We hear from a lot of thyroid patients that even though they’re taking their thyroid medications to treat their hypothyroid, they still feel like they have symptoms. Fatigue. Hair loss. Brain fog. Lack of concentration. Anxiety and depression.

Sound like you? It doesn’t mean your medication isn’t working—but it can mean we need to dig deeper. Here are four questions we ask to see if your thyroid medication is working for you.

Are You Absorbing Your Medication?

This might sound obvious, but the first step when you take your thyroid medication is that your body has to break down the capsule and allow it to be absorbed by the small intestine. This begins with the creation of proper amounts of saliva and extends to the right amount of stomach acid to finish the job.

If you’re experiencing signs of low digestive secretions, you might not be breaking down the full capsule—and a portion of your medication is undigested. This might be happening for patients who:

• are taking acid suppressing medications (or natural products). Your stomach needs to be at a certain pH to dissolve a thyroid medication capsule.
• have SIBO.
• have lactose intolerance.
• have celiac disease. 
• have IBS-D—when the gut moves too fast, it won’t have enough time to break down the capsule. 

The solution? Treating the root cause. It’s the best way to help increase your digestion/absorption of your medication—especially if you’re taking high doses and it’s not decreasing your symptoms..

Is Your Body Utilizing the Medication?

Once the medication gets into your body, it actually has to be  made into usable components. For example, Levothyroxine (or Synthroid) is synthetic T4 medication. T4 is, for the most part, biologically inactive. That means that your body needs to convert it into T3, which is the gasoline that fuels all of your cells. This process requires an enzyme called deiodinase. 

For a lot of people, this is the general hang-up in the process. This enzyme can be slow or sluggish in people who:

• have liver issues such as fatty liver, or cirrhosis. 
• are taking oral birth control pills (ones with estrogen included) or using estrogen replacement therapy.
• have nutrient deficiencies such as selenium, iodine, and iron. 
• have insulin resistance and elevated blood sugars
• have high stress levels & elevated cortisol.
• have chronic pain conditions.
• over exercise and have caloric deficiencies
• have chronic inflammatory conditions (and we can typically measure it in the blood with a CRP or other inflammatory cytokines), including chronic infections (Lyme, EBV, etc.), autoimmune diseases (Hashimoto’s, MS, Lupus, etc.), injuries/arthritis, or cancer.
• are exposed to environmental toxins such as BPAs, pesticides, mercury and flame retardants (such as PBDE).

You can typically see if this poor conversion is happening through in-depth blood testing. Your T3 levels may be low, or you could have an increase in reverse T3. One tricky piece to this puzzle is that the brain doesn’t have the same types (or amount of) of deiodinases as the rest of the body—so your brain will always get preferential treatment when it comes to the utilization of your thyroid hormone. When you only get a TSH test done to determine if your medication is working for you, you’re only measuring brain to thyroid connection, which may be normal even if you don’t ‘feel’ well controlled. The solution? Ask your doctor about a full thyroid panel.

Are You Taking the Right Formulary?

If you’ve been taking the same medication for awhile and still don’t feel well controlled, talk to your doctor about other thyroid hormone replacement options. There are several different options you can try to adjust the medication and see if it makes an impact in your symptoms.

1. Try a gluten-free formulary. Some medications are processed in labs that certify as gluten-free for those that are highly reactive or celiac. The name brands Lannett (levothyroxine), Tirosint, and NatureThroid (combination glandular) are all gluten-free. 
2. Try medications free of additives. If you’re careful to decrease food additives or dyes from your daily life, you might still be getting them from your medicine cabinet. One medication, Tirosint, is a purely levothyroxine based soft-gel that doesn’t contain extra additives. 
3. Change forms. If synthetic medications are not meeting your needs, try a glandular product such as NatureThroid, Armour, or WP Thyroid. These are animal-based products that contain both T4 and T3. 
4. Change ratios. Medications from a commercial pharmacy only come in certain dosages so there may be limits to how you dose T4/T3. Having your medication specifically compounded can remove a lot of those limits and customize the dose of T4/T3 that you are taking. Talk to your doctor about a made-for-you prescription to customize your needs.

Are There Other Root Causes to Investigate?

If original symptoms that lead you to start thyroid hormone replacement therapy are not being managed by medications, but your lab markers continue to be normal, it might be time to do back to the drawing board. Look into other root causes. Common hypothyroid symptoms like constipation, weight gain, dry hair/skin/nails, fatigue, and poor circulation can overlap with other medical conditions that may need to be investigated. Ask your doctor if this might be the next best step for you.

If you’re not feeling better from your thyroid medication, it’s important to find out why. A medication that you take daily, long-term, should be making you feel better—if it’s not, keep asking questions! Or, try a new doctor who can help you treat your symptoms holistically. We’re here for you, if you need support on your thyroid journey.

Dr. Cassie Wilder

Dr. Cassie Wilder is a registered Naturopathic Medical Doctor (NMD) and founder of MIMC. Her passion is empowering her patients through education, understanding, and support through their healing journey. After graduating from Iowa State University with a Bachelors of Science in Kinesiology and Health, Dr. Wilder earned her Doctorate of Naturopathic Medicine from Southwest College of Naturopathic Medicine & Health Sciences, a fully accredited and nationally recognized institution in Phoenix, AZ. During her clinical training, she received extensive hands-on training with many leading experts in the field of functional medicine and developed a passion for treating hormonal imbalances, thyroid disorders, cardiovascular concerns, and adrenal fatigue.