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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.
Many 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 treated. They may even do a blood test and tell them that their levels are ‘normal’. So then why do they 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 medications 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 when 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. If your doctor won’t order the full thyroid panel, do know that it is relatively inexpensive and simple to order these tests yourself. UK thyroid patients can order them from here and a worldwide link can be seen here.
Most thyroid patients seem to feel best when their levels are also optimised and not just in 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 and ensure your levels are optimised as opposed to just ‘in range’.
Your Medication Isn’t Right for You
Some people do OK on Levothyroxine or Synthroid, the T4-only medications, but many equally do not. You may be on this medication and still feel tired.
A study in 2018 demonstrated that Levothyroxine was associated with a lower quality of life in those with Hypothyroidism.  So you may well do better on a different type if you’re still not feeling well on T4-only meds like Levothyroxine.
Especially if you have a full thyroid panel tested, 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. These can be discussed with your doctor.
I support people finding what medicine works for them, and Levothyroxine simply doesn’t help a lot of people.
Thyroid UK reportsed: “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. 
If your current doctor isn’t open to exploring other medication options, you may wish to explore other types of medical professionals which may be able to help. See types here.
There’s Something 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 loss, bruise easily, are fatigued etc.
Adrenal dysfunction can also cause havoc in thyroid patients too, 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 via a 24-hour saliva cortisol test, to check cortisol levels. If your doctor won’t do this, you can very simply order it yourself and complete it at home. If your doctor won’t check your adrenals, you can very simply order testing yourself from here and here. They should ideally read as stated here.
The book by James Wilson is helpful too.
You’re Not Addressing Your Hashimoto’s
Most of us with hypothyroidism have Hashimoto’s to thank as the cause, yet don’t even know it.
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.
Getting my Hashimoto’s in to remission seriously helped in management of 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, magnesium, contraceptive pills and iron close to it in particular. Take your thyroid meds at least four hours away from these.
Oestrogen, calcium, magnesium and iron bind some of the thyroid hormones and makes them unusable, affecting how much you really absorb. 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.
Some patients on T4-only meds like Levothyroxine also state it works better for them when taken at night, instead of the morning.
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, 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. I found that my GP on the NHS wasn’t particularly helpful and it wasn’t until I started seeing a functional medicine practitioner, that I really got my health back.
Do you still feel unwell despite being on thyroid medication? Share in the comments below.
The book Be Your Own Thyroid Advocate: When You’re Sick and Tired of Being Sick and Tired, which builds on this article in detail. Learn how Rachel reclaimed her life when thyroid medication wasn’t helping.
There is also an online thyroid course exactly for thyroid fatigue. Freedom From Thyroid Fatigue helps you tackle low energy with a personalised approach, so you can wave goodbye to tiredness.
You can click on the hyperlinks in the above post to learn more and see references to information given.
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, as well as being a founding board member for the American College of Thyroidology. She is well-recognised as a crucial contributor to the thyroid community and has a large social media presence. Her books include “Be Your Own Thyroid Advocate” and “You, Me and Hypothyroidism”.