Hypothyroidism Treatments: what works and what to expect

Feeling tired, cold, or sluggish? Those are common signs of an underactive thyroid. The good news: most people get predictable, safe improvements from treatment. This page gives clear, practical info on the main treatment options, how doctors monitor progress, and simple steps you can take today to get better results.

Main medicine: levothyroxine (T4)

Levothyroxine is the standard treatment. It replaces the hormone your thyroid can’t make. Most people take a single pill once daily. Take it on an empty stomach — 30 to 60 minutes before breakfast or at bedtime several hours after eating — and keep timing consistent every day. That steady routine helps labs stay reliable.

Expect labs (TSH, sometimes free T4) about 6–8 weeks after starting or changing a dose. Symptoms like energy and mood often improve within a few weeks; other symptoms can take a few months to fully lift. If your dose or brand changes, test again after 6–8 weeks.

Watch interactions: calcium, iron, antacids, and some supplements can block absorption. Don’t take them within four hours of levothyroxine. Also tell your provider about other meds — many drugs affect thyroid levels.

Other options: T3, combos, and natural products

Liothyronine (T3) acts faster and is sometimes added if symptoms persist despite normal TSH. Combination therapy (T4 + T3) can help a minority of people, but it needs close monitoring because T3 can cause heart palpitations or sleep trouble if too high.

Desiccated thyroid (natural thyroid extract) is used by some patients. It can work but has variable hormone ratios and dose consistency. If you try it, your provider will likely monitor labs frequently and adjust carefully.

Compounded thyroid preparations exist for people with allergies to fillers or who need unusual doses. Compounded meds should come from a reputable compounding pharmacy and require careful follow-up.

Who needs extra caution? Older adults and people with heart disease usually start on lower doses to avoid strain on the heart. Pregnant people need higher doses and closer monitoring — pregnancy changes thyroid needs quickly.

Simple daily tips: take thyroid medicine the same way every day, avoid taking calcium or iron near your dose, keep a list of all your meds, and get your labs when recommended. If you feel new symptoms like racing heart, weight loss, or severe tremors after a dose change, contact your provider quickly.

Ready to make a plan? Talk with your provider about goals (clear symptoms, normal TSH) and a monitoring schedule. Small changes in timing, interactions, or brand can matter — so stay consistent and keep communication open with your care team.