How is it possible that you could be on thyroid medication, and yet it just doesn’t seem to be working?
Today, I want to share with you 19 potential reasons why your thyroid medications won’t work, and what you can do about it.
Presented in no particular order, here are the factors that could be influencing the efficacy of your thyroid medication, because while it might be any one of these — it could be a combination.
Without further ado, let’s break down each of the reasons…
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Coffee
Supplements
Oral Contraceptives/Natural Hormone Replacement Therapy
Autoimmune Gastritis
HS (Hours Sleep) Dosing
Taking Once Daily
The Wrong Potency Dispensed
Anemia Skewing Thyroid Blood Levels
Compounded Medications
Product Variability
Truly NPO?
A Lack of T3
A Lack of T2
Your Pharmacist Changed Brands
Fatty Liver
Expired Lot
Not Taking Regularly
Inaccurate Test Results
Symptoms From Other Causes
Make Your Meds Work For You
While I don’t personally drink caffeine, I am not against it. There is even data that suggests, for some people, coffee may benefit them.
However, it can make thyroid medication difficult to absorb. It can happen that you are taking thyroid medication, but it doesn’t feel like you are really getting it, that can be the reason.
Some studies have shown that coffee ingested ten hours after taking a pill, can still have an effect on your ability to absorb it.
One step is trying to do without coffee while taking your thyroid medications. From there, you may notice an almost immediate change.
Almost anything that you take during the time you take your thyroid medication can result in you not absorbing it properly (Read More: What Supplements You Should Take).
If you are not absorbing it, you are not going to benefit.
Key Insight: While it might feel like a convenient time, first thing in the morning, to take a lot of pills, you need to take your thyroid all by itself.
Here is a ritual that I encourage: put your tablet out on your bedstand, and have a glass of water ready to go with it.
When you first wake up, take your thyroid pill.
When you are going to bed, don’t just have the tablet available but open up the bottle and put a single tablet in the cap.
You might even wake up at 3 or 4 in the morning, and if you do that is a great time to take your thyroid tablet. If the opportunity arises to take it earlier, you should go for it.
Once you get up in the morning “for real,” this method will ensure that you know that you took your medication already — no second-guessing yourself!
After taking your first tablet in the morning, and completing your morning ritual, then food and pills are totally fair game.
This is a really well-known and straightforward consideration, but it remains one that is often missed by people.
Your body makes a blocking protein called thyroid-binding globulin. It is in proportion to how much estrogen can be found in your system.
If you are a menstruating woman, this is one of the reasons that your levels change throughout the month.
But, when you are adding in an oral contraceptive (or even a topical or vaginal one), it can radically change your body’s response to thyroid medication.
This is essentially true with any form of hormone replacement, or even if you start and stop things like these. If you are changing your estrogen levels, you are potentially compromising your medication’s ability to work effectively.
When a doctor is adding or removing estrogen, it is advisable to plan ahead of time.
In cases like these, you may need a boost or a decrease in the amount of medication that you are taking — in line with your hormonal needs.
At Integrative Health, for instance, our doctors actively adjust these things to make sure we are always one step ahead. It starts with a small amount, and then we re-check and give it some finetuning as needs arise and change.
This is the most common cause that you may have never heard of before.
Key Insight: 30-40% of people with autoimmune thyroid disease are known to have a condition that can make them not effectively absorb certain things.
This breaks down the cells in the stomach and causes them to stop adequately releasing hydrochloric acid.
A popular approach is to take pills of hydrochloric acid. Ultimately, it may or may not help, but it will definitely hurt you.
There is very strong data that, with autoimmune gastritis, you may be more at risk for:
This would be the case if you were taking hydrochloric acid pills. Ironically, the very people who could benefit the most in the short term are most harmed or at risk.
You should consider the presence of autoimmune gastritis if you:
If you are on thyroid medications, and you aren’t absorbing them well in addition to having anemia or gastric symptoms, you really should be screened for that.
In those cases, there are some common workarounds or dosage adjustments that often help. Ultimately, it is more about knowing whether you have it in the first place or not.
Some people do a lot better with nighttime dosing when it comes to their thyroid meds.
That said, a lot of the data still suggests that — on the whole — morning dosing is best. It is just that some individuals may do better with a nighttime dose.
If nighttime dosing is less effective, though, it really is not by much. We might be thinking about a few percentage points here or there if that is the case at all.
The one big pitfall of nighttime dosing is that it takes longer for food to leave your stomach than it does for the thyroid tablet to leave your stomach and make room.
In terms of after meals, you’ll want to look at having at least two hours after your last meal before taking the thyroid tablet.
Whereas, on the other side, if you are considering taking your meds before a meal, that could be as close as one hour beforehand.
You could have your tablet right before going to sleep, at least two hours before your last meal.
Many people have been prescribed to take their thyroid medications multiple times per day.
While I understand the logic behind it, the thought process is more relevant to T3 medications.
How frequently we take medications is not based upon a peak in the blood levels, it’s more the opposite — based on urinary excretion.
We call that a “half-life,” which is how quickly you get rid of the dose of medication. The half-life for T3, in this instance, is a little more than a day (30 hours).
So, you can take it once a day and the effects of it in your body will be constant even though the blood levels are not constant.
Many prescribe multiple medications per day trying to chase these blood levels, while healthy people who don’t need thyroid medications also do not have steady blood levels.
Key Insight: Once-daily dosing is more effective than twice or three-times-daily dosing.
Basically, it is a method that is consistent with your body’s biological circadian rhythm. Taking it multiple times is inconsistent, and many have issues with their sleep or symptoms when they take meds multiple times per day.
Over the years, I have learned the importance of assuming as little as possible.
That’s because I have witnessed so many times, someone coming in and saying “I was on what you prescribed and it wasn’t working well.”
Following that statement, I would always ask people to bring in their medication when they came in for an appointment. The results were always eye-opening.
In fact, you’d be surprised how often I would look at the prescription bottle and the potency was not at all what the patient was supposed to be getting.
There are also times where it may say the potency, but the tablets do not line up with the potency that it is supposed to have.
Any tablet that you have, based upon the code imprinted upon it, as well as the color and the scoring (or lack of scoring), you can put that code into Google and determine what you have.
The thing to know is that there are times where the label may say one thing, and the tablets themselves are something completely different.
Those things happen, and they matter. It may seem like an obvious thing, but it is always a good idea to double-check and make sure.
Did you know that anemia can skew your thyroid blood levels?
This is a two-way issue because abnormal thyroid function can skew your iron levels. If your iron is off, it can result in inconsistent thyroid levels when tested.
And, it can cause a lot of those same symptoms to show up even if they should not (even if your other blood levels are completely normal).
There are a lot of different types of thyroid medications out there (Read More: The Full Guide On Thyroid Medications). This is the one that I recommend the least.
The fact is that compounded thyroid medications are not standardized. So, while they can be intended to be made with a certain potency, there are no checks and balances on that system.
An upsetting element of this is that I have personally seen patients almost die from these types of medications being made incorrectly.
While I don’t doubt that in most cases they are good approximations and are reasonably well done, it’s important that they are exact and incredibly consistent to maintain good health.
Key Insight: If you are on a compounded medication, I would immediately consider switching to a standardized, consistently-made medication to help you.
This is where we need to get a bit more granular.
Once you have a standardized medication, there are a couple of guidelines we need to address.
There is a 20% window for potential variations of active hormones in natural thyroid (or 10% for synthetic thyroid).
When you get down to the brass tacks of micrograms and absorption, that can end up being a lot of difference.
It could even be an issue to where you are doing well, you re-fill your prescription, and suddenly things are simply not working the same way.
This is what we call product variability from batch to batch.
On the whole, I do prefer brands that have fewer fillers like:
Then, there are ones that have good standardization which include:
These are the brands that I like the most because they are the most rigorously standardized and best absorbed.
Earlier on, I mentioned coffee and supplements getting in the way of absorption.
In addition, literally any kind of food can also be a factor in the exact same way.
Key Insight: Anything can hinder your ability to absorb thyroid, but some things are particularly awful. Calcium is one of those things (like you might find in orange juice).
What you need to do is enjoy your thyroid meds completely, totally, and definitely away from any other foods. Only take it with water, as anything else may cause issues.
Sometimes, people do a lot better on medications that have T3 in them (Read More: How High Should Your T3 Be?).
Thyroid medications have been made with T4 or T3, or a combination of both, and many do better then things are combined.
While there are many people who take T4-only medications and do just fine, there are genes that make people less likely to do well on T4 alone.
The surprising thing is that these gene types which are considered “rare,” are quite prevalent — in some groups, they can be up to 80% of the population.
So, if you feel like that might be you, you are not an outlier. It is more common than not that it could be you!
Along the same lines as T3, sometimes T2 thyroid hormone can have its own game-changing effect.
Now, you may have heard before about T4 and T3, but T2 may be a bit of a newer subject.
T4 is the main hormone that your gland releases and T3 is made both by the gland and by your body using T4.
But, there is one more T that we don’t want to forget: T2!
For many people, it turns out that T2 is important for your energy levels and your metabolism. So, where do you get it from?
If your thyroid works well by itself, you already have it. If you have thyroid disease, though, you may be low in T2.
The complicated thing is that they do not make T2 on its own, as it is only found in natural desiccated thyroid (NDT).
That is one of the reasons that I prefer NDT by default. You are getting a full spectrum of T4, T3, and T2, the same way you would if your thyroid was performing optimally.
Imagine this: you are cruising along, totally fine, using Naturethroid of WP Thyroid. Things are fine, you’re feeling well, and everything is stable.
Next thing you know, after a quick refill, you are feeling just awful.
Things that weren’t happening before are now back, including:
The whole time you’re wondering, everything has stayed the same, hasn’t it? But, it could have happened that your pharmacy gave you a different brand than was prescribed.
When a doctor prescribes a medication, they can either specify which brand needs to be used, or they can check off a box that says “substitution permissible.”
But, even when a doctor checks the other box titled “dispense as written,” specifying a very particular brand, patients have come back with a different brand.
In many cases, that occurred after many times they got the right brand.
While the active hormones don’t vary much from brand to brand, the inactive ingredients do vary. This can change the way it breaks down in your body.
It’s almost like starting from scratch to determine your optimal dose, and the same applies to generic brands (which often switch between manufacturers).
At Integrative Health, our doctors give you the sealed bottle directly from the manufacturer. No more guessing if the pharmacy substituted brands without your (or your doctor’s) knowledge.
Key Insight: Your doctor should always write “dispense as written,” and then you should be double-checking to ensure you get the brand you need to thrive.
When your liver function is off, it can skew your levels and cause many of those symptoms which hinder your thyroid from working properly.
We suspect that whenever a woman’s ALT blood score is greater than 18, or her waist circumference is more than half of her height.
Ultimately, it results in your body not being able to use thyroid properly.
The good news is that there is a solution! In fact, I created the Metabolism Reset Diet for exactly this reason, to help reverse this common issue to help your body feel its best.
The truth is that most people do not go on NDT, so pharmacists may feel pressured to use whatever supplies they have on hand.
It is not something you will always know from the tablets themselves, but it is something you need to think about.
That is one of the main reasons we stock our own thyroid medications here at Integrative Health. It helps us keep track of the supply chains and know exactly when certain medications have arrived and in what batches.
When we are able to keep on top of everything like this, it simply brings a lot more clarity and assuredness into the process. This way, you never have to worry about an expired lot.
This is a big thing for a lot of people and is a big reason why I am such a huge fan of ritualizing the pill-taking process to work on your terms.
It is so easy to miss a day or two, here or there, but it is important for your health that you keep taking them at a consistent time.
That is why a pill tray is such an easy and objective tool, whether for the week or the month, to see if you had taken your pill for the day and to keep doing so consistently.
While many can miss a day or two and not feel any drawbacks, it could also be, for some, a big reason why you aren’t feeling at your best.
It could be the case that what you are on is appropriate, but you are getting inconsistent test results that are skewing your path forward.
There are several reasons for that at play here, all involving timing, which include:
You have to test in a way that gives you meaningful results to ensure you are making the proper adjustments and determining the right way to approach your thyroid medications.
If your thyroid medication simply isn’t helping with your symptoms, it may be that your symptoms are coming from other causes.
There is a whole host of conditions that are common amongst the people who are prone to thyroid disease, and many other conditions that are common in people who simply have thyroid disease in the first place.
Finally, there are many conditions that may be the result of abnormal thyroid levels or the result of autoimmune disease.
Key Insight: Those things together, there are at least 15 conditions that I have tracked that each one affects more than five percent of those with thyroid disease (some as common as 84%, which is true in the case of anemias).
Therefore, there is a good chance that something beyond your thyroid (but perhaps influenced by it) causing symptoms and disrupting your health.
Too often, I think we can get fixated on getting your thyroid levels in check. Truthfully, that shouldn’t be our only area of focus.
As you can see from the list above, there are a whole host of reasons why your thyroid medications might not be working for you.
The answer may lie in one of the reasons above, or a combination of them.
This is why it is so important to work with an expert to help determine and treat your symptoms.
You can feel better, and you shouldn’t settle for anything less than best. Start by taking the Thyroid Quiz today (Click Here: Take The Quiz), as I’m sure it can help set you on the right path for your best health.
P.S. Whenever you are ready, here is how I can help you now:
1. Schedule a Thyroid Second Opinion with me, Dr. C, Click Here for Details
2. Need a Personalized Supplement? Check out My Thyroid Specific Formulations
3. Download and use my Favorite Recipes Cookbook Here
4. Check out my podcast Medical Myths, Legends, and Fairytales Here
Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Adrenal Reset Diet, The Metabolism Reset Diet and The Thyroid Reset Diet.
Dr. C’s gift for figuring out what really works has helped hundreds of thousands of people reverse thyroid disease, lose weight, diabetes, and regain energy. Learn more about the surprising story that started his quest.
Dr. Alan Christianson
Alan Christianson is a Naturopathic Medical Doctor (NMD) who is a board-certified Naturopathic Endocrinologist with a focus on thyroid disorders. He is the author of The Metabolism Reset Diet and the New York Times bestselling book The Adrenal Reset Diet.
He founded Integrative Health, a physician group dedicated to helping people with thyroid disease and weight-loss resistance regain their health.
He has been named a Top Doctor in Phoenix magazine and has appeared on national TV shows and in numerous print media.
Dr. Christianson resides in the woods by a lake in Northern Minnesota with his wife Kirin.
