Informational Posts

Hypothyroid Patient Checklist

Hypothyroid Patient Checklist
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Originally published on 15th November 2016
Last updated on 25th November 2019

On thyroid medication and still feel rubbish? Wondering if there’s anything else you could try or investigate to see if it would help how you feel? 

Theo The Thyroid Plushie

For many of us, it’s like piecing together a jigsaw puzzle. These could be the other pieces to yours.

Optimal Thyroid Levels 

Optimal thyroid levels are shown here. If your TSH, Free T3, Free T4, TpoAb, TgAb are not optimal, it could well be why you still don’t feel well and have ongoing issues. Please know that being ‘in range’, ‘fine’ or ‘normal’ is very different to having them optimised. Taking thyroid hormone levels from simple ‘in range’ to optimal can make a world of difference.

It’s worth knowing that you can order full thyroid panels yourself from online laboratories too. Find a UK lab here and a worldwide lab here.

Thyroid Medication Options 

Not everyone does well on T4-only medication like Synthroid and Levothyroxine. Some require T3 medicine or Natural Desiccated Thyroid, to feel well.

You may also benefit from taking your thyroid medication at a different time of day e.g. T4 medication can be taken at night instead of in the morning, and NDT and T3 meds are often dosed several times a day instead of all in one go.

You should also ensure that you take your thyroid meds on an empty stomach and leave at least one hour before eating or drinking anything, as it can affect its absorption and effectiveness. You should also leave at least four hours between thyroid medication and iron, calcium, oestrogen containing pills and magnesium.

There are different brands of thyroid medication too. You could try another brand to see if one works better for you. It’s also worth noting that some patients report generic meds not being as effective as their usual branded ones, so make sure the pharmacist always gives you the same type.

Adrenal Function

Adrenal fatigue (note: it is more accurately referred to as hypothalamic-pituitary axis dysfunction) seems very common with hypothyroidism. If you have any symptoms of adrenal fatigue, such as fatigue, weight gain, sleep disruptions, craving salty and sugary foods etc. then you may benefit from completing a saliva test to check for adrenal fatigue. Addressing any adrenal dysfunction helps many people to feel well again.

Order or ask for a 24 hour saliva test, testing your cortisol levels at four key points of the day, to find out if you have adrenal fatigue. If your doctor won’t do this, you can very simply order it yourself and complete it at home.

You can simply order adrenal testing here and here.


Could you be over exercising or doing the wrong kind of exercise for your body?

Whilst exercise is beneficial and in fact required for good health, many thyroid patients push their bodies too far and can make themselves more unwell with it too.

Great care should be taken as too much exercise can exacerbate thyroid disease and actually cause us to feel worse. Repeatedly engaging in overly demanding exercise can cause a surge of biochemical imbalances to occur within the body, including the disruption of the hypothalamus-pituitary axis, which can reduce thyroid function. Intense cardio, marathon running and training, obsessive weight lifting etc. with little to no recovery time can all cause extreme stress to the body and particularly the thyroid.

You may think you are following a perfectly healthy workout routine, when in reality you could actually be causing some serious damage to your body. It is important for us to know therefore when enough is enough and when we need to slow things down. Listening to our bodies is crucial and taking things at our own pace will help us avoid causing any issues with over exercising.

Signs that you need to take things slower and reevaluate your exercise regimen include:

Vitamin Deficiencies, Low Levels, Supplementing

Having hypothyroidism and also Hashimoto’s, it’s likely you may have one or more low/deficient vitamin levels too. These include Iron, D, B12 and folate. Most doctors will test for these. You want to make sure that these are optimal and not just in range.

It’s worth checking these especially if you are tired a lot, have hair loss, bruise easily, get fatigued easily etc.

If you’re wondering what vitamins to consider supplementing, have a read here. It’s advised not to supplement anything until you’ve confirmed you are low or deficient through testing.

Stomach Acid 

If you experience indigestion, acid reflux, heartburn, GERD, GORD etc. then it would be worth exploring low stomach acid. Studies have found that people with hypothyroidism (and especially Hashimoto’s) often have low stomach acid.

Getting thyroid levels optimal (not just in range), looking at diet, apple cider vinegar and addressing overall gut health, can all help. More info here. 

Sex Hormones

I’m starting to realise that sex hormone issues and imbalances are seemingly pretty common with thyroid patients and those with adrenal fatigue.

Low progesterone (also called oestrogen dominance) seems the most common issue, which creates symptoms such as irregular periods, PCOS, migraines, acne, PMT, struggling to conceive.

For a PCOS Blood Test, click here.

Overcoming my own oestrogen dominance was a big part of my thyroid puzzle.

It may also be worth considering any hormonal contraception you’re on such as birth control pills, as these can really mess with your hormones.


Have you checked if you have the autoimmune disease Hashimoto’s Thyroiditis?

See also, the article: What is the Difference Between Hypothyroidism and Hashimoto’s? and Why It’s Important to Know if You Have Hashimoto’s

Hashimoto’s causes around 90% of hypothyroidism cases, yet often goes untested. It’s good to know if you have this because if you do, there are things you can do to lower the antibodies, and keeping antibodies low is important if you want to stop any further damage being done to your thyroid gland, and want to feel well.

Things that often help, include: going gluten-free, taking selenium and vitamin D and working on a leaky gut.

Read how I got my Hashimoto’s in to remission here.

Diet and Food Sensitivities

Your diet can play a big part in how you feel. Many thyroid patients state they feel better when they cut out gluten. Others include alcohol, caffeine, goitrogens, soy, all grains, going paleo, the AIP, eggs and dairy. It’s worth trialing cutting out some of these and giving it a month or two (preferably even longer) to see if you notice any improvements in how you feel and antibody levels.

A less-overwhelming way to do this is with a cookbook that guides you with meal ideas too. See the one I co-authored here.

It is also important to ensure you’re eating a nutrient rich diet, eating as healthily as possible. You can’t expect your body to function well if you don’t give it the right fuel.

Avoid/Eliminate Toxins

There are certain substances such as fluoride and mercury, which are toxins to the body and are known to interfere with thyroid function. Filters can be put on showers and taps to remove the fluoride. You can talk to your dentist about removing mercury fillings if you have them, as these are known to be linked to hypothyroidism.

Using only organic and natural cosmetic and beauty products is also a good idea due to xenoestrogens. Bathing in Epsom salts is also not only a good source of Magnesium, but it can help detox toxins.

Meditation, Acupuncture and Stress Levels 

Some patients report good results with meditation and acupuncture. The good news with meditation is that it can be done for free, in the comfort of your own home, and at whatever time it suits your lifestyle.

Basically, do whatever helps you to lower stress levels!


You could also try LDN. Due to Hashimoto’s being an autoimmune disease, LDN can be beneficial for those with the condition, by reducing their high antibodies, stopping the progression of the autoimmune disease or even reversing the disease. Besides improving endorphin production, LDN can also help reduce inflammation and encourage healing.

Get Good Sleep

This probably sounds obvious, but make sure you have a good bedtime routine.

We should all aim to get 7-9 hours of sleep a night and stop electronics 1-2 hours before bed. You can also try a bath with Epsom salts and having a warm drink. There are also herbal supplements which can help such as holy basil, ashwagandha and Seriphos. Always consult a pharmacist or doctor before starting any supplements, though.

Blood Sugar 

As many of us are prone to wobbly blood sugar levels, it’s crucial to ensure that you’re keeping yours balanced. Being more aware of eating a lot less sugar and more protein is often a simple enough change to banish the fatigue, nausea, acne, hangry feeling (being hungry and angry) and sugar cravings, of blood sugar imbalances.

Leaky Gut/Candida

Leaky gut and candida (a yeast overgrowth) is reportedly very common with hypothyroidism and especially Hashimoto’s patients, since a leaky gut is often cited to needing to be in place to trigger the condition in the first place.

Addressing my gut health was one of the biggest pieces of my puzzle. A UK test for Candida can be found here. and a US test here.

Other Ideas 

Lyme Disease, EBV, exposure to mould, MTHFR defect, H. pylori etc. can also all be fairly common with thyroid patients, so worth exploring as well.

See a test for Lyme Disease here.

H Pylori – A UK test can be seen here and a US test here.

Use these ideas to work with your doctor and uncover why you may still be feeling unwell.

You can find more info about why you may still be feeling tired here.

See also: The Thyroid Jigsaw Puzzle

Have you explored these thyroid jigsaw puzzle pieces?

You can click on the hyperlinks in the above post to learn more and see references to information given.

Be Your Own Thyroid Advocate Book CoverSee also:

The book Be Your Own Thyroid Advocate: When You’re Sick and Tired of Being Sick and Tiredwhich builds on this article in detail. Reclaim your thyroid healthy life.

About Author

Rachel Hill is the highly ranked and multi-award winning thyroid patient advocate, writer, speaker and author behind The Invisible Hypothyroidism. Her thyroid advocacy work includes writing articles, authoring books, producing her Thyroid Family email newsletters and speaking on podcasts and at events about the many aspects thyroid disease affects and how to overcome these. She is well-recognised as a crucial and influential contributor to the thyroid community and has a large social media presence. Her bestselling books include "Be Your Own Thyroid Advocate" and "You, Me and Hypothyroidism".


  • Laura
    June 9, 2021 at 10:14 pm

    I just want to say how pleased I am to come across this website, I love the fact its audible I have never come across this before. If I read it my self I really struggle to process it. Its made it so easy to make notes for my endo app tomorrow. Thankyou x

  • Caz / InvisiblyMe
    March 12, 2019 at 7:45 am

    A very thorough, yet easy to understand & digest checklist, and I really like that you’ve included the sex hormones aspect as that’s often something that can go by the wayside (unless you have a gynae involved in your care while investigating thyroid issues). x

  • Jae Mesecar
    December 3, 2018 at 8:25 am

    I love your web site, it has engaging articles, Have a great day!

  • Carly
    November 29, 2018 at 2:52 pm

    You are my inspiration (:

  • Barbara Brown
    February 12, 2018 at 6:22 pm

    Hi Rachael, I’ve had diagnosed hashimoto’s for 28 years. I too have come to the same conclusions you have. There are a few I’d like to add. One endocrinologist told me that Ferritin levels need to be 70+ to be able to absorb thyroxine properly. Another thing is that RAST allergy testing is useful. Even though doctors dismiss the results because some people test positive but don’t have allergy symptoms. In my experience, I tested positive but didn’t have symptoms, then later I developed symptoms. So in my view it is a good indication that one is going to be allergic to that item if you don’t cut down on it or eliminate it. Finally its worth investigating for the gut bacteria Blastocystis Hominis. The things I’ve developed an allergy to are: wheat, red peppers, almonds, oranges) and an intolerance to are: all grains (wheat is particularly bad), all fruit, corn egg, dairy, soya, potato, spices, sulphites. I live on chicken bone broth, vegetables and roast chicken. All my meals have to be cooked from scratch using raw ingredients. Eating more than a little pork or lamb gives me joint pains and soft tissue problems, which means my joints don’t work. Corn (aka maize) is in lots of stuff, even some sugars are refined using glycerine (which is derived from corn nowadays). Corn is also in every synthetic thyroxine, so I am now on a bovine NDT. Now, to viding I stick to my diet, I am pain free and have more energy. I hope there are some ideas here that are of help.


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