend off illnesses more effectively, supporting overall well-being.

Cardiovascular health

Hypothyroidism is linked to an increased risk of cardiovascular disease. Vitamin C supports cardiovascular health by improving endothelial function, reducing blood pressure, and lowering the levels of low-density lipoprotein (LDL) cholesterol. These effects can help mitigate the cardiovascular risks associated with hypothyroidism.

Skin health

Dry and rough skin is a common symptom of hypothyroidism. Vitamin C is crucial for collagen synthesis, which is essential for maintaining skin elasticity and hydration. Regular intake of vitamin C can improve skin health, reduce dryness, and promote a more youthful appearance.

Mood and cognitive function

Hypothyroidism often affects mood and cognitive function, leading to symptoms such as depression and brain fog. Vitamin C plays a role in the synthesis of neurotransmitters, which are essential for mood regulation. Additionally, its antioxidant properties protect the brain from oxidative damage, potentially improving cognitive function and mood in hypothyroid patients.

Should you take vitamin C with levothyroxine?

Keep in mind that you will want to discuss adding vitamin C to your thyroid regimen with your healthcare provider. But you should definitely consider whether vitamin C would benefit your thyroid treatment regimen if you fall into one of the following two categories.

You have a condition that causes malabsorption

The absorption studies reported that taking vitamin C with levothyroxine is particularly valuable for hypothyroid patients who have malabsorption due to various conditions, including:

  • Celiac disease
  • Inflammatory bowel disease (IBD)
  • Gastritis and atrophic gastritis
  • Gastroesophageal reflux disease (GERD)
  • Small intestinal bacterial overgrowth (SIBO)
  • Pancreatic insufficiency
  • Cystic fibrosis
  • Chronic diarrhea

If you have one of these conditions, adding a vitamin C supplement could significantly improve your absorption of levothyroxine and help you achieve optimal thyroid function.

You take a high dose of levothyroxine

Vitamin C supplementation may be particularly helpful for hypothyroid patients who require higher-than-average levothyroxine doses to achieve normal TSH levels, which could be due to other malabsorption issues.

If you are taking a high dose of levothyroxine, you may want to discuss with your doctor whether adding vitamin C to your treatment could help.

Practical considerations for vitamin C supplementation

While the benefits of vitamin C for hypothyroid patients are clear, it is important to consider the practical aspects of supplementation.

Dosage

The recommended dietary allowance (RDA) for vitamin C is 75 to 90 mg daily for adults. There’s no clear recommendation regarding the optimal dosage of vitamin C to take with your thyroid medication to enhance absorption. Most studies used higher doses (ranging from 500 to 1000 mg daily) to enhance levothyroxine absorption. It’s important to note that vitamin C can cause side effects such as diarrhea, kidney stones, and potential interactions with certain medications at these doses.

Possible change in thyroid dosage

You should also be aware that taking vitamin C with your thyroid medication could make your current dosage more effective. In some cases, your absorption may be so improved that you require a reduced dosage of levothyroxine. It’s important to have your thyroid levels rechecked six to eight weeks after you start taking your thyroid medication with vitamin C so your healthcare provider can fine-tune your dosage if needed.

A note from Paloma

If you’re hypothyroid, vitamin C offers a range of benefits, from enhancing the absorption of the medication to reducing oxidative stress and supporting immune function. By incorporating vitamin C into your treatment regimen, you can potentially improve your overall health and well-being. However, it is crucial to approach supplementation thoughtfully, consulting with your healthcare providers to ensure that your dietary supplement regimen is tailored to your specific needs and that there are no contraindications or interactions with other medications.

For the best possible care for hypothyroidism, consider becoming a Paloma Health member. You’ll have access to comprehensive, personalized, and evidence-based treatment plans. Paloma Health specializes in thyroid care, offering a team of expert practitioners, nutritionists, and coaches who tailor their approach to your specific needs. As a member, you benefit from easy home thyroid testing and customized medication adjustments. Additionally, Paloma Health incorporates dietary and lifestyle recommendations to support your overall well-being. This dedicated and integrated approach significantly enhances your management of hypothyroidism, promoting better health outcomes and an improved quality of life.

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References:

Aydogmus¸ Yasar et al. A case of levothyroxine malabsorption corrected with vitamin C. Abstract EP362. Endocrine Abstracts. May 2024. Volume 99. 26th European Congress of Endocrinology 2024. ISSN 1479-6848. https://www.endocrine-abstracts.org/media/frhpdgnp/ece2024_abstractbook.pdf

Jubiz W, Ramirez M. Effect of vitamin C on the absorption of levothyroxine in patients with hypothyroidism and gastritis. J Clin Endocrinol Metab. 2014 Jun;99(6):E1031-4. doi: 10.1210/jc.2013-4360. Epub 2014 Mar 6. PMID: 24601693. https://pubmed.ncbi.nlm.nih.gov/24601693/

Caron P, Grunenwald S, Persani L, Borson-Chazot F, Leroy R, Duntas L. Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults. Rev Endocr Metab Disord. 2022 Jun;23(3):463-483. doi: 10.1007/s11154-021-09691-9. Epub 2021 Oct 20. PMID: 34671932; PMCID: PMC8528480. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8528480/

Antúnez PB, Licht SD. Vitamin C improves the apparent absorption of levothyroxine in a subset of patients receiving this hormone for primary hypothyroidism. Rev Argent Endocrinol Metab. 2011;48. https://pesquisa.bvsalud.org/portal/resource/pt/lil-641987

Farasati Far B, Behnoush AH, Ghondaghsaz E, Habibi MA, Khalaji A. The interplay between vitamin C and thyroid. Endocrinol Diabetes Metab. 2023 Jul;6(4):e432. doi: 10.1002/edm2.432. Epub 2023 May 29. PMID: 37246589; PMCID: PMC10335618. https://pubmed.ncbi.nlm.nih.gov/37246589/

Chambial S, Dwivedi S, Shukla KK, John PJ, Sharma P. Vitamin C in disease prevention and cure: an overview. Indian J Clin Biochem. 2013 Oct;28(4):314-28. doi: 10.1007/s12291-013-0375-3. Epub 2013 Sep 1. PMID: 24426232; PMCID: PMC3783921. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783921/

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Mary Shomon

Patient Advocate

Mary Shomon is an internationally-recognized writer, award-winning patient advocate, health coach, and activist, and the New York Times bestselling author of 15 books on health and wellness, including the Thyroid Diet Revolution and Living Well With Hypothyroidism. On social media, Mary empowers and informs a community of more than a quarter million patients who have thyroid and hormonal health challenges.

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