Hypothyroid Patient Checklist

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

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 yours are not optimal, it could well be why you still don’t feel well and have ongoing issues.

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 can also try taking your thyroid medication at a different time of day e.g. Levo can be taken at night instead of in the morning, and NDT and T3 meds 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 four hours between thyroid medication and iron, calcium, oestrogen containing pills and magnesium.

There are also different brands of thyroid medication. You could try another brand of Levothyroxine. It’s also worth noting that some patients report generic Levo not being as effective as their usual branded Levo, so make sure the pharmacist always gives you the same type if you do better on it.

Adrenal Function

Adrenal fatigue (note: it is more accurately referred to as hypothalamic-pituitary axis dysfunction) is very common with hypothyroidism. If you have any symptoms of adrenal fatigue, such as fatigue, weight gain, sleep disruptions, craving salt and sugary foods etc. then you need to complete a 24 hour four-point saliva test to check for adrenal fatigue. Addressing any adrenal dysfunction helps many people to feel well again.

Vitamin Deficiencies/Low Levels/Supplementing

Having hypothyroidism and also Hashimoto’s, it’s likely you have one or more low/deficient vitamin levels. 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. Being optimal has made a lot of different to many thyroid patients. It’s worth checking these especially if you are tired a lot, have hair falling out, 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 iodine until you’ve confirmed you’re low through testing.

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 etc. You should test your progesterone at its peak, around day 21 of your cycle (this may differ or be difficult to predict if you have an irregular cycle), and oestrogen Days 3-5. Testosterone can be tested at anytime during the month. Checking FSH is also often beneficial.


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

Diet Changes 

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, 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.

Goitrogenic and soy foods may also be avoided where possible as they inhibit thyroid function and so it may help to cut back if you eat them in large amounts.

Avoid/Eliminate Toxins

There are certain substances such as fluoride and mercury, which as 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 should 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. Bathing in Epsom salts is also not only a good source of Magnesium, but it can help draw out the toxins.

Meditation and Acupuncture 

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, 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.

Good Sleep

This probably sounds obvious, but make sure you have a good bedtime routine. Get 7-9 hours of sleep a night and stop electronics 1-2 hours before bed. Have a bath, with Epsom salts preferably, and have a warm drink (though not too close to bedtime or it will wake you up!) 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 Cut/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.

There is a new personalised gut health service from Thyrve, that includes customised probiotics and dietary recommendations based on your own gut health, which may also help you improve your thyroid and overall health. The test-to-treatment service can help with weight maintenance, fitness, skin health, metabolism, mood, digestion, bloating and more, due to how important gut health is to your overall health. The status of your gut is the best indicator of your health. You can check them out here.

Investigate Other Possible Health Conditions/Issues. 

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

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.

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

This post may contain affiliate links, to find out more information, please read my disclosure statement.
If you found this article beneficial, please take a moment to share it so we can help others get better with hypothyroidism and Hashimoto's, whilst also raising awareness. "Be Your Own Thyroid Advocate."

Written by Rachel, The Invisible Hypothyroidism

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Rachel Hill is a highly ranked and award-winning Thyroid Patient Advocate, blogger and author. She has worked with The National Academy of Hypothyroidism, The BBC, The Mighty, Yahoo, MSN, Dr. HedbergThyroid Refresh and ThyroidChange, to name just a few. She is well-recognised as a useful contributor to the thyroid community and also contributed the foreword to Emily Kyle’s The 30-Minute Thyroid Cookbook. She received Six 2018 WEGO Health Award Nominations.

3 thoughts on “Hypothyroid Patient Checklist

  1. 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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