- Your symptoms are just as important as lab numbers when assessing whether your levothyroxine dose is adequate. If you feel hypothyroid despite normal TSH, your dose likely needs adjustment.
- Monitor free T3 and free T4 levels, not just TSH, because TSH alone misses cases where your body cannot properly convert T4 to active T3.
- Tirosint or Tirosint-Sol may work better than generic levothyroxine if you have absorption issues, histamine sensitivity, or persistent symptoms despite adequate dosing.
- The timing and form of levothyroxine matters for absorption. Taking it 30-60 minutes before breakfast on an empty stomach and avoiding certain supplements and foods in that window improves effectiveness.
- If levothyroxine alone does not resolve your symptoms despite dose optimization, adding T3 medication or switching to a combination therapy may be necessary.
How do you know if you are taking the right dose of levothyroxine?
The most simple way is to simply evaluate how you are feeling.
If your thyroid symptoms are 100% controlled then you know there’s nothing to worry about.
But if you are like thousands of other thyroid patients who continue to feel poorly despite taking their thyroid medication faithfully then there’s a good chance you aren’t taking enough.
What if you fall into that category? That’s where the information in this article steps in:
Are you on Levothyroxine and Still Experiencing Hypothyroid Symptoms?
It’s never normal for you to experience hypothyroid symptoms despite taking your thyroid medication.
But, what exactly is levothyroxine?
Levothyroxine is a form of thyroid hormone replacement medication and it is the most common medication used to treat hypothyroidism (low thyroid function).
This thyroid medication contains the inactive thyroid hormone T4 (also known as LT4 and Thyroxine).
If you are taking this medication to treat your sluggish thyroid, but still experiencing symptoms, then there may be a problem with your dose.
What do I mean by symptoms?
The symptoms of hypothyroidism include any or all of the following:
- Fatigue or exhaustion even after sleeping 8+ hours at night
- Weight gain or weight loss resistance (no matter how much you exercise or how little you eat)
- Depression, anxiety, or mood swings
- Problems with PMS, menstrual cycle, or low sex drive
- Chronic pain in the muscles and joints
- Cold extremities (hands and feet)
- Chronic constipation
These are the symptoms I am referring to whenever I mention the symptoms of hypothyroidism and these symptoms should be going away or reducing if you are taking thyroid medication such as levothyroxine or Synthroid.
In many cases, it’s not uncommon for patients to experience persistent symptoms of hypothyroidism despite using thyroid hormone medication.
But why is this?
This very problem exists as a result of how thyroid disease is managed.
The management of thyroid dysfunction is based largely in part on focusing on one single lab test known as the TSH.
This approach is fraught with problems and doesn’t allow for the variability required to treat each patient as an individual (2), but more on this later.
If you are frustrated with your current medical condition, frustrated with how you are feeling, or just plain confused about what is going on in your body, then this is the post for you.
We are going to discuss how you can start feeling better and how you can properly adjust your dose of levothyroxine to start feeling like “yourself” again.
How to Determine if your T4 Dose is Sufficient for Your Body
Each one of you has a different demand for thyroid hormone in your body.
And the demand for thyroid hormone depends on multiple factors including how much stress we are under, how much inflammation we are suffering from, the type of medications we are using, and so on.
Each of these will alter the amount of thyroid hormone that is necessary for our body and will, therefore, influence how much medication we need.
These factors must be taken into account when evaluating the dose of thyroid hormone that you will need.
So why do we treat every patient with thyroid disease in the exact same way?
Does it make intuitive sense that an 80-year-old patient would need the same amount of thyroid hormone as a younger individual in their 20s or 30s?
The answer is obviously no, but this is exactly how your doctor was trained to treat thyroid dysfunction.
Unfortunately, most doctors base all of their treatment recommendations, including the dosage of thyroid hormone on one single lab test known as the TSH.
TSH, which stands for thyroid stimulating hormone, is a marker secreted from your brain (the pituitary gland).
A High TSH is usually associated with hypothyroidism and poor thyroid function.
Most doctors base both diagnosis and treatment on this value.
But the problem is that newer studies are emerging that show that the pituitary TSH level is not a satisfactory mirror representation of thyroid hormone status in the body (3).
In addition, other factors, including the activity of deiodinase enzymes (4), may be more biologically active in certain individuals.
These studies finally shed light on what patients have been saying for a long time and why they are so unhappy with current thyroid treatment guidelines.
While this may sound confusing, don’t let it be, because the moral of the story is this:
You can’t create a one-size-fits-all treatment plan for all patients with thyroid dysfunction because each person is unique and may require a different dose and type of thyroid medication.
This sounds perfectly logical when we talk about it like this, but, for some reason, this logic doesn’t extend to all physicians and practitioners.
So how do you find your dose?
The best way to determine your “ideal” dose is to combine several different factors together to help paint a clear clinical picture of what is happening in your body.
These 3 steps will help you get started:
#1. Check Your Metabolism
Your Thyroid gland helps control your metabolism (5) (about 60% of it anyway) and can be used as a surrogate marker for thyroid function.
The lower your thyroid function the lower your metabolism will be.
This effect stems from how thyroid hormone (especially T3) influences the mitochondria in your body which influence how much energy you will burn at rest (6).
If you struggle with hypothyroidism you may have noticed that it is difficult to lose weight.
Weight loss resistance stems from a lower-than-normal metabolism and may be part of the reason you can’t lose weight.
So, if thyroid hormone is involved in regulating your metabolism, doesn’t it make sense that taking thyroid medication should improve your metabolism?
The answer is a resounding YES!
Following this logic, then, it makes sense to check your metabolism as you take thyroid medication to determine if it is working, right?
But the question is:
How do you do it?
A quick and easy way to test your metabolism is to check what is known as your basal body temperature each morning.
Your basal body temperature is a reflection of how much energy or heat you are producing at any given time and this can be used, indirectly, as a crude measure of metabolism (7).
But, let me be clear:
It’s not a perfect way to assess your metabolism and there may be other factors that influence your body temperature including your cycle and even certain medications.
But it’s better than nothing and it’s relatively cheap and easy to test which makes it worth looking into.
All you need is a thermometer and a pen and paper by your bed to measure it each morning.
The best way to check your basal body temperature is first thing in the morning right after you wake up.
As you take thyroid hormone your body temperature should increase over time, but it may take up to 1-2 months to notice the difference. โ
Some studies have shown that despite using levothyroxine (8) (and suppressing the TSH) resting energy expenditure (a measure of metabolic function) does not “normalize” to healthy adult levels.ย
If you find that this is happening to you, then it may be an indication that you either need to alter your dose or consider altering which medication you are taking.
#2. Follow Your labs (Including Free Thyroid Hormones)
While the TSH may not be the most valuable lab test to evaluate your thyroid that doesn’t mean that other lab tests don’t have value.
In fact, it is just the opposite.
When you are treating your thyroid with medication you should periodically evaluate your free thyroid hormone levels.
You can do this by ordering Free T3, Free T4, and Total T3 (9).
These lab tests provide a window into your body and can help you determine if your dose is sufficient.
The hallmark of hypothyroidism is a reduction in Free T4 and an elevation in TSH (typically, but not always the case).
As you take levothyroxine your Free T4 should increase.
Why?
Because levothyroxine contains the same thyroid hormone that your body produces naturally.
If you are taking thyroid medication and you only see a drop in your TSH without a simultaneous rise in your free T4, then your medication dose may not be sufficient.
It’s critical that your body has sufficient Free T4 levels because it uses T4 to create T3 through the conversion process.
Low levels of T4 may result in decreased T3 and further issues down the road.
It may seem obvious to you that it’s necessary to look at the free hormone concentration in your body, but it’s not always obvious to doctors.
But it should be, especially if you think about it.
When we evaluate all other hormones in our bodies we always look for the direct hormone concentration in the bloodstream (10).
Hypothyroidism is the only hormonal condition in which we evaluate the pituitary marker instead of the free thyroid hormone.
Take for instance testosterone:
If you have low testosterone and you take testosterone medication, doesn’t it make sense to check your testosterone levels to see if they have improved?
It makes perfect sense and that’s exactly what your doctor should be doing.
#3. Monitor Your Symptoms
Another tool you can use to determine if your dose is sufficient is how you are feeling otherwise known as your clinical symptoms.
The symptoms of hypothyroidism occur as a result of decreased circulating thyroid hormone in the cells of your body.
Symptoms such as hair loss, fatigue, weight gain, depression, and constipation all occur directly because of low thyroid hormone.
What does this mean for you?
It means that as you replace this lost hormone these symptoms should subside and completely go away over time.
In this way, you can utilize them as a very useful marker to determine if your dose is sufficient.
Your symptoms represent another crude way you can monitor your dose and they should correlate directly with your lab tests and your basal body temperature.
It’s important to realize, though, that there may be some overlap in some of your symptoms with other medical conditions.
For instance:
Fatigue is a very non-specific symptom that can be associated with many medical conditions (11).
The same is true for constipation and hair loss.
But when you put all of these symptoms together (the more you have the more likely you can be sure they are caused by your thyroid) and you are experiencing all of them you can be more certain they are related to your thyroid and not to some other medical condition.
By evaluating all three of these important factors you can easily monitor your “success” and determine if your dose of thyroid hormone is adequate for your body.
As you go through the motions, you may realize that the amount of thyroid hormone that you need is different from other people.
That’s okay and it is to be expected.
Levothyroxine VS Armour Thyroid VS Liothyronine
As you probably know there are several different types of thyroid hormone medications that are currently available.
Unfortunately, most doctors give out the same medication: levothyroxine or Synthroid.
Both of these medications contain the inactive thyroid hormone T4 and in order for it to be active in your body, it must be converted to the active T3 thyroid hormone (this process is known as T4 to T3 conversion).
So why haven’t you ever heard of this before?
Doctors operate under the assumption that all patients convert T4 to T3 at an equal rate which means that they don’t feel this conversion process should be taken into account.
But there is one problem with this philosophy:
It’s not true. In fact, up to 15% of people have been shown, due to their genetics, to have a problem with this conversion process (12).
As a result, many patients are taking the wrong type of medication which may explain why they don’t feel well and aren’t experiencing any improvement.
And that’s where the other thyroid medications come in…
Many patients do very well using combination thyroid medications that contain both T4 and T3, not just T4 medication alone.
โAnd I’m not just saying this from experience, most patients also agree that medications containing T3 are superior…
In clinical studies, many patients prefer natural desiccated thyroid hormone (13) (thyroid hormone that contains T3) over T4 medication alone.
The study shown above highlights why this is the case.
As patients switch from taking LT4 medication to thyroid extract they tend to experience a better quality of life and more weight loss.
This is felt to be secondary to the increase in free T3 and free T4 levels which can remain low even if the TSH is considered to be normal (14).
I’ve personally also found this to be the case in my practice as I transfer patients from LT4 medications over to NDT and T3 thyroid medications.
The patients who make the switch tend to experience more energy, less hair loss, more weight loss, and so on.
What to do if you have Hypothyroid Symptoms on Levothyroxine
So what should you do if you are taking levothyroxine or another T4 medication and your body temp is low, your heart rate is low and you are still symptomatic?โ
The good news is that there are several tips and tricks you can follow to make your current dose more effective (even if you can’t switch medications entirely).
When it comes to levothyroxine, this medication is actually quite difficult for your body to absorb and this may account for a significant number of problems when taking it (15).
So, even if you are taking your thyroid medication faithfully, it doesn’t matter unless you are also absorbing it in your gastrointestinal tract.
There are several steps you can take to improve the absorption of levothyroxine which may have an effect on how you feel.
At best you absorb about 80% of the thyroid hormone that you ingest (16).
But this number rapidly reduces in the setting of GI-related problems, inflammation, low stomach acid, and other intestinal issues.
Anyone who is suffering from constipation, gas/bloating, acid reflux, diarrhea, abdominal pain, gastric ulcers, low stomach acid, etc. may have reduced absorption of their medication.
This is complicated further by other medications and supplements which may reduce thyroid hormone absorption if not taken at the correct time.
So let’s talk about how you can impact the absorption component and get more “bang” for your buck so to speak.
#1. Levothyroxine 50mcg tablet
The 50mcg tablet of levothyroxine may be better absorbed and assimilated compared to other doses.
Why?
Because each dose of levothyroxine contains different colors, dyes, fillers, and otherwise inactive ingredients.
These fillers may act to cause symptoms by themselves (17) (which can be confused with hypothyroid symptoms), but they also reduce the absorption and effectiveness of thyroid hormone in your body.
The 50mcg tablet of Levothyroxine is special in that it is white and contains the fewest amount of fillers and additives when compared to the other dosages.
This presents a unique opportunity where you can switch your current dose of levothyroxine to 50mcg increments to potentially benefit from this.
Let’s say you are currently taking 150mcg of levothyroxine.
You could easily switch to taking 3 of the 50mcg tablets of levothyroxine which would be the same equivalent dose and get rid of all of the fillers/dyes in the process.
Make sense?
Something as simple as this change can actually improve how you are feeling.
Even better is that most physicians won’t have a problem with switching your dose.
#2. Consider switching to Tirosintโ or Tirosint-Sol
Tirosint and Tirosint-sol are two new T4-only thyroid medication alternatives.
Compared to levothyroxine, they are special because they contain the fewest inactive ingredients out of all available thyroid medications.
Tirosint contains a grand total of 4 total ingredients (3 inactive and 1 active) and Tirosint-sol contains a grand total of 3 total ingredients (2 inactive and 1 active).
The net result is that both are very easy to absorb and highly bioavailable (18).
Many patients report an improvement in their symptoms simply when making the switch from levothyroxine or Synthroid to Tirosint.
Compared to other thyroid medications (I’m looking at you, NDT formulations), it’s relatively easy to get your doctor to prescribe Tirosint medications because they are more similar to levothyroxine.
#3. Increasing Absorption of Thyroid Hormone And When to Take Your Thyroid Medication
If you are unable to switch to 50mcg increments of levothyroxine or if your provider isn’t willing to switch you to Tirosint there are still other steps you can take to improve absorption.
The first is to simply change the time of day that you take your thyroid medication.
Studies have shown that taking your thyroid medication at night can actually increase serum thyroid levels (19).
This is most likely due to the speed of your GI tract at various times of the day.
In the morning your GI tract is sped up which may limit the absorption of thyroid hormone.
At night your GI tract slows down which may allow for higher absorption.
In addition, your cortisol levels peak at 8 am in the morning (when most patients take thyroid hormone) which may also influence thyroid hormone metabolism.
โIt’s certainly worth a discussion with your current physician to determine if taking levothyroxine at night may help you.
The second option is to treat any GI-related problem that may be limiting your absorption.
By addressing conditions such as low stomach acid, SIBO/SIFO (very common in hypothyroid patients), and other GI-related problems you may be able to increase thyroid hormone absorption.
Do you need T3 medication?
โBy now you might be asking, do I need to be on medication containing T3?
The answer really depends on you, but I can help you figure it out…
In general, patients who should consider using Natural Desiccated thyroid hormone or T3-containing medications include:
- Those who don’t feel better on T4 only containing medications even after tracking their metabolism, symptoms, and lab tests
- Those who have not lost weight on levothyroxine or Synthroid
- Those who notice their symptoms getting WORSE despite increasing their dose of T4 medication
- Those with low serum-free thyroid hormone levels (low free T3 and low free T4)
โIf you fall into any of the above categories then it would be worth talking to your doctor about switching your medication to something that contains T3.
And don’t sweat it if your doctor isn’t willing to use Natural Desiccated thyroid because he/she may be open to using Liothyronine instead.
Liothyronine or Cytomel both contain pure T3 medications and can simply be added to your current dose of levothyroxine.
So let’s say you are taking 100mcg of T4 and you aren’t feeling well at all.
Instead of switching to 1-2 grains of NDT, you can simply add 5-10mcg of liothyronine or Cytomel to your current dose of levothyroxine.
Your regimen may look something like this:
- Levothyroxine 100mcg per day
- Liothyronine 10mcg taken twice per day for a total of 20mcg per day
โThis allows for roughly an 80/20 ratio of T4 to T3 which is similar to what the thyroid produces naturally.
Levothyroxine Dosage Chart and Comparison Table
So, what if your doctor isn’t willing to change medications or you really like being on levothyroxine?
Then make sure you are on the right dose!
Your dose should be based on the 3 step system I outlined above: Lab tests, symptoms, and your metabolism.
You can get to this dose by starting out with a low dose (around 25mcg per day) and then slowly increasing your dose and monitoring each of the steps.
From there you can check your lab tests every 6-8 weeks to follow your TSH, free T3, free t4, and reverse T3.
Dosing varies quite a bit based on the person but a typical dose may range between 25mcg and 250mcg of levothyroxine or Synthroid per day.
If you have continued to increase your dose beyond 150mcg and haven’t noticed ANY improvement in your symptoms then that may be a sign to consider switching medications.
If your doctor still isn’t willing to try NDT or T3-containing medications then you can also try other forms of T4 with fewer fillers like Tirosint and continue increasing your dose slowly over time.
If you are switching from T4 to another medication this comparison chart may be helpful:
โThis chart isn’t perfect but it is a good starting place.
I find that the conversion from T4 to NDT or natural desiccated thyroid is too low (meaning you usually need more NDT to make it equivalent to the T4 dosing).
In my experience, 2 grains are closer to 100mcg of T4 than 1 grain, but it is important to start out slowly if you are switching medications because T3 can be VERY stimulating to some people.
Final Thoughts
Believe it or not, your dose of levothyroxine depends on multiple variables, all of which need to be considered to help reduce symptoms and help you feel better.
Remember that levothyroxine absorption plays a big role in how you may feel.
By switching your dosage to 50 mcg increments of levothyroxine or switching to Tirosint altogether you may improve your thyroid hormones.
Another option is to consider changing the time of day that you take your thyroid medication.
Lastly, you should also consider treating any GI-related problems that may be limiting your absorption as well.
If these options fail then you might consider the addition of T3-containing thyroid medications.
To get these medications you will need the assistance of a physician who is knowledgeable about thyroid function.
Now I want to hear from you:
Are you currently taking levothyroxine?
Do you feel that your dose is sufficient?
Have you attempted to use other thyroid medications?
What has worked for you? What hasn’t?
Leave your questions or comments below!
Scientific References
#1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267409/
#2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763098/
#3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763098/
#4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1578599/
#5. http://www.ncbi.nlm.nih.gov/pubmed/24692351
#6. https://www.ncbi.nlm.nih.gov/pubmed/11174855
#7. http://www.ncbi.nlm.nih.gov/pubmed/19375759
#8. http://www.ncbi.nlm.nih.gov/pubmed/26700485
#9. https://www.ncbi.nlm.nih.gov/pubmed/22997973
#10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4255853/
#11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766938/
#12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219766/
#13. http://www.ncbi.nlm.nih.gov/pubmed/23539727
#14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763098/
#15. https://www.ncbi.nlm.nih.gov/pubmed/19942153
#16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4659333/
#17. https://www.ncbi.nlm.nih.gov/pubmed/26748887
#18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726924/
#19. https://www.ncbi.nlm.nih.gov/pubmed/17201800
I have been on .075mg levothyroxine for about 10 yrs. And my hair has been coming out a lot when I shower. It stopped for awhile and then it started back up again. I am desperate for some advice as my hair is quite thin, to begin with. This has been going on for the last 6-8 months.
Hi Elaine,
If you are struggling with hair loss I would recommend you look into these for more info:
Hair regrowth supplement: https://www.restartmed.com/product/thyroid-hair-regrowth-complex/
Hair regrowth with thyroid article: https://www.restartmed.com/thyroid-hair-loss/
I take 50 of Levoxyl, cannot lose a lb no matter what. How much of this should I take?
Hi Joanne,
The article outlines how to find the appropriate dose, you’ll need to monitor your thyroid lab tests and look at other variables such as your symptoms and metabolism.
Hello Dr. Childs,
I am currently taking Levothyroxine 137 mcg, one tablet daily. My latest thyroid lab indicated that my T4 and TSH levels were higher than what the normal levels should be. My doctor says that the dosage I’m taking (137 mcg) should be decreased. Shouldn’t the dosage be increased instead?
thank you!
Hi Candace,
Conventional doctors tend to base dosing off of the TSH alone which often leads to underdosing. If the TSH is high then your dose should be increased. If your T4 is high then the dose may need to be decreased. It’s not usually this cut and dry but that may be how your doctor is looking at it.
Hi Dr. Childs. EEK I guess the longer post I just submitted was way TMI. lol. My deal – I can’t tolerate ANY thryoid meds even at the lowest dosage. I tried generic levo, Synthroid and Armour and ALL these gave me a red face with acne in several days. I do not have elevated antibodies and think my thyroid issues are due to ED I was diagnosed with by my own functional medical dr.
When I see her again shortly I will propose that I just go after treating the ED first. My estradiol is around 140 and progesterone 0.2. I want to try topical progesterone oil and NOT the Prometrium she suggested since I think ANY oral hormone will only go through my liver, create more metabolites, and given my consistent reactions to levothryoxine, it makes me think my liver is overburdened. I think she might recommend T3 only as well. TSH is 4.0 give or take, Free T3 2.2; Free T.4 0.98; Reverse T3 18. Am I right in thinking we need to tackle the root cause and forget about thryoid meds for now to bypass the liver?
We also did full nutritional tests including toxicity and I am treating those. Liver detox includes silymarin, glycine, taurine, and she also recommended glutathione.
I’d really like to hear your thoughts on if someone like me with intolerable reactions to thyroid meds should just go after the ED root cause. I’ve also had hair loss/thinning for four years, terrible fat gain around the thighs, middle, hips, stomach that does not respond to exercise, weight lifting, etc. and am also seeing a functional nutritionist. My skin lost elasticity and hangs off like an 80 year olds. We are treating various nutrient deficiencies and I think I see some small improvements in skin.
Thanks for any input / thoughts in advance! Cara
Hello! I have a new outlook on this thanks to you writing this!! I’m currently taking 250mcg of levothyroxine and have been for a while now. I’ve begged my Dr. To up my dose or add something else and they just refuse. I have all the symptoms of low thyroid which I might add that I had thyroid cancer and they removed the whole thing with h that being said I’m am absolutely miserable. Now I have something in writing by taking notes from what you have said to put in front of him! Thank you!!
Hi Darcie,
You’re welcome! I hope it helps.
My body temp has always been below normal and I’m wondering if that’s just normal for me? On any given time of day my temperature is usually 1 and 1/2 to 2 degrees below the normal 98.6. I have been taking level 4 more than 7 years now and my dose has been 100 MCG for most of that time. I’m very active, 5ft 10in in about 148 lb. I’m 62 years of age. Just got my blood test results my TSH is 2.7 which is a little higher than usual, but my T3 free and free T4 are in the normal range. I’m wondering if I should be taking a higher dose of level to bring up my body temperature or if that will have an effect. Overall I feel pretty good.
Hi Terry,
Yes, that could be normal for your body or it could be secondary to some other issue (unrelated to your thyroid).
Dr. Childs, I am caregiver for my 65 year old dementia stricken nonverbal wife. For decades after her thyroidectomy she was on 100 mcg. Then her TSH numbers started fluctuating. Our MD started adjusting dosages downward not getting stability. Her TSH has been as low as .ooo4 and as high as 20 with the most recent of 11 on 11/10/2018. She is on 50mcg Synthroid and dr says to keep that dosage. My wife has lost 30 pounds in the past few months and sleeps most of the day. I feel the dosage is wrong. I give her the crushed pill in a couple of teaspoons of unsweetened applesauce on empty stomach because she doesn’t take pills whole. Any thoughts????? I am tired of her sleeping and losing weight down to 72 lbs. Thanks Steve
Hi Steve,
It’s important to differentiate the symptoms of end-stage dementia from the symptoms of hypothyroidism. Based on your history here, I’m not clear as to whether or not her symptoms are related to her dementia or her thyroid. Also, having dementia at such an early age usually means its a rapidly progressing form of dementia (or she has a strong family history) both of which may indicate that it is more related to her dementia than her thyroid. You’ll definitely need someone who understands thyroid function to take a close look at what is going on to figure it out.
Hi- I’m 46 female, 5’6″. I am currently on Levothyroxine 50mcg daily. I’ve had my meds increased slightly due to symptoms still being persistent and getting worse. I wake up exhausted. I’ve GAINED weight when I’ve been working out more and I’ve always had a good diet. I’m so frustrated!!!
I do have 3 kids, my youngest is 6 and I went into the endocrinologist with all the hypo symptoms about 4 years ago now, wondering if my thyroid took a hit from being middle aged and having kids. I do have a couple small cysts on my thyroid as well that the dr is keeping an eye on, but nothing serious. My blood work didn’t scream hypothyroid, but I am in the cusp of I guess what you’d call hypothyroid and was diagnosed.
I am curious if my dr prescribed me levothyroxine just because that was the run of the mill med to give? I’m also curious if I can just stop taking my meds and kinda restart my body with supplements and get better results from doing that? I’m just so exhausted, stressed, libido gone, depressed, frustrated, cold all the time, and just fed up with how I feel.
I am also curious if I could be suffering from adrenal fatigue as well, rather than thyroid issues???
I’ve just done a whole slew of bloodwork- all my hormone levels, all the thyroids, and have an appointment on the 19th of Feb. SO, the rambling question to you is: what should I ask my doctor? ANY help would be so appreciated as I’m at my wits end. Thanks so much.
Hi Marney,
It’s generally better to find a doctor who already knows how to help vs trying to teach your doctor how to help you. You can find more information on how to do that here: https://www.restartmed.com/thyroid-doctor/
Hi,
thank you for a very informative post.
My situation is a bit strange: I have high TSH T3 and T4 markers, which was discovered in the beginning of my pregnancy, but no symptoms. I was diagnosed with Hashimoto’s and begun taking Levothroxine, first 50 and now 100 mcg, but still not one symptom from all listed anywhere. I feel great, I am athletic, energetic, happy and my hair is thin, but it has always been so. Yes sometimes I feel a bit of choking around my thyroid gland, but that would be it. Should I be taking hormones anyway? Does it have something to do with stage of illness? I am confused, but doctors don’t say much. Thank you.
Hi Belma,
It’s possible you were placed on thyroid hormone prematurely. You can touch base with your doctor to see if you can wean off of it.
Hi Dr. Childs,
I (F26) had a complete thyroidectomy and iodine treatment for papillary thyroid cancer a few years back. Afterwards I was placed on levothyroxine (Lannett) and eventually found a comfortable dosage of 750mcg/wk. I’ve recently moved abroad where I then had to switch to a different brand (Eltroxin). However six months since then my TSH has spiked to 15 in three months and then to 18 two months later (despite increasing dosage) though my T3 and T4 were within normal range in both cases. I’ve felt completely fine during that time – no discomfort whatsoever. My doctor has increased my dosage to 800 and most recently suggested 1000mcg. What kinds of factors could cause such a big increase in TSH and also not cause any symptoms of hypothyroidism? Before switching, my TSH had always been below 5.
Thanks for your time and willingness to share your expertise with everyone!
Hi Mel,
Not everyone tolerates different medications the same even if they are within the same class. You can learn more about this idea here: https://www.restartmed.com/synthroid-vs-levothyroxine/
Where can I find a good provider in my area? Have been on a high dose of Armour Thyroid for over 30 years (4 grains) but my body temp is very low, symptoms started returning and started getting heart palps so newer Dr cut my dose in half. Symptoms getting much worse, so have now been to an Endocrinologist who thinks I am hyperthyroid but mostly fastened on to my Hypoglycemia issues which have gotten worse with the reduction of thyroid meds. She has little interest in my symptoms otherwise.
Hi D Hults,
I would take a look at this resource for more information on how to find a local doctor: https://www.restartmed.com/thyroid-doctor/
I cannot tell you how upset, angry, I am that my thyroid gland was removed approximately 18 years ago. I found a lump on my neck and had xrays done and they went in and removed it. They never said it was cancer, but that it was “sick.” What makes me so angry, is there wasn’t an alternative they gave me. If it was sick, as they said, couldn’t they have tried to heal it before removing it entirely? I’m so angry, I’m crying. I have done lots of reading and research over the years and I feel as if they knew nothing about the thyroid gland and only wanted the insurance money they received for surgery. I now suffer from weight gain, a stomach that looks like I am pregnant, vision problems, lack of energy and a whole host of other symptoms. They give me a T-4 only medication, but how am I to convert any of that to T-3 when I haven’t a thyroid?
Hi Michelle,
I’m sorry to hear about your struggle! I agree that many patients are not educated before they undergo procedures which can seriously impact their lives.
In regards to thyroid conversion, your thyroid doesn’t do the converting but instead, other cells and organs do it. You can find more information about where and how it happens here: https://www.restartmed.com/t4-to-t3-conversion/
olindyhere@gmail.com.
Hi Doctor,
Iโve had a total thyroidectomy 30 years ago. It took quite awhile fo get my level established with Synthroid.
I have been on 112mcg for 15 years and recently felt the best I have in years.
This years results showed my TSH reading as 0.49 and my dose has been lowered to 100mcg.
Should I go by my level or how I feel? Thank you
It has been almost 7 years and my last labs were fine but I am so cold, my hair is brittle and my skin is so dry my finger tips are peeling. I am also gaining weight and memory is also a problem. I was told that being on Mirtazapine for depression may have something to do with the absorption as I take that at night along with Trazadone for sleep. I wake up between midnight and 2:00 to take my Levothyroxine which I am taking 150 Mcg. I am going to try the temperature thing and try changing my diet. I see my endocrinologist once a year but I have my labs checked every 3 months. I am also going to take our article along when I go see her.
Hi Diane,
It sounds like you are heading in the right direction! Good luck, but don’t be surprised if your doctor isn’t receptive to this information. You may need to seek out a second opinion if he/she is unwilling to work with you.
I’m 53 years old and about five years ago half of my thyroid was removed because of an unidentifiable nodule and I was diagnosed with Hashimoto’s. After the surgery, I didn’t have success taking traditional levothyroxine so was switched to Tirosint. All seemed well for a while until I started feeling really bad last year. My TSH level was 7.34. I felt horrible! My doctor increased my Tirosint dosage(from 88mcg to 100mcg) and my unpleasant symptoms slowing decreased. At my recent check-up (approx. one year later) my TSH level was .18. My doctor said this was not optimal because this indicates my thyroid is now hyperthyroid and stresses the heart and bone density issues, even though I was feeling fine. He switched me back to my lower dose. After a month I started feeling horrible again (low energy, weakness, muscle pain, hair loss, etc.). I returned to my doctor and begged him to put me back on the higher dose. He agreed and I’ve started to feel better, but have to go back for lab work in a few months and he’s not comfortable keeping me on this dose if my TSH level doesn’t improve. I don’t have any hyperthyroid symptoms and I’m worried he will decrease my dose again. Do I have any other options?
Hi Lisa,
In terms of options, it’s probably best to seek out another physician if your current doctor isn’t willing to work with you.
I’m a 50 yr old female and 5 yrs ago I found a small nodule on my left side of the thyroid gland. All of my tests came back negative for cancer, T3 and T4 levels were a little low, but not much. The treatment was high dosages of Ibuprofen for almost a year. Nodule went away, but I was given 88 mcg of levothyroxine and have been on it ever since. My lab results have been the same numbers for over 2 yrs, but I have all of the systems you listed of hypothyroidism (thinning hair, dry skin, brittle nails, weight gain, anxiety, etc.). Over a year ago I changed my diet (eating for hypothyroidism), taking supplements, exercising and have seen improvements other than no weight loss. I want to know, can I ever stop taking thyroid meds?
I’m a 55 year old female diagnosed with hyperthyroidism at the age of 20. I was treated with RAI and put on Synthroid meds. Have had no issues really until menopause hit. The fatigue weight gain always tired even if I had a good nights sleep. I was sent to an endocrinologist who I feel doesn’t listen. I was on 100 Synthroid, she switched me to 75 Synthroid with 5 cytomel, every 4 weeks she dropped my Synthroid and increased my cytomel by 5. Currently on 50 Synthroid 15 cytomel, with a TSH at 0.48 and T3 levels at 6.4 free T4 of 9.4. Feel the worst I’ve probably ever felt, no energy, fatigue hair loss, chronic constipation. Having episodes of syncope ended up in emerg. EKG’s echocardiogram, Holter monitor everything came back within range. (So they say)
I have increased my Synthroid back to 100 and dropped the cytomel to 5mcg and feel better. I walk 15 km a day (work) and go to the gym at least 3 times a week, eat a keto diet with IF. My question is this should I be on a higher dose of cytomel but keep my Synthroid at 100?
Your information is fabulous, but I donโt seem to be able to find the answer to a question that my doctors cannot answer, nor can I find any reference to. Due to an extreme allergy to Synthroid when I was first put on it as a teenager, I was put on armor thyroid and had to fight every single doctor I had over the next 30 years to stay on it. This past January I was hospitalized in the hospital flat out refused to give me armor thyroid And switched me over to levothyroxine, and since this was in another state, there was not much I can do about it with my regular primary care Doctor Who had just left the practice. Long story short, itโs taken me nine months to find a doctor thatโs willing to put me back on armor, but Iโm trying to find the best way to transition back onto the armor without thinking back into a complete thyroid cra and switched me over to levothyroxine, and since this was in another state, there was not much I can do about it with my regular primary care Doctor Who had just left the practice. Long story short, itโs taken me nine months to find a doctor thatโs willing to put me back on armor, but Iโm trying to find the best way to transition back onto the armor without thinking back into a complete adrenal crash Which is what happened following the hospitalization. My new doctor is recommending that I start taking 90 MCG of armor, to completely replace the 125 I am taking of levothyroxine, but if memory serves, just stopping one on one day and starting a new one the next itโs not the best way to go about this. In your video, you talk about titrating the Armour Thyroid, but you donโt say if I am to reduce the dose of the levothyroxine at the same time, to take both simultaneously, or what? My new doctor is recommending that I start taking 90 MCG of armor, to completely replace the 125 I am taking of levothyroxine, but if memory serves, just stopping one on one day and starting a new one the next itโs not the best way to go about this. In your video, you talk about titrating the Armour Thyroid, but you donโt say if I am to reduce the dose of the levothyroxine at the same time, to take both simultaneously, or what? Can you please clarify this for me? Are you recommending taking a quarter grain of the armor along with my regular dose of levothyroxine, or replacing the levothyroxine altogether with the quarter grain can you please clarify this for me? Are you recommending taking a quarter grain of the armor along with my regular dose of levothyroxine, or replacing the levothyroxine altogether with the quarter grain? Iโm guessing itโs the former because I donโt see myself functioning well on just a quarter grain for several weeks, but itโs been so difficult to crawl out of this hole that was created by coming off of the armor for so many years, that I really want to do it properly
I have been on thyroid meds for 22 years. I have been on levothyroxine for as long as I can recall. I just had my yearly blood test and it said my TSH was low so they are altering my dose. I have typically been stable over the years with a couple of changes of dosage in the past. I looked in my history and my T3 and T4 have not been tested in several years. I joke that the hypothyroid symptoms are just me – no matter what I have always been constipated, struggle with weight loss despite exercise and what I eat, need a lot of sleep, run a body temp of around 98.0, am typically cold but cannot tolerate heat, and sometimes have brain fog. These happen even when my dose is correct based on blood work. Your article hit home with me! Should I be seeing a specialty doctor who is more experienced with thyroid issues?
I have been taking Levothyroxine NA Synthroid for about 2 years now up to 0.175 MG (pink), my Dr. and her nurse keep telling me to make sure I take it by itself, 2 hours before I eat or two hours after I eat, which is a real problem for me and my daily life schedule, My wife in her infinite wisdom, asked me if I could take it at night before bed ? What a concept, That is how I found your article. I have been gaining weight and unable to lose it no matter what I do, I am 70 and have been in reasonably good health most of my life, but over the last two years I have gained 60 lbs and have no energy to do anything, I am also taking Omeprazole 20mg, which from what you said is making the absorption even worse, I will pass this on to my Dr. at the VA and follow up with how things change over the next couple months, Thanks for the suggestions Mike.
Hi Mike,
No problem! And yeah, please do keep me updated on your progress. And you are correct in that acid blockers do limit absorption of thyroid medication as well as many other nutrients.
Sorry if I sound short, I keep getting redirected to “my cart” while typing out my comment.
1-thank you for the amazing article & information
2-Is it true that once you start on hypothyroid treatment you ate on it the rest of your life?
I was told this almost 15 years ago after a car accident and subsequent tests showed low HGH & thyroid numbers.
3. Is it possible after years of having hypothyroid issues to suddenly be told your levels are normal and that medication is no longer needed. (This was after 30 days off my normal dose of Levothyroxine 200mg/2x day)
Hi Kelly,
Yes, I would recommend you check out this article for more info on your questions: https://www.restartmed.com/stop-taking-thyroid-medication/
And this one: https://www.restartmed.com/you-cant-stay-on-the-same-thyroid-medication-dose-forever/
I am 77 years young, well I used to think so until recently. I was on Armour Thyroid for over 20 years but insurance never covered it and now on Medicare, so….Doc put me on Levo. which IS covered. I kept complaining my symptoms were back so he finally ran tests in addition to TSH. By the way, while researching thyroid issues I discovered that taking a Biotin supplement would skew the TSH test results. Sure enough, after going off of it mine went from 1.12 to 3.02, T4 10+ and T3 very low. Doc was amazed I was right. He cut me to 75 mcg Levo. plus 1/2 a 65 mcg. Liothy. in AM on empty stomach. I was on 100 mcg. Levo for over a year and last Summer started having pain in every muscle between waste and knees and in upper arms. (Otherwise VERY healthy other than Acid reflux I have under control) Xrays show no skeletal issues. This morning woke up with pain now extending up into shoulder, neck and jaw on one side and cheeks felt swollen. No other changes in my routine except 6 days on new Thyroid script. So glad a doctor cares enough to share the basics and give us insight into Thyroid issues. Kudos!
Hi Diane,
I would also recommend that you read this article for more info: https://www.restartmed.com/hypothyroidism-chronic-pain/
I have been taking 50 mcg of Levothyroxine for approximately 8 years. I am 60 years old. I have noticed over the past 6 months, my symptoms were returning. The only thing different I have been doing is supplementing DHEA (5mg) occasionally. I experimented & did not take the Levothyroxine for 2 days. I felt better almost immediately but of course suffered some gastric withdrawal. So I cut my dose in half. Some of the tell tale aches returned but to a much lessor degree. I don’t have an endocrinologist, & my GP said he would not make any major adjustments with this medicine. I am confused what to do next. I must find a doctor to do a more indepth blood work as suggested here.
Hi Gail,
Yes, it sounds like that should be your next step!
I was on 88mcg of generic Levo for almost 10 years. Placed on it two years after I had a partial thyroidectomy for a hurthle cell adenoma at 27. Yes, my complaints of fatigue in my early 20s were so grossly ignored by Drs for about eight years that I grew a tumor. I’d have to say I did very well on 88mcg for a number of years but then after 35 things started to change. My Dr switched me to Synythroid 75mcg and 88mcg because he said generics aren’t reliable. After five days I could no longer function on brand name(including Unithroid for two months and Tirosint for a week) and went back to generic because although I didn’t feel great on it I could still function. Over the past four years my “crashes” and fatigue seem to be happening more and more.
Two months ago I began to have terrible neck and shoulder pain, aches and pains, extreme fatigue , gained 3 lbs etc. My Dr said my free T4 was high at 1.74 however when my TSH fluctuates anywhere from 1.88 to .76 my free T4 doesn’t seem to fluctuate all too much, neither does my T3 and other thyroid hormones. I don’t understand what he means by too high.
I found a Dr that put me on 1 to 2 grains of NP Thyroid. Although I’m not 100% myself the severe aches and pain in my neck and traps have almost subsided as well as the tenderness in my spine and upper back shoulders. After four days of 1 grain I had to bump up to 2 grains because my hands and feet were painfully cold and I started getting really tired.
Before I got on NP Thyroid my test results were as follows. Pharmacy changed pharmaceutical companies that supplies generic Levo, which is reflected in my recent blood work from November and December 2019, which must have prompted the pains, aches and fatigue for the past two months. It seems like no matter how much my tsh fluctuates as long as it stays under the 2-ish range the other hormones don’t seem to fluctuate much but why does my Dr keep saying my free T4 is high? If a person is 40 years old, 5’1, and 103 lbs is there an optimal range for that weight or bmi?
December 2019- TSH 0.76, T4 free 1.74, Thyroxine T4 8.8, T3 uptake 30, T3 free 2.6, Triiodothyronine 76
November 2019- TSH 0.91, T4 free 1.7, T3 free 2.8
October 2018- TSH 1.43, T4 free 1.69, Thyroxine T4 8.8, T3 Uptake 30, T3 free 2.6, Triiodothyronine 78
September 2017- TSH 1.88, T4 free 1.84, Thyroxine 9.1, T3 Uptake 30, T3 free 2.7, Triiodothyronine 80
I forgot to mention that I’m five days starting Np Thyroid and I still don’t feel great. My goodness I wish I could just find the right dosage so I can enjoy my life. 88mcg Levo to 2 grains NP thyroid does this sound reasonable? I was instructed to take 1-2 grains. I test again in 4 weeks.
I love your supplements and your wonderful advice! I had a quick question about taking T4/T3 thyroid medication – does taking T3 block the body’s natural ability to convert more T4 to T3?
Thanks so much!
Hi Michelle,
Yes and no, depending on how you look at it. Taking T3 bypasses the need for conversion but doesn’t really block it.
Hi Iโm a 48yr woman, I was diagnosed as having an under active thyroid when I was approx 19yrs old. During my second pregnancy my thyroxine medication was increased and reduced between 175mcg-to 300mcg/day. Posts pregnancy it appeared to settle down once more. In September 2019 I was feeling very tired, my bloods were checked my TSH was 27 and t4 was 9.9, I was on sertraline 150mg/day and my thyroxine was increased to 325mcg/day I needed to increase the sertraline to 200mg recently also. Bloods were taken this week to check levels (on 325mcg thyroxine for 6months) TSH now 20.3 tsh 8.4????
Hi Dr. Childs โ I hope you see this question!
I just turned 31 and am a female. Father has hypothyroidism.
In 2016 I had a parathyroidectomy for hyperparathyroidism/hypercalcemia. All tests have been normal. In January 2019 I went to a new, referred endocrinologist who put me on 75mcg of Levothyroxine because I complained on brain fog. My labs were normal still. 3 months later it showed I was Hypothyroid. Then after another 3 months the tests showed hyperthyroid (.006).
I got off the medication immediately as instructed. I switched to a new doctor right after that, and I am still (April 2020) hyperthyroid (.006 tsh) and currently have normal free t3 and t4 and have positive (63) thyroperoxidase antibodies.
My new doctor is trying to prescribe me Methimazole for hyperthyroidism (he said this would be for the rest of my life?!)…. but Iโm convinced the Levothyroxine was the cause of the hyperthyroidism to begin with, so Iโm hesitant to get on any medication again at this point.
What advice can you give me?
Iโm scheduled to see him July 2020 and really want to avoid medication. We already did the iodine scan and it showed fine and I do not have any nodules. I feel โokโ for the most part at eat relatively healthy and exercise.
Sorry for the long post. Just really at a dead end.
I am on 25 dose of levothyroxine and just had my TSH texted and it was 2.23. Dr will not increase dosage and said it much more of a risk to become hyper. I cannot lose weight and hike miles and miles, I have headaches all the time and suffer from no vitamin d. Had a test done and said I have no acth but dr said it was most likely a lab error. Ugh.
Any thought?
Hi Tata,
Yes, it’s time to get a new doctor ๐ https://www.restartmed.com/thyroid-doctor/
Hi,
I have had my thyroid removed due to cancer about 5 years ago. My doctor put me on Levothyroxine and has increased it 3 times within the 5 years. For the past 2 years now I have been so fatigued, weak and depressed. It has now gotten so bad that some times I feel that I may have to go to the hospital because I feel deathly ill. It is a horrible scary feeling and is not a normal feeling at all! Since last summer I have gained 30lbs and I have tried everything and the weight isn’t coming off… I just keep gaining! I have told my doctor last year that I can’t lose weight and I am always tired and weak. Her respond was to go out and get some exercise. Yeah like I didn’t know that! But I feel deathly ill and weak, how the heck am I going to do exercise?! I have an appointment with my doctor in July, any advice for me that I can tell her? Thanks!
I am 68 yrs old and have been on 25mcg of Levothyroxine for 3 years. My basal temps run 92-94.6 every morning. My TSH is 3.56 @ my meds. T4Free 1.0 with meds. These labs were done on 3/12/20. I have hair loss, really short eyelashes, belly weight, fatigue. My doctor says labs are good. I was told that I have metabolic syndrome X. Would I benefit from zinc and selinium?
I work for Kroger’s 40 hrs a week and lift heavy totes, and pull heavy carts. I don’t feel that I am a couch potato.
Your advice will be helpful.
Yeah, those standard conversion charts are way off. I was on 88mcg of T4 and switched to NDT and 90mg is way too low for me. I”m going to give 105mg a try for a few weeks before I switch to a synthetic combo. I have to assume after a few weeks on a dose you should start improving rather than continuing to feel like crap. I”m also tired of all the recalls. Once I get it right I need it to stay right.
I had a thyroidectomy in 2017. Iโve always been a fitness nut and have never had a problem with weight until this procedure. Iโm 5โ4โ and have always been a lean 120lbs even after three kids. But since having my thyroid removed, my weight creeped up to 130 and wonโt budge no matter what I do. I have to work so hard just to stay at 130! I run 4 miles plus an hour of legit weight training 5 days/wk and then a 9-13 mile run on a saturdays. I track my macros, so I know exactly what goes in my body. In addition, Iโve had hair loss and fatigue, especially midday. I only take 50mcg of Levothyroxine a day and 5 mcg of liothyronine. I take at 3am. Does this seem like an adequate dosage for someone with no thyroid? My doctor said test results are in a normal range but they obviously donโt seem ideal for me!
Dr. Childs,
I had a hemi thyroidectomy in February. Since that time, my doctor continues to increase my Unithroid dosage and my TSH continues to climb. I feel awful and am wishing I had never agreed to have surgery. Before surgery, my TSH was 1.3. Now, it is in the teens. I am exhausted, am gaining weight, experiencing hair loss and brittle nails. The doctor’s answer to my latest bloodwork is to add one pill a week. There is NO WAY my TSH will come close to being normal with that small of an increase. Any ideas on what might help before I balloon up to 200 lbs???
Dr Childs,
From last 11 yrs I am struggling with fluctuating thyroid levels… N I have almost all the symptoms of both hyperthyroidism and hypothyroidism. From last 4yrs I am facing chronic constipation and I have got melasma over my face.. I am so depressed.
Please help me out
I had about half my thyroid removed 40+ years ago (non-cancerous nodules), everything was OK until about 8 years ago when routine blood work showed low thyroid. Have been taking levothyroxin and/or synthroid but the TSH lab work is all over the lot, 30 days apart on same dosage (currently 88) it can go from 0.01 to 6.0. I am piling on the weight, tired, achy, crabby, the hot flashes are horrendous (I should have been over those 10 years ago), nasty skin breakouts red hot itchy bumps rashes that dermatology has no answer for, lost a lot of hair including my eyebrows and eyelashes are gone. Dr refuses to give me a different medication and just is matter of fact about it (not listening) and there is no endocrinology specialist within 5 hours of us. I am confused if the dosage should go higher or be reduced as I am told this works in a “reversed loop?”. Suggestions appreciated.
I find 88mcg to be too low but 100mcg daily to be too high. Is it okay to split both pills to make 94mcg daily? Also, why do I feel even more hypo when I add 5-10mcg of T3 onto Levo? I start to get an extremely dry mouth, lips, extreme thirst, lack of appetite but if I lower the Levo and add T3 I get terrible anxiety and insomnia! I didn’t experience any of that on NDT. When I take synthetic T4/T3 combos I have no appetite, however on NDT same equivalent dose I have an appetite. What gives?!
I had my thyroid removed November 2019. We are still trying to adjust my levothyroxine. After surgery I started at 200. As of today I started 300. For a couple months in between I felt amazing (shortly after removal.) Lately I’ve been having hypo symptoms again. I’m usually never cold but my hands and feet are freezing. I’m also very overweight and haven’t been able to lose any lbs no matter what I change in my diet and exercise. My menstrual period is very absent. I used to be clockwork every 23 days. I’ve now gotten it once in 7 months. I am going to start taking my thyroid med at night. I go back for blood work in 4-6 weeks. Again. We’ve been monitoring and increasing by 25 increments. Not sure what the highest dosage can be. But it’s exhausting. I’m sick and tired of being sick and tired.
I also have noticed my memory has been so awful lately! Is that another known symptom? My migraines have gradually increased in frequency too. At least 1 every 10 days or so.
My thyroid was removed in 2014 due to Papillary Thyroid Cancer. I was 51 years old at the time, 5’10” and 215 lbs. My initial synthroid dose was 275mcg, reduced to 150mcg after 6 months and then to 137mcg and finally to 100mcg. I noticed immediately the dry skin on my hands and feet, swelling in my ankles and legs, severe depression, constipation, and weight stayed the same for about 3 years and then it began to increase. At one point my tsh jumped up to 23 and I gained about 50 lbs. At that point my Endocrinologist increased my dose back to 150mcg, which helped a lot, but the weight I gained is still here.
It has been 6-1/2 years and I still feel very fatigued, depressed, constipated, my weight is higher than it’s ever been. My Endocrinologist agreed last year to let me try NP Thyroid, “against her better judgement”, and the only thing I lost was my hair. I started 137mcg of synthroid again in 2021. I just noticed I feel slightly better than I have in quite some time, but have been having issues with extreme internal itching all over my body that makes me feel crazy! My tsh was 0.059 and now my Endocrinologist is lowering my dose to the synthroid-free (50mcg) 2x day and 1x on Saturday & Sunday. I am so worried this will cause more weight gain! ๐ It’s only been one week, but I still have the extreme itching and severe tiredness . . .and constipation. . . and. . .and. . .and . . .
I am extremely frustrated and don’t want to weigh 300lbs which isn’t far away at this point.
Hello, I have been following you for the last month and have learned so much!!! So thank you for doing what you do!
I am hoping to get help with dosing while adding t3 to t4. My levels look โgoodโ at 112mcg Levothyroxine, but low when compared to your scale. Iโm adding 5mcg t3, but Iโm confused as to how much t4 I should be taking with it. Would lowering to 88mcg or 100mcg be a better starting point? Thank you!
Hi Heidi,
In general, most people are taking too much T4 and not enough T3 so it often makes sense to adjust T4 dosing downward when starting T3.
If taking a combo of levothyroxine (100mcg 1x a day) and liothyronine (5mcg 2x a day) and taking meds at night instead of 1st thing in the morning. Would I only take levothyroxine at night or would I also take liothyronine at night?
Hi Susan,
You would probably want to experiment with both to see which works best for your body.
Hi there,
I was diagnosed with antibodies in my thyroid. My doctor put me on 75mcg levothyroxine. Its been about 7 months now, being on it. My weight keeps fluctuating. She prescribed me Phentermine hcl 15mg to try to lose some weight. Not working, she upped the dose to 30mg. Still not working. Im not sure what else to ask for? (Im eating quite well)
Any thoughts?
Thank you SO much!
Hi Teri,
Please see this article for more information on how to lose weight with Hashimoto’s: https://www.restartmed.com/lose-weight-hashimotos/
HI ,
I started taking the medicine of Euthyrox 25 mg , the 1st 3 days I was okay , but on my 4th day I got so much tired and had pain in my muscles , and head ache so I stopped the medicine immediately . SO what to do in this case?
Hi Lara,
The first thing you need to figure out is whether or not your medication actually caused those symptoms. It may have been the case (and often is) that the symptoms you experienced were not related to your thyroid medication at all but due to something else.
Hi Dr Childโs, thank you so much for your article, very informative. My Gravesโ disease was left untreated for 2 years until I had multiple thyroid storms. I had a total thyroidectomy in August, because it had become so fibrotic, all of my parathyroid glands were damaged during surgery, and Iโm no longer producing and PTH. Iโve been very unwell with multiple admissions for low calcium (currently1.6/7) and magnesium (currently 0.48). I have a feeling my endocrinologist is trying to run me as hypothyroid as possible, in order to slow bone turnover etc and reduce the demand for calcium etc in my body. He keeps lowering my thyroxine despite me complaining of all the symptoms or running low. We normally discuss my exact levels but he hasnโt told me what they are the last couple of times. Originally he was arranging PTH replacement therapy, but ran into issues with funding. He has me taking between 50mcg and 75mcg which seems so low given I have no thyroid. I feel like my whole body is being forced into reverse itโs so slow. Maybe this is crazy of me to think, but there have been so many mistakes made, I have no trust there anymore.
I canโt carry on like is, Iโm so unwell and low, Iโve lost my career and months in hospital, weeks in ICU. I know when someone isnโt being upfront with me, thatโs the distinct feeling Iโm getting right now.
I hope youโre able to see this, I really enjoy how you write and converse thank you for your time.
First- I love that you are taking the time to address these comments. Major kudos! Hypothyroidism is so frustrating. I had post-parfumerie thyroiditis that was missed, so I went 3-4 years without treatment, causing permanent damage. That was nearly 20 years ago. My rush is excellent, right where I like to see it. I am fortunate to have an MD who listens and allows me to self manage a bit. However, the past couple of years, I have been extremely bradycardic, running in the 40s and 50s consistently. Very poor bowel motility, unable to lose weight at all, despite trying things like that dratted cabbage soup diet, low carb, (thatโs just awful on so many levels and leaves me tired, cranky, and even more constipated) reduced calories, etc. I have joint pain and fatigue, lack of motivation for things I am normally passionate about, and my FBS has been slightly elevated. A1C is still good, for now. I supplement with B and C and zinc daily and try to follow a reasonable diet. I get adequate D on my daily lunchtime walkabout and a nice bump on the weekends, when I garden. I also take a low-ish dose supplement, as my levels were practically non-existent a few years ago. I am going to discuss with my witch doctor MD (self proclaimed and the shoe definitely fits lol) the possibility of trying your 80/20 approach to see if that helps. Iโm tired of feeling fat and sluggish and tired.
Can you recommend some budget friendly supplements to help with adrenal fatigue? I do have some issues with chronic stress, as I recently left a job that was absolutely grueling and all-consuming for 8 years and am just now settling in at my new job after a year and a half of tension and miscommunication, so even if my labs are ok, Iโm sure my body would appreciate some support.
Thank you for your work on what might be one of the most medically mis-managed conditions out there!
Hi Sheila,
Of course! This is my go-to for adrenal fatigue: https://www.restartmed.com/product/thyroid-adrenal-reset-complex/
I’m 40. I served as a marine infantryman from 18-22 with multiple deployments. I now get treatment from the VA for epileptic TBIs, CPTSD, major depressive disorder, gerd and, as of six years ago, hypothyroidism. When I was getting routine labs, clinicians saw my thyroid levels were off and initiated levothyroxine. However, subsequent labs to check my thyroid levels werent given. About a year later and once a year since then, my primary care physician checks my levels. And multiple times my labs caused my doctor to adjust my medication. However- just like when the medication was initiated- whenever adjustments are made, subsequent labs are not ordered (not within a year anyway). Some of the symptoms I can somewhat identify with, more or less. I sometimes feel fatigue, but usually this peaks when an event or reminder causez me sadness. Even during times when Ive had medication lapses, Im not very fatigued and have trouble sleeping. Im not sensitive to cold at all, never have been. I havent experienced constipation. I sometimes get a little dry skin in certain areas in winter, but my skin is predominantly oily. Ive had intermittent weight gain since leaving the Corps, but that’s when my diet and exercise is poor. Again, pre-levothyroxine and during times I took too long to get refills, I still had no trouble losing weight with a cleaner diet and exercise regiment. Ive had puffy face when my carb or beer intake was high, but rarely. Ive havent had a hoarse voice since combat. No problems with muscle weakness. No muscle aches except for post-workout DOMS and that rarely. No joint pain except lower back and knees- just like every other grunt i served with. I have thick hair and havent experienced significant thinning. However, i have noticed very slight thinning since the last time my synthroid dose was increased to 50mcg. I workout regularly with anaerobic and aerobic workouts, so my heart rate has always been slower than people that dont. I started experiencing depression symptoms long before any clinicians noticed abnormal thyroid levels. I have some auditory memory/processkng issues which may linked to TBIs, but my visual memory and overall episodic and semantic memory is quite proficient according to numerous neuropsych exams. Ive never had a goiter. No clinician has ever asked me about hypothyroidism symptoms, they just order labs every year. And they dont order intermediate labs to determine the efficacy of adjustments. This article and several others make me worried that my problem is different or more complex than what my providers believe it to be. And now Ive come across troubling peer-reviewed research that show harmful correlations with long-term levothyroxine use. It all has me worried, Doc. But Ive learned from experience that getting labeled a “problematic patient” at the VA (I dont doubt other healthcare systems treat self-advocating patients punitively, but i can only speak for my experiences and observations at the VA). Im thinking about just ordering labs online and doing them myself. What do you think, Doc?
Hello, my name is Jill. I have Hashimotoโs, so I take levothyroxine and Liothyronine. About six months ago I was on 75 mcg Levo, and 5 mcg Lio. My TSH test was a little high, so my doc reduced my dose of Levo to 50. Lio has stayed the same. A few months later, my TSH was too low as well as T3 and T4, so I went back to 75โs. That didnโt bring it high enough, so my doc prescribed 125โs, which seemed alarmingly high to me. Iโve never been on that high dose, and I was testing too high on 75โs just six months prior. 2 months later, as I predicted, my TSH came back extremely high, but T3 & T4 were at higher end of normal range. I want to go back on 75โs and just make small adjustments (I was taking a full pill 6 days and 1/2 pill 1 day a week at one time). My doc doesnโt think 75 will be high enough, so prescribed 100โs. I donโt feel well when my TSH is too high (hair loss, sleeplessness, tiredness, weight gain/ appetite). I donโt know if Iโm better off taking the 100โs, then testing in a couple of months, or calling her back and trying to explain why I think 75โs should be high enough, and that making small adjustments seems to work better for me. What do you suggest?
I’m 56..had a total hysterectomy about 20 years ago. I have every symptom of hypothyroidism.. Been diagnosed with it…haven’t been able to loose a pound in years.. No matter what I do.
I am on estrodial.. Should I even be taking this and nothing else?I’m depressed.. Never happpy..no sex drive what so ever…your thoughts?
2022 my daughter was diagnosed with two very large nodules on her thyroid.
Her thyroid levels prior to surgey were normal. They were extremely large so a thyroidectomy was done. Surgey was successful and it was not cancer thankfully.
Recovery went well. She weighed 128/132
Ibs Her calcium level was low so had to take supplements for a short time and she began levothyroxine 88. In 2023 dr put her on 100
Levothyroxine not sure if Sept or Feb 2023
So far everything good. She did have a window tooth extraction that she had which caused her to eat only on one side of her mouth. This is where it all went downhill (Which may be the cause of her panicking when eating because she felt chocking while swallowing) In Dec 2023 / Jan 2024 she had endoscopy and had fungus in her esophagus. She was prescribed meds and several tests (barium swallow, modified swallow testโฆThis is when she started to have difficulty swallowing, tightness around neck, feeling of choking, tingling in face hands, legs…
After several test all this led to her losing weight. She also had low vitamin D level .
Which she was then taking supplements.
She was eating soft foods… She had speech pathology, therapy.. she saw primary they recommended b12 vitamin. she has then slowly recovered to eat better but has lost 10 pounds. She also saw rheumatologist she has Primary Raynauds which is being monitored. She had visit with endo I spoke with dr re symptoms flushed, dizzy, fatigue, headache, diarrhea, always hungry. and lost 10 los, again low vitamin D (started supplements). She is still on levothyroxine 100 mcg generic. Dr says lab work looks good but what about all symptoms? Bloodwork was done but not sure if her levels are off causing all her symptoms Help are they levels off ? What is causing these symptoms. Feeling so helpless for my daughter ( PTH 22
Free T4 1.61
TSH 1.370
T3 Total 105
After reading all your blogs I requested some blood work from her primary below are results
Vitamin D 38
Vitamin B 12 436
Magnesium 2.4
Total Iron 325
Binding
Iron total 90
% saturated 28
% unsaturated 235
Ferritin 71.8
Thanks for any input or suggestions