Do you adjust the dose or the timing of levothyroxine ingestion in patients on anti-acid medications?  

Actually, adjusting the timing of levothyroxine ingestion probably doesn’t help much, since the proton pump inhibitors, and other similar drugs, have a duration of action of 12–24 hours. I would recommend checking serum TSH levels after the patient has been on the gastric acid medication...

I recommend my patients to take levothyroxine at bedtime when they are on antacid or PPI and take those medications in the morning.