I’m on Thyroid Medication but Still Feel Tired!

Are you on thyroid medication but still don’t feel well? A lot of thyroid patients feel this way. They might even question if their thyroid medication is working at all. 

Their doctor puts them on thyroid medication and tells them they’re now adequately medicated. They may even do a blood test and tell them that their levels are ‘normal’. So then why do you still feel tired?

There are a few reasons, and I’m going to explore these below.

Your thyroid levels aren’t right, despite your doctor telling you they are. 
Most doctors will put you on T4-only meds like Levothyroxine and then test you via blood samples and tell you you’re now all OK and ‘fine’.

The problem is, most doctors just test your TSH and this isn’t accurate. You can read more about why here. In order to know if your thyroid levels are actually right, you need a Full Thyroid Panel doing, and this should include at the very least: TSH, Free T3 and Free T4. RT3, TPOAB and TGAB are also hugely beneficial. You need as many doing as possible, to accurately see how you’re doing on your thyroid meds. According to a few sources, most thyroid patients feel best when their TSH is suppressed, usually below 2 (or below 1 if you’re on NDT), a Free T4 mid-range or higher and a Free T3 in the top quarter of the range.

It can be tricky getting your doctor to test a full thyroid panel, so keep on trying. I can’t stress how important it is to check all of these levels.

The thyroid medication you’re on isn’t right for you.

Some people do OK on Levothyroxine, a T4-only medicine, but many do not. Other thyroid medication includes adding T3 to your T4, or switching completely to Natural Desiccated Thyroid. I’ve covered all of these in detail here and here.

Especially if you have a Full Thyroid Panel done, and your T3 is low, you should explore adding that T3 in, and this can be done by adding T3 to your T4 (Levo), or switching to NDT, which has it in. I would always endorse working with a doctor to make any changes to your health regime.

I support people finding what medicine works for them, and Levothyroxine simply doesn’t help a lot of people.

Thyroid UK reports here“Levothyroxine treatment provided total relief of symptoms in 7% of the respondents and significant relief in 41% of respondents. However, 6% of respondents received no relief from symptoms and 40% only slight relief.
NDT provides the most relief of symptoms providing 29% with a total relief of symptoms and 57% with significant improvement. However, 10% only received slight relief and 2% no relief of symptoms.” and that is a huge difference. 

You have something else that needs addressing.

Other deficiencies or issues are common if you also have thyroid problems. These can include the below, so they’re worth exploring if you still don’t feel well. 

Vitamin Deficiencies such as D, B12, Iron, Ferritin etc. can all give you similar symptoms to low thyroid function. It’s worth checking these especially if you are tired a lot, have hair falling out, bruise easily, get fatigued easily etc.

Adrenal Fatigue, although not commonly recognised by many doctors yet, can cause havoc in thyroid patients, as well as millions of other people around the world, without us even realising. Symptoms include fatigue, waking up still feeling tired, not being able to cope with stress very well and craving sugary and salty foods. The only accurate way to test if you have adrenal fatigue is to do a 24 hour saliva cortisol test, and check your cortisol levels. They should read as stated here. A book by James Wilson walks you through how to naturally recover from adrenal problems, and is a book I recommend.

You could also have an autoimmune disease like Hashimoto’s.

I’ve created a whole piece on Hashimoto’s here, and ways to treat it include obviously getting your thyroid levels right (TSH, T3 and T4) and for a lot of patients, cutting out gluten. They claim it helps their fatigue. More ways to help your Hashi’s are listed here.

You might be taking your thyroid meds wrong.

Many patients take their thyroid meds an hour away from any food or drink, excluding water. The reason being to stop anything else from affecting its absorption. You shouldn’t really eat or drink anything for an hour either side of your thyroid meds, as well as take other medication, and you should avoid taking calcium, contraceptive pills and iron close to it in particular. Take your thyroid meds at least four hours away from these. Oestrogen, calcium and iron bind some of the thyroid hormones and makes them unusable. If you’re on NDT, many also state that taking it sub-lingually (dissolved under the tongue) has a better effect than just swallowing it. See here for more info from STTM.

Some patients on T4-only meds like Levothyroxine also state it works better for them when taken at night, instead of the morning. I’ve never tried this though.

You’ve not got the right diet. 

Eating and drinking right is key, too. Avoid alcohol where you can and there are certain foods to avoid or limit if you have thyroid problems. Many cut out gluten, or go paleo and feel the benefits. Avoid goitrogenic foods. Cut back on sugar and processed foods and make sure to give yourself a nice varied diet. You can’t expect your body to work wonderfully if you don’t feed it wonderfully!

Once you’ve corrected all of the above, you should hopefully see some improvement. You should also consider the checklist here, which you can tick off as you check each point.

Of course, if you have other health conditions, then they’ll need to be explored and managed properly, too. If you still feel ill after looking at all of the above, you may have another underlying health condition altogether, so find a doctor who will uncover this for you and medicate you properly for it.

You’ll need to realise that you may need to see several GPs to explore these, see an Endocrinologist (a thyroid specialist) or pay for them yourself, to get these crossed off. It’s important to address these as soon as possible before they get worse and have a knock-on effect with other things. Keeping your thyroid levels in check, as mentioned above, is also important. Any effects to these often then cause deficiencies in vitamin levels and adrenal function, and vice versa.

You can click on the hyperlinks in the above post to learn more and see references to information given, but more reading and references can also be found at:




Written by Rachel, The Invisible Hypothyroidism

Rachel is a Thyroid Patient Advocate and Expert with Six 2018 WEGO Health Award Nominations. She is a highly ranked writer appearing in the Top Hypothyroidism Websites and Top Thyroid Websites 2018, and is a qualified Diet and Nutritional Advisor, also currently studying for relevant qualifications and certificates in Life Coaching, Motivational Speaking, Reflexology and more. She has worked with The National Academy of Hypothyroidism, The BBC, The Mighty, Dr. Hedberg, Thyroid UK and ThyroidChange, to name just a few. She is well recognised as a trusted and useful contributor to the thyroid community.

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