Whilst levothyroxine should ideally be taken in the fasted state (30-60 minutes before breakfast), this is a challenge to many patients who may either skip doses or not adhere to the recommended timing. Furthermore, another subset of patients may skip breakfast altogether. Willems et al published their RCT in the Journal of Clinical Endocrinology and Metabolism. Participants were randomised to take their usual dose of levothyroxine on an empty stomach or to take their dose,  increased by 15%, with breakfast. Dose-adjusted levothyroxine with breakfast achieved similar TSH stability to fasted dosing. This proof of concept study provides a promising option which could benefit many patients, and further trials with more participants and longer follow-up would be ideal.

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