Explain to patient: Sarah, your blood results show that your thyroid levels are still underactive, but before we increase your dose of Levothyroxine, I’d like to address an important factor. Taking Levothyroxine with multivitamins can interfere with how well your body absorbs the medication. This might be why your thyroid levels haven’t improved as much as we expected.

I also understand that you thought your symptoms might be due to low vitamin levels.

However, your blood tests show that your vitamin D, B12, folate, and iron levels are all normal. This makes it much more likely that your symptoms are due to your underactive thyroid. The fact that your symptoms have slightly improved since starting the thyroid medication supports this as well.

I’d recommend taking your Levothyroxine on an empty stomach with water, ideally first thing in the morning, and waiting at least 4 hours before taking your multivitamins or any other supplements. Let’s repeat your blood tests in 6-8 weeks to see if this change helps improve your thyroid levels and your symptoms.

If your thyroid levels still aren’t where they need to be after that, we’ll look at adjusting your dose further. This way, we can make sure you’re on the right amount of medication without making unnecessary changes.