How To Optimize Thyroid Medication To Feel Your Best

There are many steps involved in feeling your best, and some can be a bit tricky. One of the most important things to sort out is your thyroid medication.

Do you need it? If you do how do you know if you’re on the type and dose that will work best for you? This blog will help you answer these questions.

The fact is that the right thyroid medication versus the wrong thyroid medication can make a massive difference. Let’s talk about finding the optimal thyroid dose so that you can get back to feeling your best!

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Table of Contents

Do You Need Thyroid Medication?
Can You Go Off Thyroid Medication?
How Long Does Thyroid Medication Take To Work?
Top Signs Your Thyroid Meds Are Working
Optimizing Your Thyroid Medication to Treat Symptoms
Does Your Thyroid Medication Need Adjusting?
How Often Should You Test?
Optimizing For Thyroid Medication

Do You Need Thyroid Medication?

Here’s the thing: It’s been argued that upwards of 85% or more of people on thyroid medication don’t need it. They were never meant to be given to them in the first place.

If you are on them unnecessarily, they can cause symptoms and side effects (even if your levels are normal).

In the journey of optimizing your meds, we’ll definitely need to discuss whether you need those meds in the first place. Let me start with a quick list detailing all of the people who are going to need thyroid meds on a long-term basis:

• Those without a thyroid
• Those whose thyroid was destroyed by radiation
• Those whose thyroid glands have shrunk down to nothing

Anyone in these three camps is going to need thyroid medication. The ones above are a bit of an open-and-shut case. But who are those that might need thyroid meds?

Those who have overt hypothyroidism (defined by an elevated TSH in conjunction with a severely low T4 level). In some cases, thyroid medications are needed.

Cases where medication is rarely needed include cases of subclinical hypothyroidism. That includes any kind of abnormally elevated TSH with T4 still being produced.

Finally, those who have suboptimal thyroid levels do not need medication.

Can You Go Off Thyroid Medication?

If you need thyroid medication, you can’t go off it. But, as we can see from the above, that only involves some few-and-far-between cases. In all other cases, many can taper, and many of those who do taper can come off their medications entirely.

About 84% can take less, and around half can move down to none. You may not want to try for that if you are pregnant or nursing, but those who have the best odds of coming off thyroid medication are those who have a family history of thyroid disease.

That might sound a bit odd, but it’s true! This is also true for those who have been on treatment for shorter periods of time (like less than four years), those on lower doses of medication, and those with stable TSH levels.

How Long Does Thyroid Medication Take To Work?

Let’s say you just started taking thyroid medication. The first thing to understand is how long it takes for these effects to kick in and what you should do about it.

How Long Does Levothyroxine Take To Work?

When I tell you about a thyroid medication like Levothyroxine, I mean any thyroid medication that only consists of T4. T4 is metabolized pretty slowly, which means the initial benefits may take upwards of 2-6 weeks.

The full effects could take a couple of months or even longer. But what kind of thyroid symptoms do we refer to when discussing Levothyroxine “working”? Symptoms related to mood or energy may resolve quickly, but ones like bone density or tendonitis will take longer.

Then, we need to think about stabilizing your blood levels. If you are measuring T3/T4 levels, it can take 6-8 weeks to stabilize on a T4 medication – and about 3-4 months for your TSH overall.

How Long Does Natural Thyroid Take To Work?

Now, if we are talking about natural desiccated thyroid (NDT) or a combination of T4 and T3, sometimes initial changes can occur quickly. This may even take place in the initial days and weeks, typically applying to some early, light changes.

The full effects can easily take a couple of months. The timelines for blood test changes are also faster, mainly due to the T3 being added to the equation. This could take 6-8 weeks, but still 3-4 months for your TSH to stabilize.

Top Signs Your Thyroid Meds Are Working

When we discuss optimizing your thyroid medication, we inevitably need to discuss how we know our medication is working. What do you need to look out for?

The first thing to know is that the amount you’re taking is reasonable for your body size. There are a lot of numbers to crunch here, but I have put together a very handy calculator that can help you figure this out in record time. You can take a look at it here.

If your dose is much higher than one would predict based on your body size, something may not be right! It could be that your body is not absorbing it correctly, that you don’t need it, or that there are a whole host of other factors at play.

The next sign that your dose is properly working is that your blood levels are stable. They are normal and within a reasonable range.

Finally, your dose is working when the symptoms you had prior have gone away or gotten markedly better.

How Do You Know Your Thyroid Meds Aren’t Working?

Conversely, let’s talk about some warning signs that might tell us that our thyroid medication is not working to our benefit.

If your dose doesn’t make sense or is way higher than expected per your body size, that should ring some alarm bells.

Additionally, if your blood levels are not stable and often fluctuate, a quick point here is that if your thyroid levels are unstable, there could be many issues at play.

A big thing to think about is how you are timing your thyroid blood tests. Are you testing at the right time? I’ve written a complete guide on the subject, but here’s a quick run-through:

• It has to happen in the morning (between 7:00-9:00)
• You have to test before taking your thyroid medication
• Testing should be done after fasting and without supplements
• It also must be timed properly with your menstrual cycle

Back to the topic at hand, your thyroid medications may not be working if you are still struggling with thyroid symptoms. This could include:

• Weight
• Fatigue
• Hair loss
• Mood changes

All of these are critical. While they might come from other reasons beyond your thyroid, you should still know that. This is especially true if you’re told that your thyroid is the issue, but thyroid medications aren’t helping.

Optimizing Your Thyroid Medication to Treat Symptoms

Here’s something I think you should know: You can have levels of abnormal thyroid hormones that can cause symptoms, but that doesn’t mean that medications will help those symptoms. That’s a super important thing to keep in mind.

In mild to moderate hypothyroidism, the problem is not a lack of hormones. Instead, it’s a higher signal telling the gland to work—but the gland is still working. While there is a disease, it doesn’t involve a pure lack of thyroid hormone.

Ultimately, this is the exact reason why so many people are put on thyroid medication, and it doesn’t seem to help. That’s because their issue was never a lack of thyroid hormone, even when they had a higher TSH.

Which Symptoms Mean You’re Not Getting Enough Medication?

When we talk about the symptoms of not having enough thyroid medication, we often think of some of the most typical hypothyroid symptoms, including:

• Weight gain
• Fatigue
• Hair loss

Which Symptoms Mean You’re Not Getting Too Much Medication?

On the flip side, which symptoms are often associated with getting too much medication? Let me run you through those very quickly, but I hope you’ll see a bit of a pattern:

• Weight gain
• Fatigue
• Hair loss

Isn’t that wild? It’s completely true. You can have the same symptoms of too much or too little thyroid medication, which brings us back to determining if you need it at all.

Does Your Thyroid Medication Need Adjusting?

If you have some symptoms associated with too much or too little or abnormal blood levels (even if your symptoms are fine), you likely need an adjustment.

If your levels aren’t right, even if you feel completely okay, that will cause dangers down the road and raise your risk profile.

If you are feeling well, it is okay to be anywhere in the “normal” range. There has been a lot of pressure on super narrow, “optimal” thyroid levels.

Where they matter is someone in a normal range but still isn’t feeling their best. You could adjust medication to move them into a narrow optimal range if they need it.

But you don’t have to be in these optimal ranges.

How Often Should You Test?

If you are on medication, let’s quickly touch on the best times to test. There are two scenarios that I want to take you through quickly:

1. If things aren’t stable, maybe you are tapering on medication or adjusting the dose. In those cases, I like to check between 1 and 3 months to get a sense of which way things are moving so that we can pivot quickly (if required).
2. When things become stable – I don’t encourage someone to go less often than twice yearly, so 6 months between testing is a good way to go.

But which tests are the most important? Here’s a quick recap, starting with the tests that I would deem essential to your health:

• TSH
• Thyroid antibodies

Especially if you are doing frequent testing, the two above are the bare minimum. But, we could also look to test:

• Free T4
• Total T3
• TSI
• TBII
• TG

These will depend on the details of your situation and the input of your doctor or other medical professionals.

Optimizing For Thyroid Medication

As a final recap, if you need thyroid medication and it is mandatory, you absolutely have to get it right. It is no more difficult to take the right pill than the wrong pill, so make sure you are taking the right dose.

Additionally, the right medication, in terms of the type and the dose, can be life-changing. Conversely, the wrong one can be catastrophic. I want to help you get it right for your health.

Ultimately, this will come down to your relationship with your prescriber. They should help you understand all of these things, and they should be someone you trust to help you get this right.

If you are looking for a place to start, you can also contact me to book a virtual consultation. When time allows, I would love to be your guide on this journey, so please feel free to reach out.

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 Thyroid Supplement Recommendation? Take My Thyroid Specific Formulations Quiz Now
3. Need a Personalized Supplement? Check out My Thyroid Specific Formulations
4. Download and use my Favorite Recipes Cookbook Here
5. Check out my podcast Medical Myths, Legends, and Fairytales Here

Dr. Alan Glen Christianson (Dr. C) is a board-certified Naturopathic Endocrinologist, and the author of The NY Times bestselling Adrenal Reset Diet, Metabolism Reset Diet, Thyroid Reset Diet, and the Healing Hormone Cookbook.

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.