7 reasons your thyroid med isn’t working (and what to do)

thyroid medication not working

Finding out you’re hypothyroid can be a happy day. Finally, an explanation for all of the dry skin, fatigue, weakness, cold, and weight gain. And more importantly: there’s a solution.

But a few weeks go by on your meds and nothing. No improvement whatsoever. So, are you imagining it? Not at all. Hypothyroidism can be surprisingly tricky and stubborn, and the road to feeling better isn’t always simple. Here are seven possibilities why your thyroid med isn’t doing it for you:

1. Your medicine timing is off

Double-check you’re taking your thyroid meds on an empty stomach, a half an hour to an hour before meals. Sorry to be the bearer of bad news, but that includes coffee too (unless it’s black). Research shows caffeine itself is no problem, but a cup of joe with milk or creamer affects absorption.

But food isn’t the only thing to look out for. Many vitamins—especially those with iron or calcium—need to be taken a full four hours before or after thyroid meds. So do medications for stomach acid and those for cholesterol, like cholestyramine.

With all of the rules surrounding it, you may wonder: when exactly should you take your meds? If waiting to brew your coffee in the morning just won’t do, talk to your doctor about taking your thyroid medication at night. As long as it’s four or more hours after dinner, it’s usually okay.

2. You’re carrying your medication in your purse

Okay, it’s not just about throwing your pill bottle in your bag. According to research, medicine storage matters. Getting too much heat—like leaving your bag and pills in the car—has been shown to make medicine less effective. Environments with lots of humidity and light do the same. Even keeping it in the fridge is a no-no.

What’s best? Choose a cabinet in the kitchen away from the heat of the stove or range. That way, the medication will be in a dark, room-temperature place. And if you do need to toss it in your purse? Don’t leave it in the trunk on a hot day.

3. Low vitamin D is holding you back

First, vitamin D is a pro-hormone. Because it’s needed to make other hormones, having an adequate level is vital. Also, even though additional studies are needed, research shows links between low vitamin D levels and autoimmune problems, including Hashimoto’s Thyroiditis.

In Hashimoto’s, the body mistakenly attacks the thyroid gland and interferes with hormone production. How do you know if this is happening to you? Antibodies will show up in the complete thyroid panel from number four on this list—and, over time, vitamin D may help lower them.

4. Your TSH isn’t telling the whole story

Testing thyroid stimulating hormone (TSH) is a common practice. TSH is a helpful marker because it gives a window into how much thyroid hormone your body is requesting. In general, low levels of TSH usually point to hyperthyroidism, and higher values are often associated with hypothyroidism.

But basing diagnosis and treatment decisions solely on TSH? Even though many providers do, it may not be what’s best for you. Here’s why: it’s possible to be within the reference range for TSH and still have low circulating levels of T4 and T3, the thyroid hormones virtually every cell in the body needs.

If your TSH is in range and you’re still dealing with symptoms, ask to view and access your labs. (It’s your right as a patient.) Check to see what tests were performed. Discuss whether a comprehensive thyroid panel could benefit you. That means:

  • TSH
  • Total thyroxine (T4)
  • Free thyroxine (T4) and free triiodothyronine (T3)
  • Reverse T3
  • Anti-thyroid (ATA) antibodies, such as thyroglobulin, or TgAb, and thyroid peroxidase, or TPO

5. You’re having trouble converting T4 to T3

Most doctors prescribe Synthroid (or its generic, levothyroxine) as a go-to thyroid medication. Synthroid contains T4 thyroid hormone only. In theory, this should be successful for almost everyone. What should happen: the body takes the T4 and converts what it needs into T3, which is active and usable by cells. Then, it stores the rest of the T4 for later.

But the reality is not all theories work in an imperfect world. For a number of reasons, some people have trouble converting T4 to T3. If that’s the case, even a healthy dose of levothyroxine isn’t going to help you feel better. Your T4 levels go up and your TSH appears fine, so your physician says everything’s under control. But it’s not. In order to reap the benefits of replacement, your cells need access to T3.

6. A T3-containing medication might help

If you’re not getting relief, you might want to consider adding a small dose of T3-containing medication, like Cytomel, to your levothyroxine.

Something to keep in mind: because Cytomel contains the active form of thyroid hormone, it’s ready to be used by your cells. No conversions are required. That makes it powerful. It’s important for you and your doctor to find a safe dosage for your body and symptoms—and to monitor your levels and response.

Cytomel isn’t your only option if you need T3. Natural desiccated thyroid, or NDT, is made from porcine (pig) glands. Each pill contains T4, a little T3, and even less T2—all are identical in structure to what we produce naturally. Some NDT brands include Armour Thyroid, NatureThroid, and NP Thyroid. Though some doctors shy away from prescribing these, many insurance plans do cover them.

7. Thyroid support supplements aren’t helping—they’re hurting

There’s a lot of talk about iodine being good for the thyroid. And though that’s technically true, you should take it easy and short-term. But that’s if you take it at all.

Iodine is pretty plentiful in our daily diet. Adding extra can do more harm than good—even if you initially feel like you’re getting an energy boost from it. Too much iodine can cause hyperthyroidism, but it can also work the other way. Your thyroid gland could slow down further, become inflamed, or even be more susceptible to cancer.

If you do decide to take a thyroid supplement, be sure to tell and talk it over with your provider. Being transparent will help your physician accurately advise you, prescribe medication, and make recommendations.