Many people with hypothyroidism experience a significant improvement in their symptoms upon taking thyroid hormone medication. However, some people actually feel worse when taking thyroid hormone medication. Some people feel worse when taking synthetic thyroid hormone and feel better when taking natural thyroid hormone, although there are some people whose symptoms worsen when taking natural thyroid hormone. There are numerous reasons why someone can experience a worsening of their symptoms when taking thyroid hormone, and in this blog post I’ll discuss some of the more common reasons.
Fillers and other ingredients. One of the main reasons why someone might feel worse upon taking synthetic or natural thyroid hormone is because they are reacting to one of the fillers or other ingredients. For example, many brands of synthetic thyroid hormone include ingredients people can react to. Synthroid is probably the most well known brand of synthetic thyroid hormone, and it includes corn starch, lactose monohydrate, as well as artificial coloring. And so if someone has an allergy to corn or dairy, or if they have a reaction to the artificial colors, then they probably will feel lousy when taking Synthroid. There are also fillers in some brands of natural thyroid hormone, such as Armour. I discussed the ingredients in greater detail in an article I wrote entitled “Synthetic vs. Natural Thyroid Hormone: Breaking Down The Ingredients“.
But what can someone do if they are reacting to one or more of these ingredients? Well, there are a few different options. One option is to ask your medical doctor to switch you to a different brand of synthetic or natural thyroid hormone medication. For example, Tirosint is a brand of synthetic thyroid hormone that doesn’t have all of the fillers and artificial colorings that Synthroid has. As a result, someone might do poorly when taking Synthroid, but do well when taking Tirosint. With regards to natural thyroid hormone, some people don’t do well when taking Armour, but do fine when taking Nature-Throid. Another option is to visit a compound pharmacist, as they should be able to put together a hypoallergenic form of synthetic or natural thyroid hormone medication.
Conversion problem. If someone has a problem converting T4 into T3 then they might not do well when taking certain forms of thyroid hormone medication. Remember that most people are told to take thyroxine, which is T4. And so if someone is taking levothyroxine, which is synthetic T4, and they are unable to efficiently convert this into T3 then they will most likely continue to experience hypothyroid symptoms. Switching to a natural form of thyroid hormone very well might improve the symptoms since this form includes both T4 and T3. However, taking natural thyroid hormone won’t do anything to address the cause of the conversion problem, which can be due to high cortisol levels, a selenium deficiency, gut dysbiosis, or other problems. I discussed this in greater detail in a blog post I wrote entitled “6 Factors Which Can Affect The Conversion of T4 to T3“.
Autoimmune Response To Thyroid Hormone. If someone takes natural thyroid hormone (i.e. Armour, Nature-Throid) and feels significantly worse, this might be due to an autoimmune response to thyroid hormone. In other words, your immune system can produce antibodies towards T3 and T4. This is one reason why some doctors won’t prescribe natural thyroid hormone to any of their patients. I find this to be rare, although over the years I have had a few patients feel horrible when taking natural thyroid hormone and I suspected their immune system might have been reacting to it. While in most cases I still prefer natural thyroid hormone over synthetic thyroid hormone, this is something to be aware of.
Adrenal Problems. Although an elevated TSH usually is related to a hypothyroid condition, in some cases it can be due to problems with the adrenals. One study examining three case reports linked adrenal insufficiency with subclinical hypothyroidism (1), while another study showed a relationship between the TSH and cortisol (2). As it result, if someone has subclinical hypothyroidism (high TSH and normal thyroid hormone levels) and the thyroid antibodies are normal, then it probably would be a good idea to address any adrenal problems before the person takes thyroid hormone medication.
Thyroid Hormone Resistance. Thyroid hormone resistance is when the thyroid receptors are not responsive to the actions of thyroid hormone. If someone has this condition then taking thyroid hormone medication probably won’t cause their symptoms to worsen, although they most likely won’t notice an improvement in their symptoms when taking thyroid hormone. I discussed this condition in greater detail in a blog post entitled “Thyroid Resistance and Natural Treatment Methods“:
In summary, when someone with hypothyroidism has a worsening of symptoms after taking thyroid hormone medication there can be numerous reasons for this. Some of the most common reasons include the person reacting to fillers and other ingredients, having a conversion issue, an adrenal problem, or perhaps thyroid resistance. In addition, for those taking natural thyroid hormone it is possible to experience an autoimmune response to the thyroid hormones. Sometimes it can be challenging to determine why someone is having a negative reaction to thyroid hormone medication, and while there can be causes other than the ones I listed in this post, initially it’s a good idea to look into these factors I discussed.
I have recently been diagnosed with Hashimoto’s disease all my thyroid level seem to be normal at the moment they also said I have small nodules all over my thyroid is there any way of treating this disease naturally
Hi Brendalee,
It is very possible to treat Hashimoto’s naturally, as even when the thyroid hormone levels are normal the goal should be to improve the health of the immune system. After all, Hashimoto’s is an immune system condition, not a thyroid condition, and so while some people do need to take thyroid hormone medication, the primary goal still should be to address the autoimmune component.
Just started taking the new WP thyroid pill (westhroid pure…pig thyroid). Purest pill available. I pray it works. Hashimoto’s is awful as you age. 🙁
I’ve been on Levothyroxine for 5 years now and it eventually stops working and my dose raised. I am subclinical hypothyroid. I had to fight for a diagnosis. Finally with ultrasound of thyroid it became clear I was in trouble. Enlarged thyroid (goiter) with nodules. Now a few years later I’ve been diagnosed with CFS & Fibromyalgia. I’ve found that diet plays a key role in subduing this curse.
Hi Michele,
Yes, eating well definitely plays an important role in improving one’s health when dealing with a thyroid or autoimmune thyroid condition. However, many times eating well alone won’t be enough to restore one’s health. Did they test the thyroid peroxidase and thyroglobulin antibodies to see if you have the antibodies for Hashimoto’s? Although you can’t always rely on the antibody readings (false negatives are possible), if these were positive then the primary goal should be to address the autoimmune response. In addition, mitochondrial dysfunction and/or chronic infections are common with CFS and fibromyalgia.
Dr. Osansky, I cannot put into words how informative, as well as timely, your email and its linked articles have been in my particular case. Thank you x infinite.
Having been suffering with severe hyperactivity to ~ EVERYTHING with which I have come in contact — e.g., foods, insects — the insight you have provided has hit the nail on the head with me.
Too bad other physicians, even those in high places, have no knowledge of what your posts have so clearly, astutely, brought to the fore.
Having been plagued by classic hypo-T symptoms — including severe pretibial myxedema — and been diagnosed with the primary form of the disease, I have been on a generic liothyronine for nine weeks.
Today, thus having endured more than enough whole-body inflammation to last a lifetime, I refrained from taking the lio-T, having suspected it as the cause of all my woes.
Interestingly enough, however, I had already noticed a substantial improvement in how I had felt all day, when I spied your message on my list. I could not believe my eyes, since I had been trying to find articles just like yours.
Certainly the Law of Attraction had to have been working in my favor this 21st day of May 2015.
Right now, in fact, I am awaiting communication from the manufacturer of the lio-T I have/had been taking. Of course, I want to know all substances the drug contains, but will not take it again.
Now though, my challenge is to determine which other thyroid medication would best address my symptoms — e.g., I have read myxedema responds to T3 only — given my having a T4/T3 conversion problem as part of my condition.
I do not know whether you will respond to my inquiry and realize there is no doctor/patient relationship here, but what would you suggest in such a situation? How costly might it be to work with a compounding pharmacy?
FYI, generic levothyroxine alone did nothing for the myxedema while I took it during the winter. Moreover, I recall suffering from hyper-reactivity — though to a lesser degree than what I have been, while on lio-T — on levo-T also.
Once again, I cannot thank you enough for your superb timing and articles today.
Looking forward to hearing from you,
Susan
Hi Susan,
Obviously you want to try to address the conversion problem if at all possible, but if you have low or depressed T3 levels then I agree that in the meantime it would be a good idea to address this. If you are reacting to the ingredients in the liothyronine then a compounding pharmacy could be a good option. As for how costly it might be, I’m not sure exactly how much it will cost, as I’m sure this will vary depending on the pharmacy you use, although I’m pretty certain it will be more expensive than taking something such as Cytomel. Taking a natural form of thyroid hormone such as Armour or Nature-Throid might also be an option, although in my experience the main cause of pretibial myxedema is the imbalance of the immune system, and not the thyroid hormone imbalance itself.
THANK YOU! THANK YOU! THANK YOU! I left my MD, last summer, because of this very same thing. Four years ago, this September, she diagnosed me w/ Hashimoto’s. TSH was 80. Put me on Levothyroxine, I was having side effects, namely stomach issues. I quit taking it. Went Gluten Free(another story happening @ this same time), went for my annual check up, TSH was lower but still too high to be acceptable. She put me back on Levothyroxine, stomach, dermatitis, brain fog & on & on. I called the office, talked to a nurse who forwarded the message that I was having reactions and asked what they would suggest. I was told to do my own research and let them know what I would like to take. OH I DID ALRIGHT! I called my pharmacist, explained the Hashimoto’s and Celiac and asked what they might suggest. I had the best pharmacist, who said she would do some research on ingredients and research to see what would be available. She got back to me the very same day and told me I should absolutely not be taking Levothyroxine because of the fillers and there was another possibility that did not have the corn or wheat fillers, but that pharmacy did not normally carry those products. I called another pharmacy that did and was able to get a script filled (without my Dr.). This particular med. had a depression side effect, it was listed, and I knew by the 3rd day of taking it. I immediately got off it, waited a couple days so I could be certain I was “better” before I called my MD. Called the office, talked to the nurse again, told her I just could not take any of those meds because of the side effects. She reported to the MD, whose message back to me was that she did not believe I was having all those side effects and wanted me to go in to the office so “we can address the depression issue”. I WAS FURIOUS! I told the nurse “I WILL NOT, I will not come in to be drugged for something that I know what the cause was.” I searched for a DO, had my file immediately transferred, she immediately put me on Tirosint (I had already done the research), and scheduled me with an Endocrinologist. She wanted a solid confirmation of the Hashimotos and professional feedback on the Tirosint. She did not waste any time. I also started a relationship with a Chiropractor who practices natural endocrine, just as you do. It amazes me how she can talk/treat me and next thing I know, you have an article having to do with the very same subject. She has helped me more than my MD could ever have and my DO is willing to work with the regimen I am on with her. So, Thank You, again for all you do in explaining all of this mass confusion. I know, I was like a mad woman trying to do all my own research and trying to understand it with the help of professionals like you.
For me it was because my ferritin levels were low.
I have been searching for solutions to my hypothyroidism that leaves me freezing cold, and so fatigued that I have NO energy to do anything. Hair falling out, thin skin, emotional mess…the whole thing. I went to a natural doctor who first address the adrenal issues and I have been on adrenal rebuilder and support and a thyroid support for 6 months. I was able to loose some weight with diet changes and exercise, but my thyroid levels only got worse. I am now on Nature-thyroid in addition and this is the worst I have felt. I am soooooooo tired. soooo cold. My mood is basically– depressed. what can I do? Is it that the Nature throid isn’t working or that i am taking too little of it. Or is all the problem in my body. My throat literally hurts and i can see the outline of my thyroid gland there.
this sounds just like me… what does this mean?!
I have a very difficult problem at this time and I’m very confused..I’m always been very sensitive to caffeine, sugar, alcohol… so I always stay away from it, it makes me extremely hyper, I was diagnost with hyperthyroidism and was prescribed Levothyroxine 25 mg I’ve been feeling very nervous, hypper, with a lot of anxiety, can sleep, I change my diet to no gluten, sodium, dairy, grains etc etc. and I explained it to my doctor she prescribe trazadone didn’t work at all then celexa, and hydroxyzine and still no improvement, I don’t understand why I became so resistant to this medication, I never experience something like this before and been taking it for over two months, at this point I feel very hopeless…I will appreciate any information… thank you . Best regards
Hilda, did you say you were prescribed 25 mcg of Levothyroxine for hyperthyroidism? If so then it’s not surprising that this caused you to become more hyper with anxiety, as Levothyroxine is for hypothyroidism. I can understand you feeling hopeless, but I would highly recommend working with a functional medicine practitioner. While it’s great that you changed your diet, many times doing this alone isn’t enough.
I had a TSH of 4.1 and normal T3 amd T4. 3 days later I had more labs done which showed TSH of 6.9. I started levothyroxine. I have been having very bad anxiety since I started it and terrible mood swings. I got more labs today. Only a week after I started the medication and my TSH was 3.2.
I don’t know what’s going on. My doctor said maybe the high TSH was a lab error. I have gained weight which is never an issue and have been suffering from depression and some anxiety. But I’m worried because the meds have been making things worse. I’m worried maybe I don’t need them and I’m not sure what I should do next. My doctor doesn’t seem very concerned and won’t recommend me to a specialist.
Lynn, I’d recommend seeing a functional medicine practitioner. First of all, even if the T3 and T4 are within the lab reference range, this doesn’t mean that they’re optimal. They might be optimal, but I’m not sure since you only listed the TSH values. In addition, I would recommend testing the thyroid antibodies (if you haven’t done so already), as even if the thyroid hormone levels are normal, Hashimoto’s typically starts out with elevated TSH in the presence of normal thyroid hormone levels. If the thyroid hormone levels are optimal and the thyroid antibodies are negative then it’s possible that you have a pituitary problem. And other imbalances can cause or contribute to anxiety and depression, which is yet another reason to work with a doctor who will try to address the cause of the problem. It’s also worth mentioning that even if thyroid hormone replacement is necessary, not everyone does well on levothyroxine.
HI,
So what if the problem is pituitary? What can be done for that?
Thanks!
Hello, I am very thankful for this article. I have been on levothyroxine for 15+ years and one day my thyroid started swelling up, so they upped my dose and I didnt feel better. Then they decided to switch to cytomel only (t3 only) and I felt great! I was on top of the world at 40 ,mcg a day, then I went to a specialist and they said to lower my t3 to 25 and add back 50 mcg of the levo, in the meantime I was diagnosed with possible hashimotos thyroiditis. I was ok until about day 8 or 10 then I started to feel horrible like I was taking nothing, and I stopped the levo (t4) and went back to t3 only again and felt fine. NOW when I take 25 of cytomel (t3) I feel bad, and my face puffs up, so I lowered it to half of that and I feel lees bad every day, but my thyroid dr doesnt believe me, she asked if it was in my head, which it cant be, every time I try to take the whole 25mcg of cytomel (t3) I pray to god to not make me feel bad and every time I do and the worse part is the puffiness in my face. I am embarrassed to go to work becasue I know I look bad and I dont have another dr in the area, I called and they said they are months out so I made another apt with the dr I have now. I dont know what to do other then try eating raw diet for a while and see if my body can work itself out. But I dont know if I should stop the meds completly or continue with the half of a 25 of cytomel? Even today I took a half of levothroxine (25) and a tiny piece of cytomel… I could tell right when it kicked it! I get this throbbing on the sides of my neck for a few mins when I am about to feel bad, it always goes with the rest of the symptoms and I felt that about 15 mins ago. SO I am seeking some feed back from a dr that believes me. If you have heard of this before please help me! Thanks,Nicole
Nicole, as I’m sure you can understand, I can’t advise anyone to stop taking medication. I’m assuming your T3 levels were low, which is why you were taking cytomel? Have you tried taking desiccated thyroid hormone? Even if these help I do think it’s important to try to address the cause of your condition, while at the same time incorporating the basics (i.e. eating a clean diet, doing a good job of managing stress, etc.).
I just got diagnosed with hypothyroidism at 30. It runs in my family. Both my Nan and great aunt had their thyroids removed. My tsh is very high at 127 and my t4 is low at <5.2. I just started taking 50mcg of Levothyroxine and I feel terrible. I have extreme fatigue, migraines and nausea. There’s also a possibility that I’m celiac (I’m going to get tested ASAP). Could this be creating a bad reaction to the synthroid?
Ange, how long have you been taking the Levothyroxine for? The reason I ask is because I’m wondering if you have taken it long enough to have a retest of your thyroid panel to see if it has helped to improve the numbers. Also, the next time you have blood drawn I would also recommend testing the free T3 to see if the T4 is converting into T3. That being said, numbers don’t tell the entire story, and even if they look better there’s a chance that the synthroid isn’t a good fit for you. Some people do better with a “cleaner” form of levothyroxine, such as Tirosint, while others do better on desiccated thyroid (i.e. Nature-Throid, WP-Thyroid).
My husband had his thyroid completely removed due to abnormal pre-cancerous nodules on his thyroid. He has been taking Synthroid since. He discovered that his medication was actually making him feel worse. He had no energy to do anything. He completely quit taking it. I am concerned of what not taking the medicine will do. What are his options?
Hello Taylor,
I am in a similar situation as your husband. I know it’s been awhile since your post and I’m not sure you’ll see this, but I was wondering if your husband was able to get things sorted out.
I had a TT in 2008 and I’ve tried every form of thyroid hormone replacement (T4 (even Tirosint), T3 only, combined T4/T3, and NDTs), and the only time I ever feel good and my symptoms subside is when I stop taking any replacement meds. Of course with no thyroid gland this is not a permanent viable option for me.
I am at a total loss and basically survive by taking thyroid replacement hormones for a time until I just feel terrible and then stop taking them for awhile so I can feel well for at least a few days. When I begin to feel unwell I start the replacement hormones again, and when they begin to make me feel terrible I stop taking them again for awhile. The roller coaster is horrible. I live for the days when I stop taking my meds and feel better shortly after, afraid to do that for very long though, so then I dread the days when I have to take my meds again, because I feel so sick with symptoms. I always feel like I’m forcing myself to take poison. It seems that no amount of supplements, diet change, female hormone replacement (I am in menopause), ever make any difference. Adding things to my body doesn’t make me feel any better, but not adding thyroid hormone replacement makes me feel almost well, at least for a time. I’ve been to several doctors and none of them know what to do with me. It seems I am a mystery.
If you don’t mind sharing your husband’s experience please respond.
Thank you very much!
Hi Marla,
I know exactly what you are going through as I am in the exact same position as you. I am a 58 yo male and I have been on Levo, NDT, Levo plus T3, Tirosint, and T3 only for seven years. None of the meds work and actually do the opposite of what they are supposed to do in addition to adding disabling side-effects. I can stop taking meds and I feel much better within 36 hours of discontinuing, then upon re-continuing, I feel sick again (lethargy, nausea, brain fog, depression, moodiness, no libido, shortness-of-breath, palpitations, PVC’s and PAC’s, muscle stiffness/weakness and overall feeling of sickness that is unbearable) within a few hours. The cause and effect relationship is repeatable and undeniable. I have seen several endocrinologists and none of them have a clue. It seems they were all taught that TSH, based on population based ranges that includes sick people, is all that matters. The American Thyroid Association recommends this even though their own study in 2018 of 12,000 thyroid patients found that 50% of patients were unhappy with their treatment plan or treating physician and nearly 100% said new medication is needed – yet nothing is done. This simply doesn’t happen when medication works and patients feel better. Yet the ATA still recommends normalizing TSH with levo even though they know it doesn’t work for a large portion of patients. I have found first-hand that my well-being and quality of life doesn’t matter as long as they hit a TSH number that makes them happy, while the host of unbearable side-effects that makes a patient consider suicide are largely ignored or blamed on some other “undiagnosed” issue. Typically, the patient is accused of not taking meds or are accused of having clinical depression requiring anti-depressants even though the host of other side-effects brought on by thyroid drugs aren’t related to depression. Apparently, they don’t teach clinical assessment and treatment in medical school anymore. It used to be thyroid meds (NDT) were titrated according to reduction of symptoms. Now, thyroid patients are nothing more than a lab number. I was even told to my face by an arrogant and uncooperative endocrinologist at a large teaching healthcare organization (University of Colorado Health) that she only treats TSH. Doctor’s like this are a dereliction to their own profession. If TSH is all that matters, a computer can do that more effectively. You certainly don’t need a “specialist” for that. They also seem ignorant to the fact that thyroid meds don’t work for a large portion of the patients. A simple google search will prove otherwise by producing thousands of examples like ours on a variety of thyroid advocacy sites. There is a thriving cottage industry for alternative thyroid treatment that would not exist if the mainstream doctor’s actually listened to patients and understood that it is them and not a lab chart that they are treating. But, of course, that will cause extra work for them which typically isn’t going to happen in a 15 minute appointment. Anyway, I got off topic venting my own frustration. I am sorry you are going through this but know you are not alone. There are plenty of us “numbers” out there suffering like you. I just hope that if enough people continue complaining in public forums like this, something will eventually be done for us.