Levothyroxine Dosage Guide: Are you on the Right Dose?

Levothyroxine Dosage Guide: Are you on the Right Dose?

Are you on the right Dosage of Levothyroxine for YOUR body?

If you are on Levothyroxine and NOT feeling better, then one or more of these things might be happening to you:

  • You are not on a high enough dose
  • You are on the WRONG type of T4 thyroid medication
  • You are not absorbing thyroid hormone correctly
  • You are not getting enough T3 thyroid hormone

​But the main question is:

How do you know which category you fall into?

​That's where I come in...

Sit back and enjoy this article because we are going to dive in and talk about everything you need to know about Levothyroxine and how to find the right dose for your body: ​


Are you on Levothyroxine and Still Experiencing Hypothyroid Symptoms?

It's never normal for you to experience hypothyroid symptoms despite taking your thyroid medication. 

The entire goal of using thyroid medication is to resolve this deficiency and to improve your quality of life (1). 

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 by 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. 

Download my Free Resources:

Foods to Avoid if you have Thyroid Problems: 

I've found that these 10 foods cause the most problems for thyroid patients. Learn which foods you should absolutely be avoiding if you have thyroid disease of any type. 

How to Calculate "Optimal" Free T4, Free T3, & Reverse T3 Ratio: 

Calculating these ratios is important because it can help you determine if your efforts are on the right track and whether or not your medications are working. 

Download more free resources on this page

How to Determine if your T4 Dose is Sufficient for Your Body

Each one of you has a different demand for thyroid hormone in our 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 20's or 30's

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 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 off of this value. 

But the problem is that newer studies are emerging which 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 which 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. ​

Levothyroxine and metabolism

Some studies have shown that despite using Levothyroxine (8) (and suppressing the TSH) that resting energy expenditure (a measure of metabolic function) does not "normalize" to healthy adult levels. 

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. 


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. 

natural thyroid supplements version 2

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 which 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 motion, 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 which contain both T4 and T3, not just T4 medication alone.

​And I'm not just saying this from experience, most patients also agree that medications containing T3 are superior...

NDT vs levothyroxine

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?​

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 affect 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.


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 absorption and the 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

levothyroxine added dyes and fillers

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 Tirosint​

What is Tirosint?

Tirosint is another T4 only thyroid medication.

It's special because it has the fewest inactive ingredients out of all thyroid medications.

It contains 3 inactive ingredients and 1 active ingredient (thyroid hormone/Thyroxine).

This makes Tirosint very easy to absorb and utilize by your body (18). 

Many patients have reported an improvement in their symptoms simply from switching from Levothyroxine/Synthroid (generic/brand versions) to Tirosint.

The good news is that Tirosint is another T4 only thyroid medication which means that your physician shouldn't put up much resistance if you ask for a trial.

When switching from other T4 medications to Tirosint it's important to remember that even though both medications contain T4 they may not be bioequivalent. 

What this means is that your body may be able to more actively utilize one form of thyroid medication over another, even though they both technically contain the same ingredients. 

This phenomenon has been seen in patients switching from brand name Synthroid to generic Levothyroxine as well

So how do you switch from your current medication to Tirosint?

The best way is to simply swap straight over as if your doses were equivalent but be sure to keep an eye on your lab tests and your symptoms to see how your body is tolerating the change. 

#3. Increasing Absorption of Thyroid Hormone + 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 absorption of thyroid hormone.

At night your GI tract slows down which may allow for higher absorption.

In addition, your cortisol levels peak at 8am in the morning (when most patients take thyroid hormone) which may also influence thyroid hormone metabolism.

​It'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?

​By 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)

​If 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

​This 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 off of 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 trial 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:

Armour thyroid conversion chart

​This chart isn't perfect but it is a good starting place. 

I find that the conversion from T4 to NDT or natural desiccated thyroid to be too low (meaning you usually need more NDT to make it equivalent to the T4 dosing).

In my experience, 2 grains is 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

Conclusion + 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 50mcg increments of Levothyroxine or switching to Tirosint all together 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!

References (Click to Expand)

how to find the perfect dose of levothyroxine
Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders. He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances. You can read more about his own personal journey here.

288 thoughts on “Levothyroxine Dosage Guide: Are you on the Right Dose?”

  1. Hello, I am on 175 mcg and I am still having all the thyroid symptons, you have described in this article. I have spoke to my doctor about them an he keeps reassuring me my labs are perfect. And my body says differently. I was also wondering is there a special kind of diet that needs to be followed. I have heard gluten free is the best way to go. I would greatly appreciate any advice that you can give me.

    Thank you so much, Jacqueline

    • I have no thyroid due to cancer last year in Feb
      I’m all over the place with a mount of levo. I am 69
      What would be a typical amount I need.
      I weigh 51 kilos
      I have no support from endo

    • What if I don’t have a thyroid gland since it was removed over 25 years ago based upon a diagnosis that it was pre-cancerous? This means I am hypo. I have been on 125 mpg synthroid or its generic per day and lately have developed hypo symptoms.

      • Hi Dale,
        I had the same experience and it turned out that the medicine was sensitive to heat in my bedroom, so a months dose had gone off. If you had this issue in the summer you should get a new bottle and keep in the fridge. Also avoid walnuts , dairy and iron (like in supplements or supplemented cereal) for two hours after you take the pill because they interfere with absorption.

  2. I’m on Levothyroxine following a TT for follicular carcinoma. I’ve been on Levothyroxine for the past year and still don’t feel good – many of the hypothyroid symptoms you list. I asked my doctor about the possibility of trying a different medication containing T3 like you have suggested. The doctor looked at my Free T3 level and said it was normal so dismissed my request. Does my Free T3 level effect whether something like NDT is suitable? What information can I give my doctor to support my case? Thank you.

    • Hey Lynda,

      No, your free T3 isn’t necessarily the best indicator of whether you need T3 or not. But you are wasting your time trying to bring information to your doctor. Imagine someone trying to tell you you’ve been doing your job wrong your entire life and to change because you know more than them (even if you are right) – this is the futility of trying to get your Doctor to listen to you.

  3. I went from 60mg Armour down to 30mg with 5mcg Liothyronine and was feeling completely exhausted with heart racing on occasion. Now I’m taking 1/2 tablet of 75mcg Levothyroxine wth 25mcg Liothyronine and my hair is falling out and I’m still exhausted. I wanted to avoid Levothyroxine because of the fillers (I have Hashimoto’s) but my doctor chose this route instead. Clearly, it’s not working. The weight & fatigue is not budging and I’ve always been able to manage my weight until now.

  4. Hi Dr Child’s,

    I’ve had Hashimoto’s for 15 years and always struggled with my weight. About 5 years ago I had my daughter and made some huge changes to get in shape. I lost 50lbs and put on a ton of muscle. Was feeing great! I had my son almost 2 years ago and have been struggling ever since. I have been eating right and working out and am VERY educated in this area, but have not lost a pound or an inch in over a year now. Although I am back to pre pregnancy weight, I can’t lose any fat. I’m exhausted and feel terrible every day. I’m on 150mcg of Levo, and my dr won’t change my medication. I’m not sure where to go from here.

    • Hey Lea,

      The best place to start is with a Doctor or provider who can help. My blog has some helpful tips that you can try, but if they aren’t working then I would recommend you seek professional help.

  5. Hi Dr Child’s, I was diagnosed with a very under active thyroid about March time after reading your articles on fibromyalgia and under active thyroid. I had been feeling very ill for some time and just put it down to my fibro.. But I was having other symptoms that didn’t make any sense or relate to my fibro loosing my hair was one of the big ones and gaining weight after reading your article I discovered I had about 42 of the symptoms of U/A thyroid. I went armed with a list of blood tests you recommend had them done on the Thursday afternoon, my Gp rang me first thing Friday morning to say my thyroid was dangerously low and started me on 125mg levothyroxine. I was thrilled as now I thought I would feel a lot better.
    Sadly not I felt so much worse in every way did lots of research on your website.. Kept going back to Gp’s who lowered dose I felt suicidal I felt so ill. After a few months I decided to take the plunge and self medicate on Ndt and was amazed at how much better I was all the pain went my hair stopped falling out gained some energy felt human again. BUT I still can not loose any weight though I have stopped gaining weight I think now.
    I desperate to loose weight but I do have other medical issues ie lower back problems so I’m not as active as I could be.
    Is there anything you can recommend.
    I live in the uk so ndt is only available to me through the Internet as don’t prescribe it over here.
    Sorry it’s so long winded the message.
    Many thanks Clare

    • Hey Clare,

      Unfortunately you are in a tough position, you will definitely need some guidance from a competent physician locally who can fix what has happened in your body. I know that in the UK there are some private doctors that are willing to prescribe NDT, I would recommend you seek one out.

  6. Dr Childs,
    Thanks for a great article! I’m on Liothyronin 30 mcg in the morning and 20 mcg in the afternoon. I still suffer from constipation and impossible to loose weight. However my doctor worries that my TSH is low as well as my free T4. He talks about risk of heart diseases. I don’t feel a raised heartbeat. My resting pulse is

  7. Continues since I accidentally submitted… My resting pulse is around 55. Do I need T4? Is there a risk of heart disease? Do I need to worry? And how do I get rid of my constipation and problem to loose weight? I thought that maybe I should try adding Levo as you suggest above with 80-20 ratio.

    Thank you!

    • Hey Therese,

      You will need to get the full thyroid evaluation and a complete hormone panel to say for sure. Many things can impact resting heart rate, so I don’t recommend basing any decisions off of that alone.

  8. Do you have a list of practicing doctors in different states?? That practice like you. I have called 10 doctors in my area. My current doctor wont change my dose, stating my labs are fine. In the meantime i keep gaining weight,despite all my efforts not to,my hair is falling out, and I’m exhausted all the time, even when i sleep 8-9 hrs. I have been taking 250 mcg of levo for 2 years now. How do i get help??

    • Hey Becky,

      Unfortunately I don’t know anyone that practices like me. There is no training for this type of medicine, so everything I know is self taught.

  9. Hey Dr. Childs,

    i followed your blog for a time now. It’s full of precious Informations on the subject. It helps me a lot. Thank You so much for that. One thing confuses me, though. You wrote: “This allows for roughly an 80/20 ratio of T4 to T3 which is similar to what the thyroid produces naturally.” In most of the Publications i read, it says the T4/T3 ratio should be 10:1 to 13:1 or even 16:1. Is it Your practice that leads You to the 80/20 (4:1) ratio or the fact that natural Thyroid has that Ratio (because it’s from Pigs) or something else? I look foorward to Your answer. Thanks in advance and greetings from germany.

    • My last reading was 7 and 8 weeks on its 17.8, I have an underactive and have been advised to take 100mg for 3 says and 75mg the rest of the time, I feel awful, so tired, heart races and hot flushes, cold sweats, how can it change so much in 8 weeks, I was beginning to feel ok.

  10. Just got an increase on Levothyroxine to 75 mg and still don’t feel any better and weight isn’t coming off. Really frustrating!

    • Hey Terri,

      Most people DON’T lose weight on levothyroxine, and most in general don’t lose weight on any thyroid medication. Thyroid is usually only responsible for a small amount of weight gain and when you optimize your thyroid function it usually only results in 5-15 pounds of weight loss. The rest is usually from insulin and/or leptin resistance.

      • Hello, I live in the UK and need a lot of help and will be subscribing to your program as I have just found you and think your website is amazing! I’m taking 100mcg Levothyroxine daily (one tablet )-I also am using Saxenda -on the starting dose of 0.6 should I be on a higher dose ?what is the best time of day to take both and the best dosage of Saxenda to get the maximum weight loss benefits ?? -I’ve read that Levothyroxine can affect efficacy of Saxenda ( do no have a history or family history of thyroid cancers etc) I’m just really confused about the timings each day please help.

    • I tried getting my endocrinologist to switch me from synthetic to tirosint and refused. I’m currently taking 175 for 6 days a week making it a 150 dose. And I just feel like crap. since I don’t have health insurances it makes it hard finding a good doctor that will listen to me.

  11. Hello,
    My recent lab work revealed that my TSH levels were abnormal (0.006) while taking 150 mcg of Levothyroxine. My endo lowered my dose to 137 mcg. Through a very low carb and working with a personal trainer, I’ve lost 50 lbs over the past 5 months. I inquired as to whether the lowered dose would create any weight gain and she simply said it was possible, but offered no alternatives or recommendations to avoid such a scenario. Do you have any recommendations to ensure that my current weight loss progress is not derailed by the adjusted dosage? Any help that you can provide is appreciated.
    Thank you,

    • Hey April,

      Really the only thing you can try is to promote T4 to T3 conversion from what T4 is in your system, if your body is reliant upon medication as a source of thyroid hormone then there’s not much you can do.

  12. I am 32 just diagnosed with hypothyroid and was prescribed with levothyroxine 125mcg. I have over 30 of the same symptoms still. I have changed diet, exercise, rest. Everything. I also have migraines so I take amitripilyn daily. Also have high pulse at resting, I am on verapamil for the Bp and high pulse. I am not too sure where to go from here. Thanks

    • Hey London,

      You may simply not be tolerating the T4 only medication, so you should talk to your Doctor about NDT or other thyroid medications.

  13. I was diagnosed with hypothyroidism 7 weeks ago and placed on Levo of 25 mcg for a week then increased to 50 mcg for a week then 75 mcg but I recently noticed that the 75 mcg causes me to have heart palpitations, anxiety and fatigue. My original labs were T4 3.1 and TSH 1.110 and after being on the Levo for 7 weeks my T4 is now normal at 7.3 but my TSH is now at 0.405 and although I’m not as exhausted as I was before the medication I am still tired and cannot lose any weight with healthy eating. My doctor would not switch my medication but I cannot continue taking the 75 mcg. I’m pretty sure I started having problems with my thyroid in january of this year as I suddenly started gaining weight and by May I started feeling exhausted to a point where I was falling asleep all day. HELP!!!

    • Hey Betty,

      If you are experiencing symptoms related to your medication then you need to see your Doctor, he/she is the only one that can make the necessary changes. If he/she is unwilling to change your medication then it might be worth looking for someone who is more willing to work with you to change medications, etc.

      It sounds like your symptoms may be due to too much thyroid hormone or because you titrated your dose too quickly.

  14. Hey Dr. Childs,

    i followed your blog for a time now. It’s full of precious Informations on the subject. It helps me a lot. Thank You so much for that. One thing confuses me, though. You wrote: “This allows for roughly an 80/20 ratio of T4 to T3 which is similar to what the thyroid produces naturally.” In most of the Publications i read, it says the T4/T3 ratio should be 10:1 to 13:1 or even 16:1. Is it Your practice that leads You to the 80/20 (4:1) ratio or the fact that natural Thyroid has that Ratio (because it’s from Pigs) or something else? I look foorward to Your answer. Thanks in advance and greetings from germany.

    Sorry for the possible double post. But i think something went wrong the first time.

    • Hey Dirk,

      Sorry I missed your initial comment.

      I’m basing that statement off of previous studies, my own personal experience treating post thyroidectomy patients and expert opinion. I can’t dig up the studies right now but I did do a quick search and found this: http://www.endocrineweb.com/endocrinology/overview-thyroid

      I am generally not a fan of NDT due to the fixed ratio of T4/T3 but I have found NDT + T3 to be a powerful combination because most people do need more than physiologic doses of T3 due to a number of reasons.

  15. Hello Dr.
    Just a question: you say to increase the Levothyroxine dose every 10-14 days and the majority of Doctors say to wait 6 weeks between doses increases.
    Why the faster increase?
    Thank you for this amazing site!!

    • Hey Lucas,

      This is anecdotal based off of my experience in treating patients, most patients appear to have receptor sensitivity issues if the dose remains stable too long – either that or it’s a thyroid conversion issue.

  16. Hello Dr!
    Due to fact I have following results:
    FT3: 3,690 PMOL/L,
    ATPO,173,70 UI/ML,
    D3: 35,56,
    INSULIN: 31,4 ,which dosage would recommend me?As you can see after results it’s appear that I have leptin resistance and insulin resistance.
    I’ve been taking Levothyroxine 100 mcg/day since 2001.
    Thank you for recommendation.

    • Hey Anna,

      You really need a full comprehensive evaluation and treatment plan, I can’t treat you unless you are a patient of my practice and what you really need are some medications short term to fix the issues you have.

  17. Hi I have recently been put on T3 I take levethyroxine 25mg in the morning along with 5mg T3 then 5mg T3 at night I feel Better than i did just on levethyroxine 75mg but i dont seem to be able to continue loosing weight i can loose 7 pounds then the second week its back on and i am so frustrated i dont know what to do and am desperate for help

  18. Hello I had a cancerous tumor the size of a golf ball on my thyroid about 14 years ago. I had to get most of my thyroid removed and have been on and off thyroid medication since then. Currently I am on 200 mg and I still feel bad I am constantly gaining weight and have gained over 60 lbs over the course of two years. I have tried to diet and excersize and can’t seem to loose any of the weight in fact it just seems like I am just gaining more. I have recently switched states and has asked my current doctor to look at my results she has told me that they look fine and sent me a copy my TH lvl was at 54 is that low? I thought it was and I don’t know what to do. I want to feel better and I want to loose weight and be able to have the energy to get out of bed and hanging out with my kids. I was on a dosage of 250 at one time before I moved and felt great and lost the weight. I tried telling my current doctor but she says no I don’t need it. What do you think??

  19. Hi, I was on .050 feeling fine, lots of energy, my Dr increased my dose to .075, gained 20 pounds in two months, have absolutely no energy, tired all the time. I keep telling him how I feel and he wants to increase it again! My labs keep coming back good.

    • Hey Genny,

      You may want to consider looking for a new provider if your current provider isn’t willing to work with you.

  20. I’ve been on levithyoroxine for 16 yrs and have gained 80 lbs. and am constantly tired and hair falling out and on 137 mcg of Meds. I have never experienced feeling better or weight loss. I always weighed 140 lbs until the hysterectomy and then thyroid quit working and I’ve been gaining ever since . I’ve been to specialists in thyroid problems and they just tell me levels are normal which I fight with them about not to lower it . My number is .02 right now and still gaining

  21. Although levothyroxine saved my life and improved the truly horrible overt symptoms I was suffering before starting T4 therapy the closer I got to an ‘optimised dose’ the more acutely aware I became that I did not feel at all well. I stuck it for two years and concluded my life was not worth living and I had nothing to loose by trying NDT. I am so glad I did as I have felt immeasurable better on this medication. I took 125mcg Levo and never really felt better I now take 2.25 grains of NDT and have seen great improvements in my well being. Not perfect, but good enough to retrain in a new profession, hold down full time work and succeed in it.

  22. Hello DR. I was on levoxyl for the first few years and then i switched to levothyroxine 0.025mcg ever since 2003 and been on this same dosage since then but still feeling tired and hair falling out my weight has been up and down but like many others are saying my lab works always come out good but i will save this article and show my regular doctor and the thyroid speacilist and see what they think, hopefully they will put me on something different. I mean i watch what i eat and workout but still feel the same way. Thank you

  23. Thanks for the article! I’m a little confused by the two different conversion charts. In the example of someone who is taking 125mcgs of levothyroxine, which conversion chart would you recommend to convert it to Armour? Thanks!

    • If someone is taking 125mcgs of Levothyroxine how much Armour would you recommend they take? I’m a bit confused between they conversion charts. Thanks!

      • The conversion process isn’t perfect and should just be used as a guideline. If you switch from levothyroxine to armour but you don’t tolerate armour then it wouldn’t necessarily apply to you. It’s helpful if used as a guide for converting medications if you remain symptomatic after the switch. The tolerance of T3 containing medications varies drastically from individual to individual.

  24. my daughters tsh is 18.64, t4 10.7 ad free t3 2.9, family doctor will not adjust meds, wants her to see an endocrinologist. can’t get in to see one until end of Feb. how can I help her now

    • Hey Maureen,

      Unfortunately I can’t provide medical advice about her because she isn’t my patient. It would probably be a good idea to have her antibody levels checked, however to make sure she doesn’t have Hashimoto’s thyroiditis.

  25. Hey doc, have you ever treated anyone that has done the radioactive iodine treatment? I had the radioactive iodine treatment a few months ago and haven’t felt normal since. I’m currently on 100mcg of levothyroxine. I feel fatigued all the time, have a brain fog, and can’t seem to get into deep sleep.

    • Hey James,

      Yes, I have several patients who are post RAI. Treatment is largely the same except these patients generally require more T3 in addition to T4.

      • Hey doc,

        Thank you so much for replying. I have another question. I was wondering just by seeing the levels below if you can determine if my body is having problems with absorbing/converting Levothyroxine.

        Started taking 1 Levothyroxine 75 MCG after RAI(Aug. 3)
        TSH: 4.15
        Free T4: 1.0

        Still taking 1 Levothyroxine 75 MCG
        TSH: 21.05
        Free T4: 1.1

        Started taking 100 MCG Levothyroxine
        TSH: 25.24
        Free T4: 1.1
        Total T3: 58

        Still taking 100 MCG Levothyroxine
        TSH: 11.15
        Free T4: 1.6

        Still taking 100 MCG Levothyroxine
        TSH: 18.66
        Free T4: 1.5

        Do you think I am having problems with absorbing/converting the Levothyroxine or is it too early to determine that? Thank you so much doctor.

  26. Your web site is most informative and have “hit my nail on the head” on many levels. You have given me more than something to think about. I am on Levothyroxine .75 and have narrowed this down to my weight gain (185 to 206), this is significant in my book. Not to mention dealing with constipation for nearly a year…
    My next approach I assume is to get my previous lab results and start comparing the numbers since I was diagnosed with Hashimoto’s disease and having Hypothyroidism.

    David Johnson

    • Hey David,

      I’m glad you found it helpful. In your case I would also consider evaluating other hormones including testosterone (both free and total). Males usually require higher doses of thyroid hormone and more T3 in general due to higher metabolic rates and more muscle mass. If you haven’t already you can check out a case study I recently wrote up on a 61 year old male hypothyroid patient here: https://www.restartmed.com/testosterone-weight-loss/

  27. Hi Dr. Childs,

    Thank you for your posts. They have been very informative. My issue is that I was diagnosed with Hypothyroid about 4 years ago. I went on Armour and felt a lot better. About a year and a half ago, I was under a lot of stress and eating terribly and my body went hyperthyroid. I lost about 10 pounds, which is quite a lot on my frame. Since then, the doctor put me on Levothyroxine and I gained 15 pounds. I am doing a January cleanse (which I do every year). Usually I lose about 5-7 pounds. This year I am gaining weight. My Dr. says I am too old for Armour. I am 60 years old, but I felt so much better on it. My symptoms right now are weight gain, heavy legs, dry skin, constipation, consistently low basal temperatures (around 96.8) and low energy. I am alternating 88 mgs and 100 mgs. but the increase has not been helpful. Any suggestions?

    • Hey Janet,

      There is no age restriction on T3 or Armour thyroid :). I have many patients your age and even older on some combination of NDT and/or T3. Your current symptoms are consistent with either hypothyroidism and/or metabolic damage.

  28. Hi Doctor , iam planing to take t3 medicines … iam on thyronorm 25mcg and it has been no good, i dont have any symptoms of hypothyrodism apart from the over weight and hair fall, i have been on using thyronorm …since 9 months and i see no loss in weight nor my hair grown , i excercise a lot and i eat clean

    please help me

  29. Dr. Childs, I have a complicated medical situation, but your information sounds like exactly what I need.

    Here are my particulars: I am 56 years old and weigh 235 lbs. At age 36 I was diagnosed with Congestive Heart Failure and am on many meds: Coumadin, Coreg, Entresto, water pills and potassium. I also have been taking Paxil 20 mg for the same amount of time. (I’ve gained most of this weight since starting the Paxil and being diagnoxed with CHF). Hysterectomy at age 49. And, yes my A1C is a little high, but I keep it down with exercise so I don’t have to go on insulin.

    Even though many doctors in the past have suspected hypothyroidism, only recently has the test come back showing it. So I’ve been on Levothyroxin for a few months now. It definitely helps my fatigue and at first it felt like I lost a little weight, but the last week or two, I feel myself gaining out of control. I am truly hungry often and usually have to eat just before bed or I won’t fall asleep.

    Knowing all of these facts, do you think any/all of your products would be safe for me?

  30. p.s. Also, I can feel the tightness in my throat/neck come and go and I’m sure it is my thyroid gland enlarging or something.

    Also, I do have mild bi-polar with family history of it.


  31. Hi,

    I had my thyroid removed and I’m trying to find a correct dosage. I’ve been taking T4 long before the surgery and never have felt any better. After my thyroidectomy I tried 175mcg T4 + 1,5 grains NDT, but felt still bad. After that only 3grains NDT without T4, no luck. Now I want to switch to T3 + NDT. What should be the ratio? Can I take T3 after I wake up and NDT before going to sleep?

    • Hey Michael,

      There is no specific ratio to take, you have to determine your dose based on a number of factors including T3/reverse T3 ratio and symptoms.

  32. Hi Doctor,
    I had a total thyroidectomy January 2016 because of cancer, I was started on 137 mcg Levothyroxine, the doctor lowered my dosage each time of my appointment (every 6 weeks or so), due to tsh levels. At a dosage of 112mcg, I started to lose weight (10 pounds in a few weeks) had energy, no more digestion problems, yet my tsh was too low still so they continued to lower my dosage. At 88 mcg I started feeling terrible, but they still lowered one last time to my current dosage of 75mcg levothyroxine. Te doctor said all my labs look good now and in range. However I continue to feel terrible. I feel tired all the time, palpitaions, digestion problems, can not loose weight, and severe depression and anxiety. I convinced the doctor to try to see if adding t3 would help. Reluctantly, she has started me on 5 mcg of liothyronine once a day, keep taking the 75 mcg of Levothyroxine for 6 days and not take one on the 7th day. Her main concern is I could have a heart attack. Its been 6 weeks and I feel worse than ever. I am 55 years old, weigh 173. was always very active before this. Thank you so much for listening, I hope you know a solution for me.

    • Hey Lynne,

      T3 won’t give you a heart attack, it sounds like you may need to find a provider more knowledgable in thyroid management if you want to feel optimal.

  33. Good day Dr.Childs; I was on 75mcg Levothyroxine 2 months ago but after getting my lab test results last month showing that i am hypothyroid my doctor increased my dose to 88mcg. Is this normal..? I mean, my thyroid dose going fromdoen then up..? I still feel tired, my balance is affected, ang my hair loss is getting worst. Thanks so much Dr Childs for any advice…

  34. Hello, I’m on 100 mcg a day, I am very tired, sleep all night and need to rest in the afternoon as well,
    I don’t have much energy, push myself to do things.
    I golf, and like to swim, and walk, as well as housework, meals and everyday chores.
    I am 72 years old, and am tired, shaky, nervous, cry easy, depressed, . I don’t think I should feel this way.
    I’ve tried taking it in morning and switched to taking at night.
    Could I be getting enough? Or not enough?
    I take other precritions, and vitamin D and vitaminB and C
    Still tired. What should I do??

  35. I had a thyroidectomy last March due to cancer. I felt great while I was on 50 mcg of cytomel and the 2 weeks I was off of it for the Rai treatment. Also the surgery got rid of my debilitating stomach aches and years of female problems. Since then I’m still trying to get on the right dosage of medication. I’m currently taking 50 mcg of unithroid and 25 cytomel. I suffer constipation and pain all over,(muscle?). Is Unithroid the same as Synthroid? Could the pain be from that or low thyroid? I keep wanting to get back to the beginning when I felt great. Why would I feel great on nothing? My doctor is stumped about that! I’m currently getting my vit.D checked. What should be done next? Also I feel like I have a noose around my throat from time to time. ENT Dr. said it was from acid reflux, Really? Not low thyroid?

  36. I do not believe my thyroid medication is helping, but I cannot get an appointment with my doctor for a few weeks. Should I stop taking my medication all together, or continue to suffer on 137 on Levothyroxine?

  37. Hi Dr. Childs, I have been trialing different dosages of levothyroxine and tirosint for the past 3 years. I am constantly bouncing in and out of good lab results ranges and symptoms and my Dr. has just moved me to 175mcg of a new brand (not familiar with the name yet). My Dr. says we have to keep upping the dosage until we find what works for me, and although I trust her, I am growing weary and would like to see if you might have any suggestions. Also, when I was on 100mcg all my symptoms seemed to be gone, my labs were at 3.5, but the next result came in at 6, and even though I was still symptom free we upped the dosage to 125mcg. Thanks for any thoughts.

  38. I am on total thyroid replacement as I had my total thyroid gland removed as a child. I am overweight, pre-diabetic and low energy. I was taking75 mcg of Levothyroxine and struggling to lose weight but slowly making some progress. My doctor changed my dose to 88 mcg. I don’t feel any better and have gained weight and feel hungrier and possibly more tired. on the 75 mcg my T-4 free was 1.4mg/dl and my TSH was 1.89 mcIu/mL. I haven’t had blood drawn since he switched me to 88mcg, but based on how I feel I’m going back down to the 75. Would appreciate your thoughts.

  39. I’ve been taking levothyroxine 0.100mg for 27 yrs….when treated for BC in 1991, I was experiencing numbness in arms at night….after multitude of onocology tests,they realized and I was diognosed with hypothyroidism. In the last 6-8 months I’m experiencing many old symptom (joint pain,constipation, fatique and including great weight gain)My recent thyroid test showed reading almost 10! My primary is monitoring it,BUT on same dosage. I feel I need to try another higher dose or different medication. What are your thoughts? I will try taking med’s at night.

    • Hi Sandi,

      You should also check other thyroid lab tests like reverse T3 and free T3 to see where you are at.

  40. Hello,

    I was on 0.05 mg Synthyroid for awhile after being on the 0.025 mg dose for about a decade. My govt clinic will only check TSH and it was around 2.4. My PA and dr didn’t believe me when I complained of anxiety and irritability. In fact my PA admitted that “these were symptoms of hyperthyroidism.” I was admonished to continue the higher dose. I have been on the lower dose 0.025 mg for over a week and feel great. I don’t have the frenzied need to keep moving or being irritable with my family. At the end of the month I have an appointment with a new PA to have a new lab. I eat a balanced vegan diet and take 1000 units of D3 and 500 mg Folic Acid I don’t have a weight concern and exercise 7 days a week. What do you suggest?

  41. Hello Dr. Childs,
    I am 56 years old and I was recently diagnosed to have subclinical hypothyroidism with TSH levels of 6.00. When the TSH levels were 4.0 my doctor said I am normal but I was having such a struggle to lose weight. Now he put me on Levothyroxin (50 mcg) and I am feeling worse. I rapidly gained 8-9 pounds, I feel that my stomach is bloated as it increased in size and I don’t get sleep and I feel tired and sleepy all the time. When I mentioned to my doctor he asked me to increase the Levothyroxine dosage.
    I would like to ask my physician to change my medication.
    1) Should I increase the dosage of Levo?
    2) Should I increase the dosage of Should I first do the lab tests and then decide what medication to switch to?
    3) Should switch to NDT or T3 only medication?

    I am from New York city area. Would it be possible to suggest me physicians who will treat hypothyroidism like you do? I will be grateful for your advise and help.

  42. Hello doctor

    I’m 27 years old I’ve been taking levothyroxine for the past 3yrs , I stared with 50 mg took it for a year and after that my doctor decided to give 100 mg I’ve been taking it for 2 years already but I recently staring to feel weekness my legs feel weak and my back really hurts plus dizziness and a lot of gain weight and hair loss .. my lab work are normal all the time and I really think is the medicine that’s causing me all does symptoms.. I spoke to my doctor but she said that my thyroid problem cannot be causing me that or the medicine .. what do you think is causing me that doctor can it be the medication ??? Please help I’m so stress out I want to feel normal again

  43. Hi
    Looking for some much needed advice. My Mum was diagnosed with an Over Active Thyroid many years ago, she had Iodene treatment which then turned her thyroid into Under Active. Since then she has been on Thyroxine. Ranging from 50mg – 75mg.
    She had a routine yearly levels check and the GP telephoned the house to say that her levels were too high & to stop her Thyroxine for 6 weeks & then have her levels rechecked. Just short of the 6 weeks wee awoke one morning to my Mum having a seizure in her bed, we telephoned for an ambulance and they took her into resus and did all sorts of tests on her, Lumber Puncture, x-ray, CT Scan & various bloods. They came back to tell us they had done all these tests on my Mum & couldn’t find out why she was having the seizures & that they didn’t think she was gonna pull through. At this point, they asked us if my Mum had been unwell? We said no, but the only thing was that my Mum had had her levels checked 6 weeks ago & was told by the GP to stop her Thyroxine. So they checked her levels & it turned out my Mum was in Thyroxine Crisis!
    To cut a long story short, my Mum ended up on a Ventilator for 6 weeks, during this time, she contracted MRSA & Sepsis Pneumonia. Thankfully, my Mum is an amazing woman & a fighter & she is luckily enough to still be here. On being discharged from hospital, she was on 100mg of Thyroxine. She was a little tired, but I’d say that was to be expected due to everything she had been through. But on the ehole was doing good. She’s had reviews at clinic & each time, been told that her levels are too high & it’s been reduced, 75mg, then 75mg/50mg alternative days and now on 50mg. She has steadily got worse & is now at the point where she gets up in the morning, lays on the couch all day resting & goes to bed at night! I recently requested her GP test her T3 but have been told her levels are “normal” I phoned her Endocrine Consultant to be told that if she was more tired, then to contact her GP (which i already did & that’s why I was contacting him) and that he didn’t want to increase her Thyroxine as it could cause her to be more tired & be more dangerous if her levels where too high!! I know my Mum is just not right, she is 73, but I don’t think that should be a major factor in the way she is feeling. I feel as though I am banging my head against a brick wall & feel she deserves better care than this!
    I look forward to hearing your thoughts.

  44. HI, I had my thyroid removed two years ago. Still fighting with my dosage. I am curious if someone without a thyroid needs T3 added? i am on 200 mcg of Levothyroxine. My endocrinologist dropped seeing me after he got my numbers in range. I do have a general doctor who is willing to work with me to help me feel better.My biggest question is if i need T3 added. I am very interested too in switching to the 50 mcg. When they raised me to high levels i started having horrible eczema. Never had before. Thank you for all this information.

    • Hi Neysha,

      All of this information is relevant for those with a thyroid and for those without a thyroid.

  45. Hello,
    I’m 42-year old, 6’3” male taking levothyroxine the past couple years (every morning on empty stomach). Tests kept coming back to increase. Went all the way up to 300mcg, but now back down to 275mcg. Haven’t had tests done in over 6 mos.
    I have had all the typical thyroid disorder symptoms over time, and they have steadily gotten much worse lately (puffy face and jaw, unexplained weight gain , fatigue, waking up throughout the night , heart palpitations and chest fluttering, irritability, depression, aching joints, heartburn/GERD, etc).
    I’ve researched a lot of info on my symptoms and possible solutions that echo what you talk about…malabsorption issues, not on the right type of medication, etc.
    My previous family doctor retired and I want to make an appointment with a new one. My concern is he/she will just take another panel and look at my numbers and say they’re in normal range…to which I don’t feel anywhere near a person should…and I’m seeing many other people seem to get the same frustrating diagnosis.
    Do you have any suggestions or what are some key points I could address or stress with a new doctor that may help he/she being open-minded to this medication is NOT working for me as intended?

    • Hi Paul,

      There is really very little you can do to try and convince a doctor to practice in a different way. It would be the equivalent of someone on the street telling a major CEO how to fix their business, even if you are right they just aren’t going to listen. Instead it’s much easier and more effective to find a like minded physician so you don’t waste time or energy trying to convince them.

      Men are also different from women in that they tend to both need more T3 and tolerate T3 better than women.

  46. Hi Dr Childs

    I am a 60 yr 5ft.2 122 lb female just diagnosed with hypothyroidism and was put on 25 mcg of Levothyroxine. I have only been on it 2 days so I really don’t know how I will handle it, but I have a fear of the chance of weight gain that I have been reading about. For 23 yrs from 20-43 I was bulimic and although I have been free of that for 17 yrs and have learned how to keep my weight down (122) in a good way I truly do not want to gain weight. Is this going to be a problem for me. If so what do you recommend.

    Thank you Dr. Childs
    LaVonne Mitchell

  47. Just starting with Levothyroxine 50mg today so a really informative read. I know doctors in the UK are not the best at handing low thyroid function particularly with using T3 so this has given me good guidance should my dosesge not work.

  48. Hi Dr. Westin

    I was taking 50 mcg levothyroxine and 12.5 mcg liothyronine for a year or two and my free T4 and T3 are always on the low end of theIR ranges. My TSH is below the given range and my free T3 to reverse T3 ratio is 0.23 and should be about 20.

    Is it OK to increase levothyroxine from 50 mcg to 100 mcg, or should it only be increased in 25 mcg increments? Also, do you have any other suggestions on how to get my free T4 and free T3 into the upper part of their ranges?

    I have Hashimoto’s and I am staying away from wheat and grains. I have put on 18 lbs in the last few years and it keeps creeping up no matter what I do.

    Thanks and I look forward to your response.


  49. Hi, my tsh was normal but my ft4 was high & my doctor refuses to test anything other than my tsh & ft4. Currently on 100mcg of levo. But still feel horrible & have all the classic hypo symptoms, what advice can you give me so I can better communicate with my doctor & start feeling better

  50. Hello Dr Westin,
    My experience with T4 only Doctors has been debilitating. I was a former cycling champ with no hypo symptoms to talk about. I averaged 12% @ 175 lbs during this time, up to age 54. My Doctor decided that due to a TSH OF 5.5 that I needed to be on syntroid for the rest of my life. Note: No other test contributed to this conclusion. Within 2 weeks of taking 100mcg Levo. I started to gain weight. After 2 months I was 20 pounds heavier @195 lbs and feeling like crap. I continued for over a year, and just kept getting worse. The whole time my Dr was saying that my numbers were perfect. I don’t recall a TSH of 2.0 perfect. I went to 2 other Endos, all from the same T4 only list of doctors because my Dr refused anything else. Finally I went to Bodylogic, at my own expense, $3900 worth of no results with a compounded T4/T3. I gave up hope on being normal so I discontinued all medication, but not the bike riding od an estm. 200 miles a week. One year I totaled 8500 miles riding to work and back, all year long. I still gained weight, and felt like crap with body temps going down to 91F. I average 96.5F first thing in the morning, and have yet to see 98.6 unless I have a fever. I am also very heat intolerant. My Dr sent me to a cardiologist last year, and he didn’t want to hear about a thyroid issue, he took a blind eye to it. I was given a stress test within a couple weeks, but the results were not posted on my patient account like all the other Drs that have posted results. I feel like a LAB RAT being used to make a profit and that I was deliberately pushed into a medically induced state of Hypothyroidism so that this medical facility can profit on the side effects. I have read about T3 ONLY and other therapy like Armour, but finding any Doctor is almost impossible, and going outside my Insurance will once again cost me $$$. By the way, my Doctor call these alternative Doctors, QUACKS! I beginning to wonder who the quacks really are. Now my Doctor want’s me on statin drugs . My answer to all his suggestions for the moment is that until he puts me back to normal, his services/advice will not be considered. Snake oil salesmen need to look for another job, people are hurting due to complications from their actions.
    What advice do have?

  51. I was a hyperthyroidism sufferer and I had my total thyroidectomy in early 2015. However, I’ve been feeling great but my TSH seems to disagree with my overall feelings. According to my lab result, my TSH level is about 8.0 (US scale). My physician increased my medication to 150 mcg. I really do wonder what is going on in my body. I feel happy and content. My period is regular including vitals. What do you think I should do? Refuse to take my new dosage?

    • Hi Jent,

      As a rule of thumb your physician should never just treat your lab numbers, he/she should evaluate you in context based on a combination of all factors including your symptoms, labs, etc.

  52. Good day,
    I suffer with hypothyroidism and i have been on Lthyroxine tablets for the past 3-4 years. I was on 50 mcg per day then eventually on 100 mcg. I also take omez tablets for acid reflux on a daily basis. Since last year i have gained weight and its becoming very troubling for me. I did not change diet, I try to exercise when I can. I do still get symptoms of feeling cold, constipation at times, depression, insomnia. I was even thinking of to stop taking the Lthyroxine for awhile and see what goes on. I attend clinic for this every 6 months or so, I am due for a visit next month. When I do go, I wanted an idea of questions i should ask the doctor or if I could suggest to them what other blood test can I take to see if the medication is working properly for me. I am really bothered by the weight gain as I was at a constant weight for a number of years.
    Could you please assist me with some advice/suggestions in my matter. Thanking you in advance… Regards….

    • Hi Rowena,

      I have the appropriate tests listed on several blog posts on my site, if you poke around you will be able to find them. Just realize that if you have to ask your doctor for the tests there is a high chance that he/she will not be able to help you.

  53. I was on Levothyroxine for 20 years. Now, I have Hashimotos. Started WP thyroid, got a lump in my throat in two days. Now, I am working with an ND who put me on Eco-Thyroid 125, and I have a lump in my throat. Increased by 39 mg and I still have a lump in my throat. TSH on 100 mcg Levo is 6.1, Antibodies are high. I am gluten and dairy free.

    So frustrating!

  54. Hi! I am currently drinking Novotiral which contains 100mcg of levothyroxine and 20 mcg of liothironine. The doctor told me the dosage is according to your weight. I gained weight and now I weigh 112 pounds so I don’t know if my dosage should go up.Thank you

  55. Hello,

    I want to make sure I am understanding your chart correctly. My doctor recently switched me from NDT to levo and liothyronine because my antibodies were increasing with the NDT. I was on two grain and she switched me to 100mcg of T4 and 25 mcg T3. If I understand your chart correctly my T3 medicine should be more at 50mcg and 200mcg levo. Am I correct? Thanks!

    • Hi Courtney,

      The chart is more of a guideline than anything else, some people might have to reduce their dose when switching due to sensitivity to T3, etc. At the end of the day it’s more important to evaluate thyroid dosing based on labs and symptoms and not pre set ranges. Unfortunately there is no “perfect” dose equivalent.

  56. I had an afib incident (first and only time). During the testing it was found my TSH level is 8.6. It was 4.0 three months earlier. I was prescribed 88mcg Levothyroxine. It should be noted at the time of my afib I felt fantastic. I working out 5 days a week and was in good shape. I have been on Levo for 4 1/2 weeks and I feel awful. My hands tremble. I feel faint several times a day. My arms and legs feel weak. And I can feel my heart poumding in my chest. My doctor told me she was starting me on the lowest dosage. Obviously that wasn’t true. I cut a pill in half (44 mcg instead of 88) today and I already feel better. Do you have an opinion on what is happening?

    • Hi Jeff,

      It sounds like your physicians were assuming that your a fib episode was, at least in part, caused by the hypothyroidism. I generally don’t recommend treatment for hypothyroidism with thyroid hormone based on 1 TSH reading in the setting where someone is asymptomatic. Your current symptoms may be consistent with taking too much medication, but I’m not really in a position to make that assertion.

  57. Thank you for the reply. I suspected diagnosing me as hypo after a single TSH test was premature. I am getting a new blood test in a week and I will request the T3 and T4 testing as well as the TSH. Thank you again.

  58. I am currently being treated by a single payer system, the VA. Because of this I have little or no say about which doctors I see or what they do.

    I had my thyroid removed 14 months ago due to cancer. I have been sleeping 16 to 26 hours at a time since then. I am and have been taking Levothyroxine 0.2 MG per day and Liothyronine 5MCG per day. The last doctor I saw for this said that was the max they could do because any more medication would cause bone damage and refuses to do anything else. I am not even 60 and can not see spending the rest of my life sleeping. This problem has caused me to have a bankruptcy because I can not work. If I go outside the VA, I will still be stuck with the same doctors because of the area I live in, so I need some alternatives that I can take to then and I need to know if they are just BSing me as far as the medication levels.

    I hope you can take some time to help me with information I can present to the doctors at the VA that may help.



  59. I have a diagnosis of hypothyroid I currently had a increase in levothyroxine due to my levels being high. however I was taking Levothyroxine 112 MCG Monday through Saturday and 2 tabs on Sunday equaling 896 MCG per week I know am taking 125 MCG daily which equals 875 MCG which is less then I was getting weekly. Does taking a higher dose daily improve your levels or could this be a error.

  60. I have been on pig thyroid, synthroid and now levothryn my blood work is now in range on a 75 and on a 150 and on 137 but I have Afib pretty regularly from the higher dose of 137 and 150 but very rare on the 75(I was cutting 150s in half) I get terrible fluid retention with my dosing off and have absolutely zero weight loss with a very strict diet. They also diagnosed me with Hoshimotos due to my antibodies number. My brother had hypo and hyperthyroidism but now requires no medicine. Any thoughts?

  61. What would be the downside to taking half the dosage of levothyroxin if you feel your dosage may be to high? My doctor increased my dosage to 88mcg because I did not feel I was obtaining the desired result. Turns out that the symptoms I was having was corrected by simply drinking more water. So my thinking is by simply breaking breaking my pills in half would get me back closer to where I was before the increase. Then when I get my new refill prescription I’ll just go back to my normal mcg. Thanks, Doug

  62. I have been on Synthroid since I was 18 years old. I am now 48 and taking 200mcg daily. With an extra 100mcg a week. A year ago my insurance company stopped covering synthroid so I was changed to levothyroxine. My latest labs however are TSH 9.9 and t3 and t4 normal. I’m having issues with weight gain and tiredness. And I do get occasional palpitations which started after increasing to 200 from 175. I have acid reflux and was taking a multivitamin and Pepcid at same time as my synthroid daily. What I don’t understand is why my TSH continues to run high even on such a high dose of synthroid. Any help would be appreciated.

  63. Hello,

    I’m currently on 125 mcg levothyroxine, my dosage increased from 75mcg to 125mcg after sudden weight gain of 15lbs and worsening symptoms. It’s been about 6 weeks since I started the new dosage and not much has changed. I’ve been using levothyroxine for 15 years and my dosage keeps increasing because every few years my symptoms worsen and sudden weight gain and then my dosage increases and I generally improve, but not this time. On 75mcg my tsh level was 3.08, I’m getting blood work today to see how the increased dosage had effected the levels. What are your recommendations?

  64. I was diagnosed with thyroid tocsicosis at the age of 18, that was 38 years ago at the age of 21 I had a thyroidectomy that was 35 years ago.
    I have been fighting all these years to try and sort this iam at the end I have no energy I feel I am dieing and the doctor still saying my labs are fine. I have an appointment to see an endocrinolcoli gest if he won’t sort or at least try to sort my medication then I will have to buy it on the Internet, please advice I am taking 175mg per day levothroxine

  65. I was on 100 MCG Levothyroxin and felt wonderful. I moved and found a new doctor. He ran a TSH but not a T3 or T4 test. The TSH 0.098 so he reduced my medication to 88MCG. I feel horrible! I can’t believe it makes that much difference. He wants me to take this dosage for 3 months. I haven’t even made it through a month. I called with my concerns and all he said was come see me in 2 months and keep taking that dosage.

  66. Dear Dr Childs

    I switched from 75 mcg of Synthroid to 75mcg of Tirosint. 3 Months later I started developing sever muscle spasms, twitches and tremor in my right hand. 6 months later I switched to Levoxyl also 75 mcg but still have the same symptoms. MRI shows no problems. Soon after taking my T4 the overall body shaking, twitches and spasms start. I am too sensitive to take T3 as it seems to increase an adrenaline response. Should I lower my T4 intake, I am 5 feet 2 inches and weigh 104 pounds, have no weight issue but for sure develop severe adrenal issues when using NDT or T3. Thanks

  67. Hi Dr Childs
    I am taking 50mg of Euthyrox which is Levothyroxine-Natrium here in Switzerland. I have Hashimotos. Since taking it I experience anxiety. Will this pass in time or should I try to switch medication? Thanks for any advice.

  68. HHello, I have been dignosed with hyopthyroidsm for about 18 years. I am taking 100mg of snythroid, and 10mg of cytomel. I have been on this same dosage for about 10 years now, give or take a year. I am feeling all the symthoms that you have described in this article. I have been a small framed person all my life, and now I am about 30 lbs over weight. I have had my 4th child, and have lost weight only to gain it back again. I am tired all the time, and I am depressed. Some nights I stay up all night, cause I can’t sleep, and end up sleeping in late in the day. Other days I go, go, go all day because I have kids ranging in age from 14 to 3, and I have no choice but to go go go. By the afternoon I am ready for a nap, and I feel like I haven’t slept for days. I am at an endless cycle. I want to be myself again, and not get out of bed every morning feeling like I am 90 years old with body aches, and pains, and tired all the time. On top of that I want to lose this 30 pounds. I am a very active person, and the last 5 years I am to tired all the time to be this way. What can I do.

  69. I have been on Synthroid/Levothyroxine for over 25 years. I am still gaining weight, even when I eat healthier and exercise, I gain … doesn’t matter what I do. I have asked my doctor multiple times to try a different thyroid med and he refuses. The last year has been very stressful and isn’t likely to change anytime soon, but for the last 6 months, I have felt like crap … and it’s getting worse. I ache all the time now. I hate feeling this way, but it is difficult to find a doctor who is willing to help me try other types of meds. What questions should I be asking or where should I be looking to find a doctor in my area that has a more open mind about getting me off of Levothyroxine and on to something that helps? Please help!! Thanks!

  70. Hello Doctor,

    I was diagnosed with Hashimoto’s that lead to hypothyroidism a year ago. I started with 50, in June this year my TSH was 0.03, T3 and T4 were at the desired levels.My doctor decreased the dosage to 25 and 50 alternatively. However, I took only 25.Today TSH is at 5.02 and T4 at 0.88, T3 is again at desired levels.

    what is the appropriate dosage that you suggest? I am 40 and trying to conceive, I have also had a miscarriage in 2015 and that was before I was diagnosed with Hashimoto’s. Please advise.

  71. Hi Dr.Childs: I have a great story to tell about my hypothyroidism journey.
    3years ago my doctor diagnosed me as hypo with only 6 points out of range.
    She gave me script for 25 mcg’s levo. At first it made me feel great. About
    6 months in I started in with shakes, shivers, low temp and significant eye
    issues. I thought my weight was stable. I was wrong. It came on slowly and
    in 2 years I was 25 lbs higher.
    I am referred to as the ‘witch doctor’ by my family and friends as I have studied and used alternative medicine for about 30 years. My son got quite sick at 2 years old and Ped could not tell me what was wrong after 3years of
    sickness for him a homeopathist told me he probably had parasites and sure
    enough he did. He was cured by homeopathics and then tested after a year by
    his Ped and was clear. I’ve studied alternative med since. So I researched
    and spoke to a few nutritionists and added Selenium and L Tyrosine daily starting last September along with the levo. I did change my diet also as I
    detox twice a year but would go back to the poor ways of eating and feel
    decrepit after a few months. So reduced fat no bread, a mix of good protein
    and alittle carbs with low coffee and alcohol. And I’ve lost 22 lbs and am
    still losing. Almost all symtoms are gone except my hair is thinning on the
    levo. I do feel alittle reved up so I may reduce the L tyrosine (which also
    has Iodine added to the supplement I forgot tomention. I occasionally have
    minor eye issues, light sensitivity, watering, but no gritty feeling. I
    am going to take my temp again at your suggestion as it was very low years
    ago. I am 70 years old and look a healthy 50. I work out, walk 5 miles every
    week. I would love to stop my hair from thinning. Do you have any suggestion?
    There are a lot of allopathic Doctors that practice alternative medicine in
    every state. I know of several in Pa. New York and New Jersey and California.
    They do know about the things you are writing about. I am surprised that you
    say you are the only one. There are medical societies of all kinds that could
    help patients looking for a doctor in their state.

  72. I was “scare-tacticed” into thyroid surgery this winter for follicular carcinoma that had not spread but was contained to a few nodules, not impairing my quality of life. I was also being treated for a pituitary adenoma diagnosed by high prolactin/mri that fall. I finally was feeling normal (less brain fog and fatigue) and losing weight 1 month before surgery after being on cabergoline for a couple months prior. Then they told me I had to have thyroid surgery. I only let them take half the thyroid (not going to go back for another surgery 3 days after the first). They assured me my thyroid would function normally but it hasnt. My tsh was .7 in ’14, 1.1 in ’16, 2.3 after surgery, 1.5 in May and in July I noticed more brain fog, falling asleep while driving and being tired. My weight has continued to skyrocket despite once being an elite athlete–145lb (normal weight) in 2005 after birthing 1 child, and now Im close to 175 after having a 2nd child in 2007–i havent seen the 150s in 8-9 years. I bike close to 300mi/wk, swim 2-3xs/wk, play soccer 1/wk, and just started another round of strength training which I used to do only in the winter but now do spring and fall to try to lose weight. I was hoping to compete in pro cycling races but my health has put a stop to that and you cant race elite 30lbs overweight.

    I finally called the doc after i couldnt take it anymore (i ruined my triathlon wetsuit i had fit into for 7 years prior because I had gained so much weight) and physically could not exercise anymore or eat less to lose weight or feel better.

    I just got my labs back and my TSH is 2.03. They would not test anything else even though I asked for t3. Of course they wont call me back with what to do. Ive been on 50mcg of levo since April which i take between 1am-3am to make sure it is absorbed and used. I hate taking this medication. I take a ton of herbal stuff and supplements too but it doesnt help anything.

    Am I doomed to be fat and tired the rest of my life? How does one get a provider to listen and afford the all the medical bills from it all (esp if you need 10-12 hrs of sleep and cant hold a normal hr job due to all the sleep needed)? 🙁 i found your article interesting and am going to try to up my levo myself and see what i can do.

  73. Hello Dr.Westin, l,m 76 have been taking levothroxine (150mcg) since my 40,s because my thyroid apparently destroyed itself.My GP recently reduced my dosage to 125mcg citing recent lad tests.What could prompt this reduction in my dosage? Thank you.

  74. I had a thyroidectomy 2 years ago leaving 3 small pockets of cancer in my lymph nodes. Dr says as long as tsh under .1 which it has been, all is good I lost 30 lbs then my tsh went to 4.29. Dr changed levothryxon from 137 to 150 and came down after 10 weeks to 2.39. I now have a afib needing a cardioversion and ablation. I think tsh is causing it Dr doesn’t think so.

  75. I had thyroid removal 10/16. After 8 months on Levothyroxine 75 mcg, I still felt lethargic and about 10-15 pounds over my normal pre-surgery weight. My TSH was then 1.83, T4 was 1.32 . My endocrinologist changed me to Levothyroxine 50 mcg & liothyronine 5 mcg . Now, 2 months later, I feel better, but still not as good as I used to feel consistently; and am still the 10 pounds overweight. My TSH is now 3.04, T4 free 1.12, T3 triiodothyronine is 117. I don’t have an earlier T4 free and T3 as she didn’t test for it.
    My doctor says that is all she can do, get a second opinion if I don’t like it. I do not wish to take the desiccated animal thyroid if possible. Any thoughts?

  76. Hi there
    I was put on Thyroxine when I was about to start IVF and my TSH was 5.2 and needed to be 2.5 or lower. I am on 75 daily but recently have put on about 2lb a week and am feeling tired and down all the time. Do you think i just need more Thyroxine or also T3? It’s hard to get T3 in the UK now unless you buy it from abroad.

  77. My tsh was .39 in beg May and Dr chgd my synthroid from 112 mcg to 100 mcg. Been on 112 for quite some time. Only prob was harder to lose wgt, but had been maintaining. Now wgt increase and trbl sleeping since dose chg and end of may recheck, tsh 1.12. Still not feeling well, tsh recheck now is 3.29 and requested t3/t4 checked. Says normal, but I felt btr on 112mcg, but won’t let me go back, wants on 100 mcg. So not helping complaints and then what, in 3 mos, tsh triples agin and add another 10 lbs to 10 already gained and no good sleep??? HELP!!!

  78. Hi doctor. I had ensiphilitus last year and was overdosed with steroids leading me to have a 14 TSH level. My symptoms are confusion,short term memory problems,cold hands,tinnitus and a few more. First,can high TSH levels cause these symptoms and 2nd is this hypothyroidism? My T3 and T4 are normal only TSH is high at 14. Thanks

  79. Hi Dr. Westin, I am 72 years old and have been on levothyroxine 100mcg for 7 years. Having moved to Ecuador the medication brand changed to Eutirox, since this change I am experiencing more hair loss. Medication is over the counter and I am considering increasing my dosage. Do you recommend adding a T3 medication and how much dosage increase would be acceptable?
    Thanks, looking forward to a reply.

  80. Hi Dr. Childs,

    In the past 3 years, I beat stage 3 uterine cancer and now have ME/CFS which seems to be from Epstein Barr and other infections plus low IgG – am on IVIG.

    I have Hashimotos, was originally on all T3, then on 75mcg each T3 and T4 and felt fine. However, I’m actively losing bone – all tests say so. My PCP moved me to 100mcg T4 and 62.5mcg T3. That feels fine and my temp has been 97 to 97.7F consistently and heart isn’t racing or pounding.

    Saw an endo specializing in bone health and he thinks I should go to 125mcg T4 only, even though he calculated my dose equivalent to 350mcg T4. My TSH has been less than .1 for 6 years.

    I can’t have my bones dissolving, but I’m not buying that the 125mcg T4 is going to keep me functioning. Every time I’ve tried dropping my dose, I’ve gotten cold and crashed.

    Any thoughts?

    Much appreciated…

    • Hi Sharon,

      Many things may contribute to osteoporosis so it’s worth evaluating other causes. From the history you provide it sounds as if someone believes that your osteoporosis is secondary to a suppressed TSH (which is possible but the data is inconclusive). If you are menopausal it may be secondary to a drop in estrogen/progesterone, but your history of uterine cancer would likely remove you as a candidate for HRT.

  81. My thyroid was removed over 2 months ago due to Thyroid Papillary Carcinoma. Two weeks after surgery, I went on a low iodine diet so I could receive radioactive iodine treatment. It took my body 8 weeks for my TSH to get to 31 before I could get treatment. I started on 125 MCG’s of Levothyroxine 6 days ago. My endocrinologist said that my Total body scan after treatment was negative and also told me to make an appointment in eight weeks for blood work and a visit, even though my initial paperwork said 6 weeks. I feel terrible. I am exhausted, have muscle and joint pain, I can’t think straight, I am moody,and I am still losing hair. I am a mother of two and I teach full time. I am concerned and think 8 weeks is too long to go in. Is it too soon to tell if the medication is or isn’t working? Could it get better over time? I almost feel worse then when I had no thyroid at all.

    • Hi Krista,

      Usually if you are reliant upon thyroid medication (post thyroidectomy) then you notice changes to your thyroid dosing very quickly.

  82. I was on Levothyroxine 125 mcg for years and I felt pretty good. We moved to a different town and a new doctor. My problem is within 2 months my doctor lowered my dosage to 100 mcg and then again to 75 mcg. My acid feflux has returned and I am so tired after getting plenty of sleep. I know I need to consult with my doctor, but what do I tell her.

    Thank you

    • Hi Diana,

      You can mention exactly what you mentioned here. Acid reflux may be related to thyroid function both from a reduction in HCL production in the stomach and from a reduction in intestinal motility which may promote acid reflux and SIBO.

  83. I was on 125 mcg. I’m under the care of a VA Doctor. She has dropped me to 37mcg per day.

    I have loose bowels and I am cold I don’t remember things which is frustrating. Been this dosage since 9-13-17. Don’t know what to do.

    • Hi Bruce,

      If you are symptomatic after the change then it’s probably best to ask your doctor to recheck your thyroid lab studies and then go from there.

  84. Hi Dr. Westin,

    I am 59 year old male. I am a Veteran. I had an Acute Aschemic Stroke at 53 years old (2010). I was treated at the WLA VA- (Los Angeles) and the Sepulveda Amblatory Hospital VA in the SFV. They did several MRI’s with contrast and determined that I had approximately 30 percent defused white matter on my brain- (Short Term Memory Loss). I was in a mixadema coma for two weeks. And there is more. But I am just capping on the major points here.

    The results were from a diagnosis of Hashomoto’s Disease and Binwinger’s Disease determined by multiple specialist determining the diagnosis. Later it was diagnosed that I had a 80% blockage in my right renal artery, so I have a stent now. My thyroid completely shut down and I was within two hours of death. I have HBP (160/95 typically), and High Cholesterol (268 LDL currently). My thoughts of Statins is They almost killed me when they put me in Stage 4 Acute Renal Failure, so I do not like Statins. I tried Niacin and both Stanols and Sterols with no success, so I will be going back on the Statins against my better judgement. I take .137 mcg Levothyroxine, 20mg Benazapril, 25 mg Hydro Cloro Thyazide, and a 81 mg aspirin. I went into the WLA VA ER at over 200 lbs. My B/P was 200/150. I had a team of 12 VA physicians working together to save my life. When I left the VA Hospital, I weighed 163 lbs. I have stayed that way for 7 years, until recently. I am now back up to 195 lbs. I have several symptoms that you have mentioned that I surmise my Synthroid is not working anymore, or not absorbing properly?

    I have contemplated that it is my metabolism that is the problem. I have researched this extensively to determine if my free T3 and free T4 are the root of the cause. My primary care physician tells me my lab test are normal- TSH, Limpid Panel, Thyroid Panel, Comprehensive Chemistry Panel, Hepatic Panel, PSA, Thyroperoxidase Antibody, CEA, CBC, etc. But I am putting on weight regardless. I eat healthy/exercise, and I am still gaining weight. I am 6 feet tall, and I got up to 220 lbs. I do not know what my BMI was, but I am sure it was above 30. I feel comfortable about 160/170 max, not 195+. I can drink only water and still gain weight. My thoughts are that I could use a T3 supplement to compliment the T4 Synthroid. Do you concur?

    I realize it is almost impossible to diagnose an individual without examining them. I am aware of that fact. I have had some of the this countries leading SME’s in their fields from both USC MD/Professors, and UCLA MD/Professors, including Cedars Sinai physicians examine me and say my labs are normal. And my one Endocrinologist is the Department Head Professor at UCLA Endocrinology Department, and my other Endocrinologist is also considered a SME in her field of Endocrinology also, and they saved my life. Any suggestions? Where are you located? I have Veterans Choice, and TriCare, so I can go outside the VA to private practice, and did so for three years. I would have no problem to come to you to find the solution to this. I am frustrated. Thank you!

  85. Hi I’ve been diagnosed with hypothyroid after having hyper thyroid for 13 years. They radiated it to shrink it so my levels are now hypo. They started me on 75 mcg three days ago when should I expect to see results?

  86. Hi,

    I had a Thyroidectomy for (cancer) a year ago and for the past few months Ive had a burning/stinging sensation off and on through out my body and oddly only one numb big toe and horrible feet pains that cripple me at times.

    My Endo has me on 125mg synthroid and 5mg Cytomel and I still feel off and he won’t listen to my complaints says I should talk to a professional about my stress and now I suffer in silence.

    Is this random burning/stinging sensation have something to do with my lack of thyroid or something else?

    • Hi Grace,

      It’s hard to say because no less than 20 different conditions can cause burning/stinging ranging from vitamin deficiencies to nerve damage and so on. The best thing you can do is find someone who is willing to take your complaints seriously and at least try to help diagnose the problem.

  87. My TSH was 3.2 in dec 2016, then skyrocketed to 7.6 in June 2017. Started on 50 levothyroxine, just took 8-week blood tests, TSH dropped to 3.0. However, endo wanted to bump me up to 75. Can I try 75 and if there’s no difference, go back to 50?

    I feel ok, some occasional acid reflux, some mild tiredness and some problems sleeping. And haven’t lost any weight.

    Can dosages change, particularly decrease, with no issues?

    Thank you! Your article was a great read and very helpful.

    • Hi Cindy,

      I’m not really sure of what you are asking. A high TSH is indicative of hypothyroidism and the TSH should drop down as you take thyroid medication. Some studies suggest that a healthy TSH is around 1.0 or so (depending on the literature). If you drop your dose your TSH will increase and may make your symptoms worse.

      If you want to take a natural approach, as opposed to using medication, then you can find more info in this post: https://www.restartmed.com/increase-free-t3-naturally/

  88. Hi again
    One more quick question about water retention is it common for people without a thyroid to carry 4-6 pounds of water weight?

    No I don’t have heart related issues and I know for a fact I drop the 4-6 lbs because I take HCTZ/TRIAM 25mg for Meineres disease prior to my thyroidectomy I use to only take it once in a great while during hearing attacks now that my thyroid has been removed I need it more often and I can drop 4-6 lbs of water. When I had a thyroid and took this pill I would only drop a pound or less of water.

    I do a low sodium diet for my ear disease I just never had this much fluid build up. Is this common and what should we do to fight this type of fluid build up and What causes this?

    Thanks, Grace

  89. Dr. Westin,
    I’ve been going in circles for 5 years trying to figure out why my energy level is so low. I finally figured out I was very low in ferritin and have been working on that. My B12 wasnt great so I corrected that, D wasn’t optimal so I fixed that. Then I went to a functional doc and they decided to put me on Naturethroid. After about 10 days I was wigging out and had a high pulse and heart palps so I stopped taking it. For a year I took ashwaghanda. My thyroid labs never got better… slowly got worse. Then I tried a supplement with zinc, selenium, iodine, tyrosine, etc… it didn’t help. So I finally tried to get back on NDT but very slowly. A half of a 1/4 grain every other day and built it up to half of a 1/4 grain everyday. I felt so much better but still with the side effect of that anxious, over caffeinated feeling. I got very sensitive to my morning coffee and sometimes found myself talking pretty rapidly haha! So I finally decided to go to an endocrinologist. He was not against NDT at all but he said in my case I’m too sensitive to the T3 so he put me on synthroid/levo (25mcg) and said to get off the NDT right away. I’m also having fertility issues. 2 years and not pregnant. So anyway about 4 days after the medication switch I feel like death. I’m wondering if I just need to give it some time? I feel like I’m walking through mud, I’m moody, weepy, bloated. Does it just need a chance to get working in my system? HELP! Thank you so much.

  90. My OB GYN noticed after blood test were drawn that my thyroid levels were off. He prescribed me with Levothyroxine 0.025MG. After knowing this be the cause of my fatigue, weight, etc. I went through my old blood test from my primary doctor and noticed my thyroid levels have always been off slightly, not sure why my primary doctor never thought this was an alert! After taking this pill for almost two weeks, I noticed couple days ago my left thumb (only finger) that constantly twitches. I couldnt find anything on the internet for this side effect. I am unsure if the dosage is too high (I know 0.025 isn’t much) or is to low. I still haven’t seen any changes in my weight and I do eat a lot healthier than I did before. Not knowing what is actually going on is very frustrating if you can provide any clarity for this will be a great help!

  91. My OB GYN noticed after blood test were drawn that my thyroid levels were off. He prescribed me with Levothyroxine 0.025MG. After knowing this be the cause of my fatigue, weight, etc. I went through my old blood test from my primary doctor and noticed my thyroid levels have always been off slightly, not sure why my primary doctor never thought this was an alert! After taking this pill for almost two weeks, I noticed couple days ago my left thumb (only finger) that constantly twitches. I couldnt find anything on the internet for this side effect. I am unsure if the dosage is too high (I know 0.025 isn’t much) or is to low. I still haven’t seen any changes in my weight and I do eat a lot healthier than I did before. Not knowing what is actually going on is very frustrating if you can provide any clarity for this will be a great help!

  92. Just had my labs done. Dr. had decreased my levothyroxine from 150 mcg to 125 mcg because my levels were to high. Now they say my levels are to low, & are lowering my dose to 100 mcg. This seems completely wrong to me. They tell me Thyroid meds are confusing and insist this is right. Your thoughts please, before I start a new dosage. I have been on thyroid meds since the early 1980’s, & I am 65 years old.
    Thank You!!

  93. I had my thyroid removed in June, 2017 – no cancer. five days later I was hospitalized for extremely low calcium. My starting dosage was 137 mg, then it was reduced to 125 mg, then 112 mg, and just recently 88 mg. My symptoms are worsening. I’m fatigued all day, experiencing cold sensitivity ( I wear two sweaters usually, and at hope have a blanket while watching television) have gained weight although my appetite his decreased. I’ve been told the meds must be lowered as my TSH is still elevated. Have been referred finally to an endocrinologist as my doctor is stumped however, there is only one endocrinologist in my area and the wait to see him is 6 to 9 months. I really need some relief and explanation why my dosage is repeated reduced and my symptoms are worse.
    Any information would be greatly appreciated.

  94. Hi Doctor Childs. I was diagnose with Graves disease in my 30s with it. I did radioactive iodine. I am on levothyroxine, I’m 58 now. My Doc up my med from 50 mg to 88mcg. He said because my numbers are a little off. It’s a green tab.my question is, he say the thyroid is still ok but why did the numbers go off. The new med makes me feel that it’s turning back to the other way that it was before I drank the radioactive iodine. Is it possible, I need to drink it again. Thanks Pam

  95. My endo refuses to prescribe anything other than the generic synthroid. He’s also got me on victoza and metformin for my type 2 diabetes. I’m losing weight while also following a keto type diet. My hair is thinning and my skin is dry. This happened before when I was on synthroid. My GP prescribed nature throid in the past, but a very low dose. I’m on 112 mcg synthroid, and I’d like my GP to refill my nature throid so I can get off the synthroid, but how to know what the correct dose would be. Any suggestions?

  96. Hello Dr. Childs,

    I have am an RN diagnosed with hypothyroidism since I was 14 years old. I am 60 now. Taking synthroid 0.075mg daily.
    I don’t have Hashimotos, no antibodies against thyroid.
    I still have a lot of hypo symptoms. Fibromyalgia, hair loss, insomnia, anxiety and others.
    I did a lot of research on my options and wanted to try a product called Thyrovanz. Comes from grass fed cows from New Zeland.
    Have you have any experience switching patients from Synthroid to this particular product?

    I respect you and your work greatly!!!!

    I wish I had a Doc like you!!


    Rosa Bazzani RN BSN IBCLC

  97. Hi, I am a 61 year old taking 150mg levothyroxine. I suffer from insomnia and migraine. By chance, I ran out of my supply of thyroxine and took a spare pack of 25mg I had and took [email protected] per day for a week.All my symptoms disappeared, I felt great and I slept for 6 hours – first time in years.
    I reran this test 3 times – always same result. Symptoms come back within 48 hours of old higher dose pills.
    As both doses add up to 150mg how can this be?
    I wrote to the 3 manufacturers supplying the thyroxine but they won’t give any advice.

  98. Dear Doctor Childs,

    Since 2000 I was on Levoxyl 225mcg and I was feel brain fog, hard time to articulate and other bad symptoms. My doc switched me to Armor and it was the BEST thing since slice bread 2008. I was able to articulate and brain fog was gone. Words flow easy. Now this year I gained weight 30lbs and my wife as well gained weight. Both on Armour. She went to the Houston ENDO and doctor switched her to Synthroid and Cytomel a year ago. She lost 50 lbs and told me you feels good and her food craving was gone. Now I am taking 50mcg Synthroid and 2 grains armor and still have significant cravings. I really need assistance as what to do. I made an appt to go see her doctor. The Endo Dr says taking Armour makes you eat like a crack addict because you are taking too much T3. He say the human body is 90/10 T4/T3 ratio and armor is 80/20. I am all confused. I was going to ask my primary doctor to switch be from the Synthroid 50mcg Armour 2 grains combination to 150 mcg synthroid and 25mcg cytomel
    Please please what do you recommend? Your help is significantly appreciated.

  99. I have a question. My dr about a year ago changed my Levothyroxine dose from 50mcg to 25mcg. Since then I became lethargic. Tired all the time and at times unable to wake so I sleep all day. Good thing I’m permantely disabled or is been fired already. Guess a good point to make would’ve been to mention I’ve been on Levothyroxine for quite a while at the 50mcg dose. My original cardiologist passed away and his colleague became my dr. He is the one that made the change to half the dose I was originally on. Isince the change I have gone downhill I’m inactive now I rarely leave the house. I have just gone down hill to the point of I ended up with a rash on my body which the dermatologist said was eczema and I have had a high level of histamine and ige. My eyelids have been swelling up to the point of my eye almost being shut closed. My dr said my thyroid labs came back and n normal range. How they determine normal really ticks me off because anyone that’s looked at thyroid normals has seen the range of normal is pretty big. Could it be possible I just need to get my dose back tomorrow 50mcg. My dr won’t budge but he’s also not the one that feels left me crap. Not the mention I’m 46yo with copd and have a artificial heart valve and was not super active but in the gym 5 days a week on a light workout to keep my lung strength up and my body strong. Could the change in dosage be the cause of my terrible state of life?

  100. Dear Dr. Childs, I had a thyroidectomy in 2014 due to thyroid cancer. I also have been diagnosed with celiac disease. I follow a gluten free diet without fail. My Doctor has put me on Synthroid starting at 175 and has been decreasing to 150 in July and now 125 in September. He seems more worried on lowering the dosage than anything else. I have not noticed any difference since the medication is being decreased other then weight gain (20 lbs in 3 1/2 months). I have severe chronic muscle and joint pain and the doctor says it is not related although I have had multiple MRIs, CTs and bone scans. I have tried every kind of treatment such as physio, accupucture, massage, athlete therapy, chiropractic. Do you have any suggestions? I am at a lose, I am 49 years old in fairly good shape and feel like an 100 year old.

  101. Hello. I think your information is excellent and easy to read. Where to start, I am 67. Been on Meds since 32 History of hypo in the family. Early on could not tolerate synthroid as it made my heart race and insomnia. Have a,ways been a poor sleeper. Found a doctor I loved for 30 plus years. Only took cytomel. 25 x 2 and felt fine, he said I did not convert t4. He retired and my GP just continues that dose, eventually I began to feel awful. No sleep sweating. Etc. so went to a new doctor. Now it has been a year and the worst roller coaster. Her first statement is that only prescribing T3 is insane and it goes against her oath of do not harm. When I first saw her my T3 was almost 6 so you can see why I felt awful. I have tried all combos. Armour 75. Then. Armour 60 was only sleeping 3 hours a night. Finally went to 50 of Tirostint. Felt better but still sluggish. Last labs T4 .8. T 3 4.87. TSH .61. But still not feeling right. So went to Tirostint .88 and added cytomel .5 x 2. As it does not come in a .10. NO SLEEP. So stayed on the Tirostint dose and cut cytomel to .5. Sleeping better but now have muscle aches and some fatigue and stomach aches. I have a hietal hernia and take 40 of nexium and have struggled to space the dosages apart. Also take 300 XL Wellbutrin. I am thinking that taking Tirostint at night could be a game changer. I go for blood work again in about 2 weeks She really wants me to take 100 Tirostint. She says that very few people can’t convert and that I do not know what normal feels like because I was at such a high level of T 3. I don’t disagree with that. Ok. I know there is more info I should be giving but any thoughts you could give me would be appreciated Thank you

  102. I have been on 50 mcg of levothyroxine and cytomel.for years. I have gained a lot of weight over the years and exercise 5 times a week meaning 5 days a week eat healthy and cannot lose weight for nothing in fact I just keep gaining. I’ve talked to my doctor have gotten blood test regular and she says I’m always in the right level I’m. I’m very frustrated. I’ve tried different ways of eating with no results. Have added more cardio and still no results. The only thing she says to me is I’m getting older and weight tends to settle in the middle. I walk out of there every time with no answers. My breasts have increased in size also for no apparent reason. I’m going to try going off the medication entirely and see what happens do you have any suggestions?

  103. Hi. My daughter (34) had had hypothyroidism since infancy. She is now on 300mcg of levothyroxine. She decided several months ago she was fed up with all the ill side affects she was experiencing and quit taking her medications. We had a myxedema crisis. She almost died. Now 3 months out and she is still recovering. She is so miserable. Her hair is falling out in handfuls! She’s so tired and has either constipation or horrible bouts of diarrhea. She has dark pigmentation around her neck and hasn’t had a menstruation in over 2 years (never has been regular) She’s been trying to get back to work but hasn’t the energy to work for more than a couple hours a day. WE live in a very rural community and don’t have access to an endocrinologist. I am very scared for her. She has started again having the symptoms that led to her stopping the medicine. Mainly exhaustion and palpitations. She says it feels like all of her engery just drains suddenly. I know more needs to be done but no one knows what. I diagnosed the myxedema. They had no idea what was going with Her! The ER kept saying she had sleep apena! Her TSH was 79 when they finally tested it! Her GP said she still isn’t on enough but her dosage is too high. Can you please give me a jump off place I can talk with her doctor about. Once I suggest something they do investigate. They admit to being out of their element when it comes to her. Any help at all is greatly appreciated!

    • Hi Kandace,

      You might have better luck traveling out of your rural area and looking into more specialized physicians in a larger city. If her quality of life is that poor then it may make sense to try and make the sacrifices necessary to find a new physician.

  104. I hope you can help me. I am 70 and I had a total thyroidectomy January 2017, am seeing an endocrinologist but still up and down with levels and having problems with sore joints, leg muscles, eyes and feeling terrible. I am other wise very very health and active. I have my whole life had trouble with even taking an aspirin sensitive to drugs of any kind, luckily I’ve never been on anything til now with Levothyroxine. I am on 88 mcg now and feel worse and also on my own figured out the inactive ingredients bother me a lot. My question is why do all these different doses have to have so many fillers that creates problems in our bodies, and my doctor doesn’t think that is my issue, and I do, I feel sick when I take my pills in the morning and by later in the night feel better. Thank you for your time

    • Hi Cheryl,

      Each person reacts differently to the fillers and binders and a lot of that just depends on their body and their genetics. I can’t really answer why your physician doesn’t take this into account, however, but you might feel better switching to a medication such as tirosint if that is the case.

  105. Dr. Westin
    Why do endocrinologist insist that your lab numbers are perfect and that the weight gain and horrible tendon pains are not the result of your thyroidectomy and medication even though these this were never an issue prior to thyroidectomy and offer diet pills instead of changing med dose? I’m fed up with being told my labs are perfect and still feel like my body has been invaded by an alien….awful feeling awful all the time.

    It’s been suggested that I should NOT take my synthtiod or Cytomel the morning of my blood test in order to get a better result. Would you recommend this if not why?

    • Hi Grace,

      Most physicians recommend against taking medication prior to the lab draw because it makes the labs look “worse” because serum T3 levels spike about 3 hours after ingestion. In addition they want to see what your thyroid levels look like 24 hours after dosing because that’s the “lowest” point your serum levels will be prior to taking another dose.

      • Dr. Westin
        Why would taking your t4 and t3 meds prior to your blood test make your numbers worse instead of better ? I thought taking you thyroid meds prior to testing you would get you better results not worse.


        • It has to do with the way that the medications raise serum levels of thyroid and how that influences the way that your doctor alters your dose in response to those changes. It’s a complex topic but I would recommend you read this post for more information which may help make sense of it: https://www.restartmed.com/hypothyroidism/

          This topic can also be confusing for patients because they assume that blood levels perfectly represent the status of thyroid hormone in your body and it assumes that these tests are 100% accurate, neither of which are true.

  106. Hi Dr. Childs,
    Quick question – I have started taking Cytomel with my synthroid (which I’ve been taking for 5 years alone) because I thought it would help my hair get back to what it was pre-thyroid issues and medication. Unfortunately it has caused balding on my hairline (or a severe miniaturization of hair follicles to the point it becomes skin and very high forehead). I’ve been on it for about 4 months and see no sign of improvement. My labs are excellent, and have tested the entire thyroid panel. I am at a healthy weight (130lbs, 5’4″). What is the next step you would recommend to address this issue? I was thinking of slowly waning off cytomel from 5mcg to 2.5mcg.

    Any thoughts or advice would be much appreciated! Thank you for your thorough and informative articles!

    – F

    • Hi F,

      I would recommend you read this post for more information about hair loss: https://www.restartmed.com/thyroid-hair-loss/

      There are many reasons that thyroid patients may lose weight ranging from their medication to nutrient deficiencies and so forth. That article will give you a good idea of where to start and how to evaluate your hair loss.

  107. I am currently on Levothyroxine 100mcg and Liothyronine 10 mcg, my last blood work came in at Free T3 6.0 pg/ml and Free T4 at 2.2 ng/dL; TSH 0.0 uIU/mL and my Thyroglobulin Ab at 10.7 IU.ml, Thyroperoxidase at 2.2 IU/mL.

    My doctor wants me to increase the Levothyroxine to 150mcg, I am worried that it may be too much and cause weight gain. I already have all the symptoms of Hypothyroid, and it has never gotten better being on the medications. Should I increase my Levothyroxine dosage to the 150mcg??

    • Hi Jamie,

      It might be a good idea to evaluate your reverse T3 before increasing your hormones further, but you should definitely discuss this with your current doctor before you make any changes. In general it’s not a good idea to suppress the TSH with T4 medication as it may lead to long term consequences in certain people.

  108. Hi Doctor,

    I have all of the symptoms you mentioned above and have been on Levothyroxine 50 mcg for a little over two years now. I keep telling my gp and endo I do not feel well but they only test my tsh. I finally got them to test my tsh with ft4 and my ft4 is 0.993 right on the low range of normal, however my tsh is 1.27. Does this mean I am not absorbing enough ft4 from my Levothyroxine? Would you recommend trying to switch to Tirosint or a drug with t3?

    Thank you,

    • Hi Mary,

      You would need a free T3, total T3 and reverse T3 to assess peripheral thyroid conversion and obtain a clear picture as to what is going on.

  109. Hi Dr.Childs

    My Endo recently changed my synthyroid from 125mcg to 112mcg after a day on the 112mcg I developed a horrible burning skin sensation that at first would come and go but on the 2nd day this burning sensation increased to involve burning sensation on my face,neck,tongue,forearm and hands by the 3rd day I had all the same burning and now on top of burning I had severe sweating with teeth chattering coldness and a red welt on my neck the size of a half dollar. I took a benadryl and within 30 minutes all my issues disappeared.

    I had simular issues while taking the 125mcg synthyroid it just wasn’t as bad as the 112mcg and it never occurred to me I could be allergic.

    If this is an allergic reaction to synthyroid will this reaction cause me to absorb less of the medication? Why does no one talk about being allergic to synthroid or anything else for that matter?

    I have no thyroid and multiple immune system issue to boot. My Endo is now putting me on 50mcg synthroid (2) a day for 6 days and (300mcg) on the 7th day along with 15mcg Cytomel. Does this seems like alot of synthyroid (300mcg)for one day?



  110. Hi Dr. Childs,
    My daughter is 9 and has Hashimoto’s. When it was discovered her TSH levels were over 100! She was 7 years old. She is on Synthroid (100 mcg.) She still gets migranes although not nearly as many, and tells me several times a week that she’s really sad (she says her heart hurts). I’m curious to know what the average mcg. for children her age is? Thank you so much for your time!

  111. Good morning,

    I just had my thyroid, a mass and lymph nodes on the left side of my neck removed due to cancer. They have started me on 100 mg a day of the levothyroxine. Overall, I feel pretty good, but the biggest thing I have noticed is that I am hungry all the time and I am having cravings for sweets some kind of awful. Is this due to lack of thyroid? Is the medicine supposed to help this and if so is the dosage not right? Please any advice would be greatly appreciated.


  112. Hello, I was recently prescribed 0.025 synthroid but my symptoms seem to be getting worse. The one that I am worried about the most is my heart. I’ve been experiencing pain/tightness in the left side of my chest and angina every once in a while. I did experience these symptoms before starting synthroid but happens more frequently. Can your symptoms get worse if the dosage is too low? Or is it probably because I have poor t4-t3 conversion? Thanks for your help.

  113. My son had thyroid cancer and they removed the entire thyroid last spring. They started him on levo at a very low dose and have slowly increased it. They have not settled on 175mcg. After some research online, I’m concerned that is a relatively high dose. Since this will be a life long medication, should we consider other meds or is levo relatively safe for life long use? Thanks so much! (My son is 19yrs.)

  114. I have been on Leboxthorine for 3 years and my results haven’t stabilised at all. Every few months my dose gas been changed. Symptoms are ever present (anxiety, fatigue, sleeplessness) and weight loss IMPOSSIBLE. I have been trying to get my Dr to add T3 medication and they refuse to consider it. They even told me today that it is not possible to have this medication in Australia. I’m so frustrated that I’m considering ordering NDT elsewhere without Dr help!

  115. Hi Dr.Childs
    Can you point me in the right direction for how much Cytomel you should be taking based on how much synthyroid your taking? I’m on 100mcg synthyroid and 15mcg Cytomel and curious if I should be on 20mcg cytomel, my Endo recently reduced my synthyroid by 50mcg per week and left me taking 15mcg cytomel and I’m starting to have fluid retention in my lower extremities that cause terrible leg pains.

  116. Hello Dr. My TSH is 37.93. My endo keeps insisting that I’m not taking my meds but I am daily. My med is 200 mcg levothyroxine. What can I do?

  117. Feeling fatigue, cold feet, pain in my hips. I have my yearly checkup next Monday. I will request to switch to Tirosint, if the Dr refuses to help, like she did last time, I will switch doctors. (On generic levothyroxine now) Please give advice on finding a better doctor. Thanks

  118. My TSH was 5.180. My PCP put me on Levothyroxine 50 mcg.No other thyroid testing was done and no physical exam.I have knots in neck and MANY other physical issues. Should additional tests be done,should I see endocrinologist?

  119. Please help me I had a TT Nov 14 2017 and have felt awful since. Now I’m in despair I’m on just under 100mcg levythroxine. I feel there is no hope and the life is slowly draining from me. I beg you please ring me on 07783757986. Andrea

  120. Hi Dr. Childs,
    I was on 50 mcg Levothyroxine and yet lab results showed TSH level of 3.93. I was feeling fuzzyheaded, tired and sleepy. So, I increased my dosage of Levothyroxine to 75mcg two days ago. Now I feel hyperactive, with drastically reduced sleep, nervous with increased appetite although I don’t think I have gained weight. Should I reduce Levothyroxine dosage to 62.5mcg?

  121. I’m 64 been on levothyroxine 75mcg a day for years my last blood put my tsh at 2.56 I’m tired all the time have short term memory probs and feel very lethargic all the time, just lately I yawn and take deep breaths all the time a feeling of not getting enough air in but sleep well should I up my dose my doctor always says blood is within normal range no action needed.

  122. I use 100 mcg of levothyroxine and I am not losing weight but I begin with tremor.
    Can I use 50 mcg in the morning and 50 mcg at night?

  123. I am 60 and have taken levothyroxine for 30 years. 6 months ago, a routine med check showed abnormal and increased dose from 150 to 160, 2 months later, labs showed no difference and doctor increased to 160, then again 2 months later to 170 then to 175. When checked again and labs hadn’t changed the doctor reduced fade to 125. I’m about to go back in for another lab test but wonder if I should switch doctor? I’m healthy otherwise and take Adderall as only other med for add. I am 5’5 and 146 lbs. I have all the symptoms of hypothyroidism especially cold all the time.

  124. Recently diagnosed with Hypothyroidism, my doctor prescribed Levothyroxine 25mcg. I am still sick after a month, just had new blood work for dr. to analyze to perhaps increase the prescription. I am 82 years old on 4/14/18. Been healthy and active all my life and now I’m debilitated. Help! Thank you!

  125. Hi, I am an 18-year-old and I have been diagnosed with hyperthyroidism, I took radioactive iodine, and now I have hypothyroidism since last year. My medication was 100 mg of Levothyroxine, but my doctor saw that levels were wrong so he made me take 125 mg daily. Since then, I started getting cystic acne around my lower cheek area, cheekbone, and forehead. I usually never get acne, but when it happens, it is because of menstruation. My hair also started getting dry for no reason. What do I do? I have thought about taking Accutane for my acne because it is getting out of hand, but it might affect my thyroid? What should I do?

  126. Hello, Dr. Childs! I have hypothyroidism. My doc put me on 25mcg. I have only been on it for two weeks. I keep feeling super shaky and just last night my heart is racing. I am not sure what’s going on. Why is this happening? any advice would be appreciated! Thanks.

  127. I need all the help I can get ….I’ve had Hashimoto’s for over 14 years and it hasn’t gotten better just worst. I can’t lose weight even when exercising and eating right. So I give up, I hate my life! If it wasn’t for my children I’d rather be dead. I can’t live like this.

  128. Hi Dr. Childs,

    I’m really hoping you still respond to this thread because I am at a loss! I was put on levothyroxine during pregnancy due to my thyroid lagging (started at 25mcg, went to 50mcg, and the third trimester was at 75mcg). I was retested on the 75mcg 6 weeks postpartum and my levels were TSH .051 and Free T4 1.85. Was told to stay on 75mcg and skip one pill a week. 8 weeks later my numbers were TSH <.006 and Free T4 1.33.

    I was then bumped down to 50mcg. In the 4 weeks since being put on the 50mcg I have gained 14 pounds and am extremely lethargic and depressed, despite the same diet and actually adding exercise to my routine. Note: I am still breastfeeding my 4-month-old.

    I feel like total dog doodie on the 50mcg-going in for blood work tomorrow because I asked my doctor for it but TERRIFIED she will say my numbers are good on the 50mcg dose and that I will have to stay on that dose feeling this terrible. I felt great on the 75mcg (aside from some trouble falling asleep). Any advice on what to say and how to advocate for my health?

    Thank you so very much!

  129. Hi Dr. Childs:

    I have been diagnosed with hypothyroidism. I started on 12.5 mg. levothyroxine, went to 25 mg., then to 50 mg. I began to have heart palpitations, panic attacks, feel rageful, irritable, had headaches and body aches. So I stopped. I started 13 mg. of Tirosint. On day 14, I began waking up with some of the same symptoms of fluttery heart and extreme irritability. On day 15, I added 5 mg. of Cytomel and had a horrible headache the next day so I haven’t taken another. Today is day 20 on Tirosint (a Friday and I will call my Dr. on Monday) and those symptoms are getting worse. I need thyroid replacement but why does such a low dose make me feel like I’m hyperthyroid? What could be happening and what do you recommend? Thank you in advance.

  130. I apologize – I just sent an email about having problems with low doses of levothyroxine and Tirosint – I meant .mcg, not mg. 50 of levo and 13 of Tirosint – such low doses are causing me heart palpitations and extreme anxiety and irritability. I am on day 20 of 13 Tirosint and those symptoms are getting worse. I tried 5 of Cytomel on day 15 and had a terrible headache the next day so stopped that. Why is such a low dose of Tirosint causing symptoms that seem like hyperthyroid? I will get with my doctor but wonder what your thoughts are and what do you recommend? Thank you.

  131. Dr.Childs
    I’m 64, at 40 my thyroid went hyperactive, treated with radioactive iodine, been on Levi (125) since. Diagnosed with stage 3 breast cancer, HR+,HER2+. Chemo, radiation, Herceptin and now taking Anastrazole daily. TSH levels have gone from 3.0 in 2016 When first diagnosed to 2.720 in 2017(1 year into treatment) now to 0.363 in 2018. My physician has changed my Levo from 125 to 112 and doesn’t seem too concerned about the change. Is decreasing the dosage the right thing. I am experiencing all the symptoms now of hypothyroidism. Thanks for your caring.

  132. My doctor prescribed, as per my request, Levothyroxine 50mcg a year ago, when my TSH was at 3.25. I was re-tested 3 months later and it went down to 0.75. Now, 8 months later, after taking my pill every day at night, as instructed, my TSH test came back at 5.23. I don’t feel tired or depressed but I still struggle to lose weight and I continue to lose hair.

    So what now? When I asked to have the T3 and T4 tested, I am told that it’s not necessary. Should I take a higher dosage of the same medication?

    Thanks in advance.

  133. Hi, can you comment a bit about dose adjustments in pregnant women, since the new recommendation is to be generally under 2.5 tsh in the 1st trimester and under 3 in the remaining trimesters? I went up from 25 to 50 preparing for pregnancy and was tested 1.93, but at 10 weeks the reading jumped to 2.69. I was increased to 75 mcg but I am so afraid the gap between 6 and 10-week reading that at some point went up could have harmed the fetus. How much damage could have been done not having it managed until I was urged to go up to 75 mcg? Thank you ahead of time.

  134. Hello Dr. Childs

    I have gained 30lbs in 6 months. I have no idea what to do. I have a functional medicine doctor. She found my RT3 to be 16. She didn’t add or change any meds but she did increase my T4 (tirosint) and told me to get my labs drawn again in 8 weeks. Do you think i should be on a t3 medication? I have gained more weight since she increased my T4 medication (6 weeks ago)

  135. Good day Dr, would be very grateful for some advice, I’m 44 year old male 73kg 5.8ft tall, I had thyroid cancer 2 years ago and had a total thyroidectomy. I was switched to 125mcg of levothyroxine after 3 months. After 2 years I waited for my body to adjust to the medication ( lab results where within range) I still had the same symptoms, pains in lower legs and arms (random would come and go) hair loss (patchy), severe anxiety and depression extremely low heart rate 46bpm, carpal tunnel syndrome in my right hand, my oncologist has now reduced my dose to 100mcg, I feel slightly better about myself but the carpel tunnel and hair loss persist. I’m confused as to whether I was on to high a dose or not enough. My symptoms indicate both, hair Loss and carpal tunnel etc, my dr said if after 2 months I’m not better they will add T3 liothyronine to see if that helps. What would be my best method of testing to see if I’m heading the right way? It’s confusing and frustrating ave gets me down at times, I’m in the UK btw. Thanks in advance Mark.

  136. Hello

    I was diagnosed in 2004 with hyperthyroidism, had the radioactive iodine in 2010. I am now hypothyroid. My doctor prescribed me with 50mcg two years ago and for about the last 8 months I have extremely dry skin and nails, fatigue, slow body movements, and anxiety. I become nauseous and lightheaded after taking the pill. Is this an allergic reaction? Please help.

    Thank you

    • Hi Alesia,

      It sounds like it may be more related to your dose of thyroid medication as opposed to an allergic reaction!

  137. Hello, thinking of increasing my Levothyroxine dosage myself from 75mcg 100mcg. I’m also currently taking 5mcg Cytomel. (on Sunday I take a half of levothyroxine) I had a miscarriage last August and pregnant now. I firmly believe my diagnosis of Hashimoto’s was linked to my miscarriage. My endocrinologist said my levels were fine late April 2018. I just moved and have no Endocrinologist yet. The Nurse Practitioner (May 2018) recently told me the endo wouldn’t up my medication just monitor my levels. My Endo before I moved said if I became pregnant let her know so she could increase my meds. It will be a while before I get in to see a new Endocrinologist, and the NP said she hasn’t met a good endocrinologist yet and praised the Naturethroid and how it works for lots of people. I’m sure the levothyroxine I was taking before wasn’t enough and miscarried at 10 weeks. I’m about 2 weeks pregnant now. I’m 39, any suggestions?
    [email protected]

  138. Dr. Childs,
    I am a Type 1 Diabetic (35 Yrs) on a insulin pump, and have had Hashimotos and Hypothyroid for 15 years. I am 46 YO and have been suffering from tachycardia (resting 85 daily average 108-130), weight gain, excessive sweating, numbness in my arms at night, depression, brain fog, chronic muscle pain and tension, extreme fatigue and NO sex drive… the list goes on. My doctor has been increasing my Synthyroid for years and added liothioine about a year ago. I am currently taking 200mcg of Synthroid and 10 mg of Liothione. However, I still feel awful all of the time. My husband thinks is it something I have control over and I cant get him to understand that my body is not working properly. My last 3 TSH levels were
    0.03 – 07/17
    0.05 – 11/17
    Below 0.01 – 04/18.

    T4 Free
    1.07 – 07/17
    1.10 – 11/17
    1.16 – 04/18

    2.9 – 07/17
    2.7 – 11/17
    3.5 – 04/18

    I need help!!! I just want to crawl into bed and stay there. Any advice would be greatly appreciated!

  139. My doc recently lowered my levothyroxine from 125 to 120, because he said I was slightly over! I have been on 100 now for a few months but feel terrible. The blood test was bang in the middle, which he said was where I should be! So why do I feel so bad?

    • Hi Janice,

      The short answer is because your TSH is not the single best marker to assess thyroid function and a better marker would be total t3/free T3. It sounds like your physician probably based your dose solely on the TSH.

  140. Started with NDT…my TSH got worse. Dr moved me to the combo Levo/Lioth. I am gaining weight?!? (5lbs in 2weeks!) My resting heart rate has gone up (Fitbit). Will have blood drawn in 3 weeks… but don’t want to gain 15lbs before then! Any suggestions?

    • Hi Nancy,

      Unfortunately, without lab tests or symptoms it’s difficult to say what is going on. I will say that it is not unusual for some people to gain weight while using levothyroxine.

  141. [email protected]
    Hello, I have been taking 50mcg of Levothyroxine for over three years now. Instead of losing weight I have gained about 15 pounds without any significant changing my diet or physical activity. My concerns have gone unanswered or dismissed by my doctor. I know something is not right but don’t know what to do. Thank you.

    • Hi Mercedes,

      Some of your symptoms may be explained by poor T4 to T3 conversion, you can figure this out with some simple blood work such as reverse T3, free T3 and free T4.

  142. hi Dr Childs,

    I have learned a lot here. I had Graves and had thyroid ablated in 2016. I was initially on Levo 112 but Dr switched me to NP Thyroid at 90 mg. I have been there ever since and do NOT feel well at all now. I am waking up at 2:30 every single night with severe adrenaline anxiety type issues, nauseated and shaky all day, cycles are now irregular, losing weight bc I can’t eat. I had lab done last week. TSH was .7 but that was all that was tested. I’m so overwhelmed and confused. Would love your advice. Thank you.

  143. I have Hashimoto’s and am on 50mcg of L-Thyroxine each morning. Have had all the low thyroid symptoms for over 6 months and chalked it up to getting older. Made a goofy mistake and doubled up on med, one morning and one at night and was astounded to notice immediate difference in the way I felt. I know, too soon to tell, but I was so tired and cold and kept working out and fighting through, not making the connection until now. Can I continue this dosage and times?

    • Hi Colleen,

      Unfortunately, I can’t provide specific medical advice unless you are a patient! Sorry about that.

  144. Your article has helped me a lot.

    Thyroid removed due to a false positive of cancer. Removed 5/10/18. I have Hashimoto’s. 125 mcg of Levo since surgery. Talked to endo, got blood work done yesterday, TSH is above 7.6. The highest it got before surgery was 5.9.

    Not sure what my T4 is, but lab results are being mailed to me.

    Levo got increased to 150 mcg starting tonight. I take it at 2am.

    If this doesn’t work, I’ll ask to be put on the 50 mcg pills.

    I realize this is going to take time and me keeping communication open with my endo. She’s fantastic and listens to my symptoms.

    Hopefully, with what I’ve learned from your article, I’ll be feeling better sooner than later. 🙂

  145. Yes, I do feel better since starting levothyroxine. I started on 25. But the pharmacy did not have so they gave me 50. I took the 50 and immediately began to feel better. After reading your article, I believe 50 is perfect. I respect my specialist, however, he isn’t up to listening much to your symptoms. He seems to be more into the basic everyone symptoms and not taking what you say as important. I will continue to advocate for or myself and read more about my condition. Thank you for sharing this east to read and understand article.

  146. Thanks for the information! 25 years in(levo 50mcg) and about 4 years ago I began losing hair, gaining weight, long bones ache so bad I need advil pm to sleep, get up and feel like the flu after 5-6 hours. Naps are my weekend routine. I’m going to begin taking my levo at night and see what happens. Elevated CK, low creatine. Had me stop taking my statin about 18 months ago and ck was temporarily normal, slowly increased and now back at 400 ul. Red ‘rash’ near my thyroid makes me think it may be time to increase dosage. Anyway, thanks for the information.

    • Hi Kevin,

      Make sure you also check your thyroid lab tests as they will also give you valuable information. It sounds like you are on the right track!

  147. Hi Dr.
    I am 59 and have Hashimoto’s and have been on Levothyroxine for years. After my last blood test my endocrinologist lowered my Lthyroxine dosage from 100 mcg to 88 mcg. I started feeling a little joint pain and a little anxiety. I went back in six weeks for a follow up blood test thinking he would increase the dosage back to 100 mcg where I had no negative symptoms. Instead he decreased it again to 75 mcg. Now I have rotating joint and muscle pain, hot flashes, tingling in hands, and clicking noises in joints. Your article makes me think that my dosage is wrong even though my blood test say otherwise. What do you suggest that I do?
    Thank you!

    • Hi Carole,

      If you feel like your dose is not accurate you’ll want to start with a complete thyroid panel which includes free t3, total t3, reverse T3, TSH and free T4. The information you get from there can help you determine what changes need to be made.

  148. 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 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.

  149. 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.

  150. 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

  151. 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!!

  152. 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.

  153. 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.

  154. 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.

  155. 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.

  156. 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!

  157. 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.

  158. 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?

  159. [email protected].
    Hi Doctor,
    I’ve 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

  160. 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.

  161. 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?

  162. 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?

  163. 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?

  164. Your information is fabulous, but I don’t 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, it’s taken me nine months to find a doctor that’s willing to put me back on armor, but I’m 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, it’s taken me nine months to find a doctor that’s willing to put me back on armor, but I’m 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 it’s not the best way to go about this. In your video, you talk about titrating the Armour Thyroid, but you don’t 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 it’s not the best way to go about this. In your video, you talk about titrating the Armour Thyroid, but you don’t 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? I’m guessing it’s the former because I don’t see myself functioning well on just a quarter grain for several weeks, but it’s 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

  165. 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?

  166. 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.

  167. 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)

  168. 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!

  169. 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.

  170. 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.

  171. 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!

  172. Hi I’m 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????

  173. Hi Dr. Childs — 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 I’m convinced the Levothyroxine was the cause of the hyperthyroidism to begin with, so I’m hesitant to get on any medication again at this point.

    What advice can you give me?

    I’m 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 “ok” for the most part at eat relatively healthy and exercise.

    Sorry for the long post. Just really at a dead end.

  174. 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?

  175. 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!

  176. 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.

  177. 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.

  178. I had a thyroidectomy in 2017. I’ve always been a fitness nut and have never had a problem with weight until this procedure. I’m 5’4” and have always been a lean 120lbs even after three kids. But since having my thyroid removed, my weight creeped up to 130 and won’t 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, I’ve 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 don’t seem ideal for me!

  179. 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???


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