Q. Before I was put on levothyroxine for underactive thyroid I was irritated by even the smallest things. I felt so tired and depressed that I was always crying. I couldn’t sleep or lose any weight and I always felt cold.

When I started on levothyroxine (150 mcg), I felt more like my normal self than I had in a long time. My doctor lowered the dose and my symptoms have gotten worse again. The doctor says the blood test is OK, but I still feel bad.

What do the tests mean? How can I overcome the lethargy and depression?

A. Depression, fatigue and feeling cold can be symptoms of inadequate thyroid hormone. So is trouble losing weight.

Getting the dose of levothyroxine (T4) right can be tricky. Some people do better with a combination of T4 (Levothroid, Levoxyl, Synthroid) and T3 (Cytomel). We are sending you our Guide to Thyroid Hormones with details on interpreting test results and using natural treatments such as Armour Thyroid. You can also read more stories about Armour here and here.

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  1. Terry G

    Those who are interested in thyroid diagnosis and treatments, as all of you are, may want to listen to our latest show on the subject. You can stream it from http://www.peoplespharmacy.com/2012/04/14/853-thyroid-controversies/
    or go to iTunes to get a podcast download. We interviewed three different experts (one of them expert patient Mary Shomon) to get different perspectives on the controversies.

  2. mk

    I was just put on levonth something (still cant say it) for under active thyroid and I feel worse… more depressed and irritable than before and want to do nothing but sleep. it’s been a week on the meds. is this normal?

  3. fbl

    Kathleen, your body is probably trying to tell you that it doesn’t like the artificial thyroid med. You might talk to your Dr and have him give you the natural stuff. Every body is different and it took my Dr and I awhile to find what made my body happy. I am now on Cytomel and NatureThyroid and doing great. Even my body temperature (taken before I get out of bed in the morning) has responded well and I’m usually at least 98 now and sometimes even a little higher. I started out just under 96 degrees!

  4. Kathleen H.

    I totally agree with this statement. Thank you for explaining it so clearly.

  5. Melinda F.

    Make sure they do s sonogram to see if you have a thyroid nodule. If you do have a thyroid nodule, be sure that they do a biopsy. I had always been told since age of 15 that I had an enlarged thyroid. But, doctors at Planned Parenthood never did anything about it. Now in my 40’s, I developed hypothyroidism.
    I went to the Endocrinologists and they knew I had an enlarged thyroid. Two Endocrinologists later, and 3 years later, the Physician Assistant had me do a sonogram–not the Endocrinologist! It took the PA to send me. So I went for the sonogram and they found out that I had a nodule. Then they sent me for a biopsy which said folicular neoplasm, but that it was unlikely cancer.
    Another 3 years goes by and the Endocrinologist sent me for another biopsy. This time I went to a different facility. The found that it was Suspicious of Cancer. And doctors don’t know for sure until they do the surgery and splice it. So, I went to MD Anderson in Houston, TX. Right away they ordered the tissue from both biopsy’s. They confirmed that the recent one was Suspicious of cancer.
    But what I didn’t expect was that the one from 3 yrs ago was also Suspicious of Cancer! Both of the biopsy’s were done at different facilities. I recommend to anyone to go to different ones if you’re in this situation. I had my surgery–they removed my entire thyroid. It was indeed cancer, but it was contained in the nodule so I didn’t have to have radioactive iodine. Thank God! The Lord is my helper.

  6. OKJ

    Your doctor is reading the paper but not the patient. Lab results first of all are not 100% not always accurate. Listen to the symptoms and read the signs first to treat a patient. If you had good results with a larger dose for crying out loud use it.

  7. fbl

    My Dr. had me take my temperature before I got out of bed in the morning for several days. Even though the blood tests showed no problem, I did have one. He played around with various meds until we got the combination that brought my body temp up. I’m on NatureThyroid and Cytomel. Apparently some of us don’t convert from T3 to T4, hmmm, or is it from T4 to T3?
    At any rate he tests me periodically to make sure I’m still good. A few years ago the FDA in their infinite wisdom pulled the natural thyroids off the market. I crashed and burned. Couldn’t even get out of my Lazy-boy to cook dinner. I did get enough energy to write some letters though. Thankfully the FDA backed down. Apparently there are a lot of people like me who do not respond to the other meds.

  8. SM

    I had low thyroid too for a year and none of the typical pharmaceuticals helped me at all. In fact, I got worse as my doctor tried various drugs. He tested my vitamin D levels and found that they were extremely low. He put me on 10,000 IU of vitamin D3 daily and my thyroid is back in a normal range now. All my symptoms were gone in about a month of the vitamin D3 therapy and I take no thyroid medicine. Vitamin D3 has worked a miracle for me!

  9. Kathleen H.

    I have had hypothyroidism ever since my first child was born in 1974. When he was 6 months olds, I noticed I was irritable and restless, getting colds all the time, gaining weight and generally being quite miserable. After a thorough check by my GP, I was sent to a thyroid specialist. Hypothyroidism was the diagnosis. I was only 26 years old. Now I am 63.
    I have had many ups and downs over the years with medication doses. The new normal range now is between .3 and 3.00 However, it varies from lab to lab and even between countries like Canada and the U.S. So it is hard to treat. The best way to know if you are on the right dose is how you feel and not what the test results say. I feel tired now and I am on .125 mg synthroid. I am positive I should be on a higher dose since my reading jumped from .91 all the way up to 2.64. This number is getting very high and close to the 3.00 upper end of the thyroid normal scale.
    My doctor felt that I was at the right dose and would not issue a higher dose even though I feel tired all the time.
    Since my doctor doesn’t know about T3 medication, I am only on one pill called Synthroid. When depression hit me in 09, my thyroid went into override. I started with heart palpitations. The doctor reduced my medication from .137 to .125 and at one point lowered me again to .1 mg.
    Unless you have a very well educated thyroid doctor, it is highly unlikely to be on the correct dose all the time. I have learned that getting stressed out can make the thyroid problem worse. The thyroid condition can in itself cause depression and stress. There is no easy answer with this condition.
    If you have found a good physician who knows how to treat you and understands the TSH blood test results and also recommends free T3 and Free T4 blood test lab testing, then you are extremely fortunate.

  10. LSW

    She more than likely needs a combination of both the levothyroxine and the Armour thyroid works better than the synthetics. My doctor added the T4 to my regimen recently and have been on Armour thyroid for several yrs. taking as much as 150 mg. a day. Still have cold hands, but am not depressed or lethargic anymore. At age 74 I work out at the gym for 2 hrs. 3 times a week and get in some extra exercise in between.

  11. mmu

    Don’t go by the numbers. Go by how you feel. Make your doctor work with you. I have been hypothyroid for years, on Synthroid, and I feel best when my TSH is around 1, lower than the “normal” values.

  12. DA

    Don’t settle for “normal” as the answer to your thyroid levels. Most doctors just don’t get it when it comes to thyroid, especially endocrinologists, who are supposed to be the experts. Google Mary Shomon for some good reading on the subject.

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