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 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. [1] So you may well do better on a different type if you’re still not feeling well on T4-only meds like Levothyroxine.

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 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. [2]

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. A UK test can be found here and a worldwide test here. They should 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.

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.

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!

Find a thyroid cookbook here.

***

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.

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. Learn how Rachel reclaimed her life when thyroid medication wasn’t helping.

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

References:

[1] https://www.healio.com/endocrinology/thyroid/news/online/%7Beb193222-2795-4321-8761-607131d2f743%7D/levothyroxine-therapy-associated-with-lower-quality-of-life-in-hypothyroidism?fbclid=IwAR0Dk8tGRAxB6at_Mc7jgDiPyp0YikRuy6ZmG6yS8CMOz3lPEj67zH_g4vY

[2] http://www.thyroiduk.org.uk/tuk/campaigns/Patient-Expereince-Survey.html

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

  1. Hi there
    I’ve been on 225mg thyroxine for over 15 years no problem. The last two years my tsh levels have been yo yo ing from 0.005 to 78. I have been feeling absolutely lousy, fatigue, hair falling out, weight gain and muscle pain in my legs but my GP won’t agree it’s because of my thyroid, my tsh is now 0.05 but I’m still feeling like rubbish and have been for months,
    I have gone away from my doctor and booked an apt to see a top endocrinologist in London. Can you offer any advice on what I should ask hi and what I should be tested for. I have hashimotos but don’t believe I have had any other blood tests done apart from the usual nhs ones. I feel at the end of my tether and am hoping this chap will be the answer to my prayers

  2. I’ve been feeling tired for the last two years and I’m only 18. My hairs been falling out excessively too and now it’s so thin. I’m on synthroid but it doesn’t seem to make a difference and I don’t know what else to do because I managed to get my doctor to do a T3 and that was hard because she only does T4 and Tsh but my levels for T3 were in the middle range. Not sure what other options are left. My T4 was on the lower end too like the borderline. But it doesn’t seem to be going up even with Synthroid. It’s only my tsh going down but my T4 not going up.

  3. Hi can you tell me what I can do for me being tired and lethargic all the time I work but through the day and at the end of the day I just want to sleep and have mood swings.
    I’am on levothyroxine 75mg lansoprazole 30mg loratadine 10mg also inhalers.

  4. 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!!!!!!

  5. 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.

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