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Is there any clear benefit on taking levothyroxine on fasting?

Answer

Levothyroxine is typically recommended to be taken on an empty stomach, ideally 30 to 60 minutes before breakfast, to enhance its absorption and bioavailability
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Abstract

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A novel levothyroxine solution results in similar bioavailability whether taken 30 or just 15 minutes before a high-fat high-calorie meal

PubMed
. This recommendation is based on the understanding that food ingestion can significantly affect the oral absorption of many drugs, including levothyroxine

Impact of food on levothyroxine absorption

Levothyroxine administration recommendations

In conclusion, taking levothyroxine on an empty stomach is generally recommended to enhance its absorption and bioavailability. However, for patients who have difficulty adhering to the fasting requirement, taking levothyroxine with breakfast or at bedtime, 4 hours after the last meal, could be considered, with the understanding that this may lead to more variability in TSH levels and may require closer monitoring.

References

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Hypothyroidism

Patient education

Guidelines

Timing of L-thyroxine doses

Pathway
AACE/.../ATA 2012