Levothyroxine sodium for the treatment of non-toxic goiter (normal thyroid function), prevention of goiter recurrence after goiter resection, replacement therapy for hypothyroidism, adjuvant therapy for antithyroid drug smelting for hyperthyroidism and suppressive therapy for postoperative thyroid cancer. Studies have shown that levothyroxine can be taken at bedtime. I. OBJECTIVE: To review the published evidence on levothyroxine taken at bedtime vs. before breakfast. Summary: Because levothyroxine has shown increased absorption when administered to patients in the fasting state, the standard recommendation for administration of this drug is to take levothyroxine 0.5 to 1 hour before breakfast and at least 4 hours before or after possible interacting drugs. However, compliance with this recommendation may pose a problem for patients with unpredictable or variable conditions. A literature search identified 4 published studies on levothyroxine administration before bedtime. Two of these showed a significant decrease in thyroid stimulating hormone levels after bedtime administration compared to levothyroxine taken 30 min before breakfast. one study showed an increase in TSH after bedtime administration compared to levothyroxine taken 1 hour after breakfast. one study found no significant difference in TSH levels or other thyroid There was no significant difference in TSH levels or other thyroid function test limitations in subjects who had not been treated with levothyroxine. This inconsistent finding may be attributable to a number of variables, including dietary differences in the study population, the use of potentially interacting supplements in one study, and the variable interval between levothyroxine use and food intake. Method of administration was not associated with substantial change when assessing quality of life or symptom severity; in 2 of the studies, patients preferred to take levothyroxine at bedtime. II. CONCLUSION: Based on the current literature, levothyroxine at bedtime is an option for hypothyroid patients who want to avoid taking medication and food together.