Doctor endocrinologist checking tyroide goiter of pregnant woman and holding hands on her throat, sluggish thyroid

Millions of Americans are struggling to manage despite a sluggish thyroid gland. Levothyroxine, the main treatment for underactive thyroid, is among the most frequently prescribed drugs in the country. But getting by without a functioning thyroid gland can indeed be a struggle. The hormones this little organ produces are critical for just about every cell in the body, and when they fall short, the potential symptoms are wide-ranging.

What to Do About a Sluggish Thyroid?

Q. I am depressed, lethargic and overweight. My skin is very dry, and my hair is thinning.

I have been taking levothyroxine tablets for over twenty years and I still feel like crap. Is there anything I can do to feel better?

A. All of your symptoms are typical of an underactive thyroid gland. Since you are taking thyroid hormone (levothyroxine), we assume your doctor diagnosed you as hypothyroid. Are your TSH, T4 and T3 levels tested periodically? You should ask for those results so you can follow your own progress.

Going Beyond Levothyroxine to Treat Your Sluggish Thyroid:

Although many people do well on levothyroxine (T4) alone, you may not be one of them. There are some people who don’t convert T4 to the active hormone T3 efficiently (Gereben et al, Nature Reviews. Endocrinology, Nov. 2015). These individuals may feel better if they take a medication that supplies T3 as well as T4.

Learn More:

You can read more about this in our Guide to Thyroid Hormones. It also tells you how to interpret the results of your blood test so that you can keep track of how your sluggish thyroid is doing.

You may also want to listen to one of our interviews on this topic. In 2017, we spoke with eminent researcher Antonio Bianco, MD, and leading patient advocate Mary Shomon (Show 1096). In 2015, the same guests discussed Thyroid Mysteries, Controversies and the Latest Research (Show 1015).

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    I was on Armor for about a year, but the pharmacy I went to said they quite making it. Is that true?

  2. Terry Graedon

    Hi Sonya
    You can currently access any show for which we have posted an mp3 for free. Just go to the store on the website and select mp3 for the show you want. You “buy” it for $0.
    Best wishes

  3. Jean
    North Carolina

    Take ARMOR THYROID…..I have taken this medication for 60 years and have no complaints. I feel great all the time. This is the only medication I take on a regular schedule.

    • Lil
      Buffalo, NY

      I just switched to Armour Thyroid about 6 months ago in the hopes of getting my energy back and my weight under control. So far no luck. I’m seeing a specialist who is still adjusting to the dosage. Fingers crossed!!

  4. Avaline

    I’m 67, was diagnosed w/Hashimoto’s almost 20 years ago, and have been on levothyroxine ever since. A year ago my internist added liothyronine at my insistence, after I complained that I was having trouble regulating my body temperature and that my hair and eyebrows were thinning. It has made no difference, so she told me to stop the liothyronine. As of this month, my TSH is “within goal range” (0.697 uIU/mL). She won’t put me on Armour because she said it’s too hard to get the correct dose. I have your 25-page booklet on Thyroid Hormones from January of 2016. I’m on Medicare and will have difficulty paying for a consult w/an endocrinologist but will do it if I must. Is there anything else I should consider, or will I simply need to learn to live with this? It’s not life-threatening, just uncomfortable sometimes. Thanks in advance.

  5. Emma H.

    You have to monitor your thyroid. At an young age I was hypothyroid. Due to a large goiter, I had half of my thyroid removed in the 80’s. Been on Levothyroxine before the first surgery. Then about 10 years ago. due to goiter growing, I had other side removed. It has been at times like a rollercoaster to get the right dosage. You have to be patient and stay on top of it.

    When you start feeling those unusual symptoms, immediately get lab work. My latest example was my hair coming out. I just thought it was usual and did not pay attention because I had never had hair problems. One morning I just ran my hand through, and my hand was full of hair. It was awful. My thyroid numbers were way-way off. It took almost nine months for my hair to be normal after we finally got right dosage. I have been going to a specialist about 4 years, and that is when we have had the best results. I am 91 years young, very active. So stay on top of it. I have experienced all those bad feelings.

  6. Liz

    This is an ad masquerading as a newsworthy article. Anybody who is pro-active enough to read The People’s Pharmacy and has dealt with thyroid issues will know all of this, without sending for the guide. I was excited about reading something new and useful, but did not find it here.

  7. Janice
    High Point, NC

    I have Hypothyroidism and have been treated w/Levothyroxin since 1980’s, but I struggle w/weight gain and difficulty losing weight and aggravating skin issues that don’t ever seem to go away! No physicians I can find in my area, who also accept health insurance (I am on Medicare/supplement ins.), will consider any thyroid treatments other than Synthroid/Levothyroxin! Dermatologists don’t really have many effective treatments for chronic eczema/psoriasis & Rosacea. Especially, treating the thick, crusty skin that remains. As long as my numbers are on the low end of normal, since I am 73, all is ok! Very frustrating!

    Unless you can afford out of pocket payments, I have found no physician who will experiment with more effective treatments that help eliminate such chronic, nagging, and embarrassing symptoms. I have a copy of your Thyroid article! I read everything I can find, so I am informed, but without an alternative physician who accepts insurance in the area!!

  8. Lyn

    Family Practice Doctors to readily hand out Levothyroxine scripts for borderline T3 thyroid test results or worse no blood test at all. Their theory is it can’t hurt and will give woman some “pep”. Every woman can go through a period where the thyroid gland is sluggish. Its often best to leave it alone to regulate itself. Taking thyroid drugs should be based on a thyroid panel of 4 tests. Not just one T3 result as that is the last test to base drug use on. If at all possible, see an endocrinologist. Your family physican does not have the knowledge to treat thyroid and probably can’t order more definitive testing. I took a thyroid med for 10 years and never felt better. Then, original symptoms became worse. I saw an endocrinologist who took me off my med for 8 weeks, then retested for the 4 test panel. One test came back borderline. I will not take any med again for 8 weeks and then retest. If one test comes back borderline I don’t need thryoid med. Do yourself a favor and get tested by a specialist. I think the entire 10 years my thyroid gland was trying to do its job and was being overwhelmed by a massive dose of Levothyroxine.

  9. mildred

    I have heard, and experienced, that TSH is useless after having taken thyroid meds , for some time.

    I took synthroid, more and more, and not doing much.

    then learned rT3 needs to be tested. If too high, it blocks the T3 from entering their receptors. I took just T3 and got energy back, after letting the rT3 dissipate.

    I added a little synthroid but the rT3 began to build up again.

    Doing OK on T3 for a few years, when I remember to take enough.

    I learned this from Dr Holtorf interview on PeoplesPharmacy some years back. Saved my life!

  10. Jim

    I take levo (50mcg) daily for my hypothyroidism. I have a lot of the symptoms (except my weight is too low) but my TSH is around 2.0, right where my doctor says it should be. So he says the levo is doing its job and that’s all that should be done. So my question is – if my TSH is within range does that mean the thyroid is functioning properly?

  11. June

    You can have adequate levels of everything, including T3 and still feel like crap. Amor Thyroid doesn’t fix it either.

  12. ariel

    i agree. the same thing happened to me . I even got blue places also on my body.
    for a very long time dr did NOT give me T3. finally he did along with T4. and things got better.
    suggest you find another Endocronologist.
    also there are side effects IF you get too much T3 or T4. It will need adjusting.
    hope this helps

  13. "Patrice"

    I struggled with hypothyroid symptoms for years, although I also have ME/CFS (which causes severe fatigue), and it’s often hard to tell which illness causes the fatigue. However, there is a distinct sluggishness with thyroid issues, that I-can’t-get-out-of-bed in the morning experience, that is clearly hypothyroid, and it tends to worsen over time.

    When I first started taking Synthroid years ago, I only needed a little bit. In the last few years, the hypothyroidism has worsened, so the exact medications and dosages I take are critical for daily functioning. My ME/CFS doctor had put me on Cytomel as well, some years ago, but the combination of Synthroid and Cytomel just wasn’t doing the job. Finally this year, against the advice of my endocrinologist, my GP put me on Armour Thyroid instead. It has made a world of difference! I encourage anyone who still feels sluggish with Synthroid alone or the Synthroid/Cytomel combination to seek a doctor who is willing to prescribe Armour Thyroid, and stick it out with dosage adjustment until you feel better. It sure worked for me!

  14. Jim
    metro Raleigh, NC

    Hypothyroidism is rampant on one side of my family and I was diagnosed two decades ago. After 15 years on Synthroid / Levothyroxine (adjusted for “normal TSH”), my internist agreed to let me supplement with T3 (liothyronine), in a compounded sustained release (SR) capsule. At my suggestion, T4 was reduced moderately and a 5mcg T3 SR2 cap was added, every 12 hours. It was like the sun came up! I have much more energy and all the typical hypothyroidism symptoms abated. The only down side is insurance does not recognize the therapy “because TSH was normal on T4 only!” Despite their propaganda, my insurance carrier is obviously not outcomes-oriented (and I can’t switch).

  15. Rita
    San Diego

    Regarding thyroid issues, there is a pharmacist who has educated herself for around twenty years regarding thyroid issues. Her name is Izabella Wentz; she has written several books on the thyroid gland and how to heal when it is not functioning properly.

    I personally have found her suggestions helpful.

    Rita D

  16. Charlotte

    I had right thyroid lobectomy (because of nodules) a year ago along with one hyperparathyroid. Thus, I have mild hypothyroid levels. I was prescribed 37.5 mcg of levothyroxine, which I took for about six months. Still not feeling very well (mostly tired with no energy), I was referred to an endocrinologist who basically thinks everything looks fine. I will add that even though lab work indicates my TSH is creeping up again, this doctor decided that was no problem. She has prescribed adding 2.5 mcg liothyronine to a 25 mcg levothyroxine dose. I have been taking this for two weeks. I may feel slightly better, but I am having a difficult time in splitting a 5 mcg tablet in half. It is not scored, and the pill splitter is practically useless. I am not getting a consistent dose no matter what I try. I am also concerned that the doctor is ignoring that the TSH is increasing. Is there a manufacturer of the liothyronine that is easier to split?

  17. Micki
    Huntsville, AL

    My thyroid quit functioning 35 years ago. The symptoms I suffered was pain in my lower back, hand, wrists so severe that I couldn’t even use a knife and fork to eat with. Blood work immediately diagnosed I was suffering from hypothyroidism and was put on Synthroid which I was not able to take (had a major reaction). I was then put on Armour desiccated Thyroid which has worked perfectly for me, all these years. So thankful as the painful joints I suffered were beyond debilitating. The dosage I have been on all these years has not changed. It Works!

  18. karen

    I have Hashimotos and really believe that most doctors are not prescribing correctly for those of us with this disease or underactive thyroids. I take compounded thyroid which is a combination of T3 and T4 and I feel great. I have also done very well on Naturethroid, Amour and WP thyroid, but there is a shortage right now and so I am taking the compounded. I would urge anyone struggling like I am to find a doctor to prescribe this treatment, along with a good diet.

  19. Connie

    I was confused about levothyroxine dosages. I have taken it for years, but my TSH is high. I can’t lose weight and have classic symptoms of being hypothyroid. The doctor just adjusted my dosage from .075 to .05. Why adjust down, as to adjusting up? I have two of your books, but can’t quite understand this dosage stuff.

  20. John

    Not much of an article, really just a sales pitch. I was disappointed, to be honest.

  21. Marciab.

    What to do about the people who have all the symptoms of sluggish thyroid but all tests are normal. THATS the problem of many of us.

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