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June 28, 2023 8 min read

Are you taking levothyroxine and still feeling tired? You're not alone. We understand the frustration of dealing with persistent fatigue despite taking thyroid replacement medication.

While it's an effective treatment for hypothyroidism, some people may still experience fatigue even when taking levothyroxine as prescribed. Let's see why this happens and what you can do to start feeling more energized and less tired.

What is levothyroxine?

Levothyroxine, a synthetic form of thyroxine (T4), serves as a medication designed to address thyroid disorders, specifically hypothyroidism—an underactive thyroid gland marked by insufficient hormone production. Individuals struggling with hypothyroidism often experience symptoms like fatigue, weight gain, and depression as a result of their body's inability to produce adequate levels of thyroid hormones.

To treat hypothyroidism, levothyroxine effectively boosts thyroxine levels, which in turn helps regulate metabolism and energy levels. Consequently, this alleviates feelings of tiredness. It's worth noting that thyroid antibodies can sometimes play a role in the development of hypothyroidism, further emphasizing the importance of proper diagnosis and treatment with medications like levothyroxine.

Why are you still feeling tired on levothyroxine, and what can you do about it?

Are you taking levothyroxine and still tired?

As we continue our discussion on levothyroxine, let's address why some people may still feel tired even while taking the medication. There are a few potential reasons for this.

1. Insufficient dosage

If you're feeling tired even though you take levothyroxine, your dosage may not be enough. For example, you may have started on a low dose and never had it adjusted, leading to ongoing fatigue despite taking the medication regularly.

That's why working with your doctor and taking regular thyroid tests to ensure that your thyroid hormone levels are within a healthy range is important.

Especially if you're taking levothyroxine, monitoring your TSH (thyroid-stimulating hormone) levels is important to ensure you receive the appropriate medication dosage.

Blood tests can also help identify potential issues or imbalances contributing to fatigue or other symptoms. It's recommended that individuals taking levothyroxine get their TSH levels checked every six to eight weeks until their hormone levels stabilize and then every six months after that. However, this frequency may vary depending on individual circumstances and doctor recommendations.

By keeping up with regular blood tests, you can work with your healthcare team to adjust medication dosages as needed and address any concerns or questions about your thyroid health and overall well-being.

2. Too high of a dosage

Conversely, feeling tired while on levothyroxine might also be a result of taking too high a dosage. If the dose is too high, it can lead to an overstimulation of the thyroid gland, causing symptoms similar to hyperthyroidism. Also known as overactive thyroid, hypothyroidism is a thyroid disorder that occurs when there's too much thyroid hormone in your body. These can include fatigue, along with other symptoms like anxiety, rapid heart rate, and weight loss.

Again, working closely with your doctor and having regular thyroid tests will be crucial in determining the right dosage for you. If your dosage is indeed too high, your doctor may adjust it accordingly to prevent further fatigue and other undesirable side effects.

3. Poor absorption of the medication

You may not be getting the full benefit of your levothyroxine medication because it's not being absorbed properly by your body. This can make it feel like the medicine is simply passing through without making a difference.

Proper administration of levothyroxine is crucial for its effectiveness. When improper consumption is an issue, absorption of the medication may be compromised, leading to decreased effectiveness and continued fatigue.

To ensure proper administration, follow these guidelines:

  • Take levothyroxine with a full glass of water on an empty stomach, ideally first thing in the morning. Do not drink or eat anything at the same time.

  • Wait at least 30-60 minutes before eating or drinking anything other than water.

  • Avoid taking other medications within four hours of taking your levothyroxine, as they can interfere with absorption. If you have other health issues, talk to your doctor about how and when to take your thyroid medication. In some cases, your doctor may need to alter your levothyroxine dosage since a variety of medicines can affect your thyroid hormone-activating enzyme.

  • Taking your levothyroxine consistently at the same time each day can also help ensure your body receives the right amount of the medication to function properly.

4. The need for additional hormones (T3)

You may benefit from considering the addition of T3 hormones to your thyroid hormone replacement medication if you're still experiencing symptoms despite trying other solutions.

T3 (triiodothyronine) is a hormone produced by the thyroid gland that plays a critical role in regulating metabolism and energy levels in the body. T3 is the active thyroid hormone. It acts on various tissues and organs in the body to increase metabolic rate, which in turn helps to produce energy.

Levothyroxine only contains T4 hormones, which is the inactive form of thyroid hormone. Your body needs to convert T4 to T3 in order to use it. However, some people may have difficulty converting T4 to T3, leading to persistent fatigue or another thyroid disease. Here are three things to keep in mind as you consider this option:

There are different forms of T3 supplementation. If you want to try adding T3 to your hypothyroidism treatment, you can consider taking liothyronine (the synthetic form of T3) in addition to your levothyroxine or natural desiccated thyroid (NDT).

If you don't want to take two medications at the same time or you prefer a more natural option, then natural desiccated thyroid (NDT) is the best option. Made of pig thyroid glands, NDT is a natural alternative to synthetic thyroid hormone medications like levothyroxine. NDT contains both T3 and T4 hormones, which can be beneficial for those who have difficulty converting T4 to T3 in the body. This can lead to a more balanced and effective hormone replacement therapy. According to research, many hypothyroid patients prefer NDT compared to levothyroxine.

The most popular NDT medications in the US are Armour Thyroid and NP Thyroid. However, you can also buy desiccated thyroid online without a prescription in the form of a supplement, such as VitaliThy. This NDT supplement does not only contain T4 and T3 thyroid hormones but also other ingredients that can support your thyroid health, such as spica prunellae siccus, ashwagandha extract, and selenium yeast.

5. Coexisting conditions

We need to discuss coexisting conditions that can make you feel tired even if you take levothyroxine as your thyroid hormone medication.

Iron deficiency anemia, sleep apnea, depression, and vitamin D deficiency are some common culprits.

It's important to recognize and address these conditions with your healthcare provider to improve your overall well-being and energy levels.

Iron deficiency anemia

Iron deficiency anemia can often contribute to fatigue in individuals taking levothyroxine. When the body lacks iron, it's unable to produce enough hemoglobin, which carries oxygen throughout the body. This lack of oxygen can cause symptoms such as weakness, dizziness, and exhaustion, worsening thyroid fatigue.

It's important to note that taking levothyroxine may also interfere with iron absorption, making it even more critical for those on the medication to monitor their iron levels. To address this issue, many doctors will recommend dietary changes or supplements to increase iron intake.

Sleep apnea

Sleep apnea is a condition where breathing is repeatedly interrupted during sleep. It can be an underlying factor contributing to constant exhaustion despite treatment for anemia and optimal thyroid function. Even if you take levothyroxine for hypothyroidism and have corrected your iron levels, sleep apnea can still make you feel fatigued throughout the day. This is because the constant interruptions in breathing prevent restful sleep and lead to daytime drowsiness.

It's important to talk to your doctor if you suspect sleep apnea may affect your energy levels. They can recommend diagnostic testing or refer you to a specialist for further evaluation. With proper treatment for sleep apnea, your fatigue improves significantly and helps improve your overall quality of life.


Like a dark cloud hovering over your mind, depression can greatly impact your energy levels and overall well-being. It can make even the simplest tasks feel like monumental challenges, leaving us drained and fatigued.

Getting out of bed in the morning can feel like moving through quicksand; completing daily responsibilities may feel like climbing a mountain; finding enjoyment in activities we used to love may seem impossible.

While taking levothyroxine may help with thyroid-related fatigue, addressing any underlying mental health concerns contributing to exhaustion is important. Speaking with a healthcare provider about potential treatment options for depression, such as therapy or medication, could greatly improve the quality of life.

Vitamin D deficiency

Vitamin D is essential for bone health and immune function but also affects energy levels. Levothyroxine can affect how the body absorbs vitamin D, so it's important to check your levels regularly.

Your doctor may recommend supplements or increasing your sun exposure if you're deficient. However, lifestyle factors like sleep habits and diet can also impact fatigue.

6. Lifestyle factors

Quality of sleep, diet and nutrition, and exercise and physical activity are all important components of a healthy lifestyle. By prioritizing these areas, we can improve our energy levels and feel more alert throughout the day.

Quality of sleep

You may be counting sheep, but if you're still tired after taking levothyroxine, perhaps the quality of your sleep is causing the issue.

Here are three things to consider about your sleep:

  • Are you getting enough hours of sleep each night? Thyroid medication can disrupt sleep patterns, so it's important to aim for at least 7-8 hours of uninterrupted rest.

  • Is your bedroom conducive to good sleep? Keep your room cool and dark, invest in a comfortable mattress and pillows, and limit electronic devices before bed.

  • Do you have any underlying sleep disorders? Sleep apnea or restless leg syndrome could contribute to fatigue even if you get enough hours of rest.

By improving the quality of your sleep, your energy levels also improve. 

Diet and nutrition

Eating a balanced diet and getting proper nutrition are crucial for maximizing the effectiveness of your levothyroxine medication. This means consuming various nutrient-dense foods, such as fruits, vegetables, and lean protein, in order to provide your body with essential vitamins and minerals.

Avoiding processed and high-fat foods can help reduce inflammation in the body which can interfere with thyroid function. It's also important to ensure you're getting enough iodine in your diet, as it plays a vital role in thyroid hormone production.

By nourishing your body with healthy foods, you may experience improved energy levels and reduced fatigue that often accompanies hypothyroidism.

Exercise and physical activity

Getting off the couch and moving your body is essential for maximizing the effectiveness of your levothyroxine medication and experiencing a significant improvement in your energy levels.

Exercise can do wonders for your overall health, including boosting metabolism, improving blood flow and circulation, reducing stress levels, and increasing muscle strength. It also helps to combat fatigue by releasing endorphins that make you feel good.

Incorporating exercise into your daily routine doesn't have to be complicated or time-consuming; even just a 30-minute walk around the block can make a big difference in your overall health. So if you're taking levothyroxine due to thyroid dysfunction and still feeling tired, try adding some physical activity into your day-to-day life.

Conclusion: There are ways to combat hypothyroidism fatigue

If you're taking levothyroxine and still feeling tired, there are several reasons why this may be happening. It could be due to incorrect dosage or timing of medication, underlying health conditions, or lifestyle factors such as poor sleep habits and stress.

Fortunately, there are steps you can take to combat fatigue and improve your overall well-being. Remember, small changes can make a big difference in how you feel. For example, incorporating regular exercise into your routine can boost energy levels and reduce stress.

However, if you've tried tweaking your dosage and making some lifestyle changes, but you're still feeling exhausted, it might be a good idea to look into switching up your thyroid hormone replacement. VitaliThy, a natural desiccated thyroid you can buy online, can be a great option to try.

Wojciech Majda
Wojciech Majda

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