What if Your Thyroid Medication Does Not Work?

After being diagnosed with hypothyroidism and prescribed Synthroid (levothyroxine), some people continue to not feel "normal." They may report persistent exhaustion, weight gain, dry skin, or feeling cold. If this is happening to you, here are some questions you and your doctor can consider, as you navigate your sometimes bumpy thyroid journey. 

1
Are You Taking the Right Dose of Your Thyroid Medication?

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Not enough or even too much thyroid hormone replacement medication may cause a variety of symptoms, including fatigue, weight changes, and mood swings, among others.

In order to determine your response to the medication, your doctor will check a simple blood test, called the thyroid stimulating hormone (TSH) test. Be sure you understand the TSH normal range your doctor and laboratory are using. Often, it takes some adjusting to get the right dosage.

2
Should You Try a Different Brand Name?

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Sometimes people taking Synthroid switch to another brand of levothyroxine (for example Levoxyl or Unithroid) and find that even at the same dose, they feel better. It's definitely worth discussing this option with your doctor if you are still experiencing symptoms or not feeling right on your current thyroid medication.

3
Do You Need Additional T3?

While controversial, some studies have shown that patients have improvement in overall symptoms when they add triiodothyronine (T3) to their treatment. 

If you are taking Synthroid or another levothyroxine drug, you can ask your doctor about adding Cytomel (the brand name synthetic T3 drug) to your treatment.

Keep in mind, though, T3 testing and incorporating T3 into your thyroid care is a controversial issue, and not favored by many endocrinologists. One reason for this is that T3 has a short half-life, so a person has to take it several times a day. Moreover, with the short half-life, there is a risk for high T3 levels in the body, which can lead to a fast heart rate, insomnia, and anxiety and with long-term use, may be harmful to the heart and bones. 

That said, according to the American Thyroid Association, attempting a three to six month trial of low dose of Cytomel (T3), in addition to T4 (your Synthroid), is a reasonable next step if a person is not feeling normal or well on T4 alone. 

 

4
Would You Do Better on Natural Thyroid Medication?

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Some people report feeling better taking one of the natural, desiccated thyroid drugs instead of a synthetic. The most popular and easily obtained brand is Armour Thyroid, but RLC Labs also makes Nature-throid. All the desiccated thyroid drugs are prescription drugs, and made from dried porcine (pig) thyroid. 

As an aside, some concerns about desiccated thyroid drugs is that while they contain both T4 and T3, the ratio (or the balance) between these two hormones is not the same as in humans. Moreover, the precise amount of T4 and T3 in each desiccated thyroid pill varies, so blood levels of these hormones are not always stable. Finally, these pills do contain chemical binders, so are not exactly "natural." 

5
Do You Have an Adrenal Problem That is Interfering With Thyroid Function?

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According to a study in European Thyroid Journal, approximately 5 percent of people with autoimmune thyroid disease have primary adrenal insufficiency. While this may seem like a small percentage, it's actually rather high considering how rare primary adrenal insufficiency is. 

This is why many experts suggest testing for primary adrenal insufficiency, if a person continues to have problems despite being prescribed adequate amounts of thyroid hormone. If there is an underlying adrenal gland problem, thyroid hormone replacement medication will not be as effective until the adrenal gland issue is addressed.

6
Could You Have an Underlying or Related Autoimmune Condition?

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The vast majority of people with hypothyroidism have Hashimoto's disease, meaning the cause or the "why" behind their underactive thyroid gland is due to an autoimmune problem.

Keep in mind, having one autoimmune disease puts you at risk of developing others. With that, symptoms you may attribute to your thyroid disease, like dry eyes, joint aches, or hair loss, may actually be from another health condition (possible autoimmune-related). Talk with your doctor about looking into other health conditions that may mimic the symptoms of thyroid disease.

A Word From Verywell

In the end, if you are still not feeling right on your current thyroid hormone replacement medication, it's to best make an appointment with your doctor to explore the above-mentioned questions in more detail.

Rest assured that you can get to the bottom of your symptoms—it will likely take a little patience and resilience on your part, and possibly some trial and error periods, but you can feel well again. 

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