I’m on Thyroid Medication but Still Feel Tired!

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Originally published on 4th April 2016
Last updated on 2nd November 2018

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. 

May people are often left confused and wondering:

  • Why am I feeling extremely tired on Levothyroxine?
  • My thyroid meds make me tired!
  • Does thyroid medicine make you sleepy?

Their doctor puts them on thyroid medication and tells them they are 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? Can thyroid medicine make you feel tired?

There are a few reasons you can still feel unwell and I’m going to explore these below.

Your Thyroid Levels Aren’t Optimal

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 alone and this isn’t accurate in getting the full picture of your thyroid health.

In order to know if your thyroid levels are actually optimal, you need a full Thyroid Panel doing, and this should include at the very least: TSH, Free T3 and Free T4. Reverse T3, 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.

Most thyroid patients seem to 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, but ordering tests yourself is also an option. I can’t stress how important it is to check all of these levels.

Your Medication Isn’t Right for You

Some people do OK on Levothyroxine or Synthroid, a T4-only medicine, but many equally do not. You may be on this medication and still tired. 

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 the possibility of a conversion problem and maybe adding that T3 in. This can be done by adding T3 to your T4 (Levo), or switching to NDT, which has it in. NoteI 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. 

There’s Someone Else at Play

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, so it’s worth checking these if you are tired a lot, have hair falling out, bruise easily, are fatigued etc.

Adrenal Fatigue, although not commonly recognised by many mainstream doctors yet, can cause havoc in thyroid patients too, 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 most 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’re Not Addressing Your 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, Free T3 and Free T4,Thyroid antibodies) 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.

Addressing the autoimmune condition that may be causing your hypothyroidism and getting it under control can help with fatigue and managing symptoms.

You May be Taking Your Thyroid Medication 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 a full article on how to correctly take your medication here.

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 

You’ve got to nourish to flourish!

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, Keto or try AIP and feel the benefits. We’re advised to eat goitrogenic foods in moderation and cut back on sugar and processed foods, also ensuring you 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. If not, 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 may need to see several GP’s or other medical professionals to explore all of these, or even order tests yourself, in order to get them investigated and 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.

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:


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Written by Rachel, The Invisible Hypothyroidism

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Rachel Hill, Thyroid Patient Expert and Advocate, blogger and author, has Six 2018 WEGO Health Award Nominations. She is a highly ranked writer appearing in the Top Hypothyroidism Websites and Top Thyroid Websites 2018, with relevant qualifications and certificates in Diet and Nutrition, whilst also currently studying  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.

4 thoughts on “I’m on Thyroid Medication but Still Feel Tired!

  1. Hi, I had my thyroid removed at the end o 2013-214 due to a cancerous tiny lump on both sides, I’m on thyroxine 150mg Monday to Friday then 100 mg on the weekend. Would I benefit trying natural I do feel tied with no energy, I get checked once a year for it. I have being researching ashwandgha it’s a herb I want to take without stopping the medication.

    1. Hi Rachel, have you had a full thyroid panel test done recently? It includes free t3 and free t4 and can show whether you’re converting your t4 medication (thyroxine) to t3. A lot of people don’t convert very well and so are left with low free t3. If this is the case, Natural Desiccated Thyroid, a medication containing t3 can indeed help.

  2. 2014 rightcdide thyroidectomy, two months later my hair started falling out. Went AIP, on WP and my adrenal and cortisol fine. How can I stop my hair from falling out??????? Help!!!!!!

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