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Symptoms of Too Little Thyroid Medication

Learn how to tell and what to do if you have symptoms of too little thyroid medication in this article.
Symptoms of Too Little Thyroid Medication
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The thyroid gland is a small, butterfly-shaped gland located at the base of your neck. Your thyroid makes hormones that control how your body uses and stores energy. When your thyroid does not produce enough thyroid hormones (hypothyroidism), it affects virtually all systems in your body. Hypothyroidism can negatively impact your energy, your heart, digestion, and fertility if left untreated.

Some people with too little thyroid hormone may be symptom-free. However, many people with hypothyroidism experience symptoms that feel as if the body is slowing down.

Common signs and symptoms of hypothyroidism include: 

  • Sensitivity to cold
  • Constipation
  • Dry skin
  • Puffy face
  • Hoarseness
  • Muscle weakness
  • Elevated blood cholesterol level
  • Muscle aches, tenderness, and stiffness
  • Pain, stiffness, or swelling in your joints
  • Heavy or irregular menstrual periods
  • Thinning hair
  • Slowed heart rate
  • Depression
  • Impaired memory

Hypothyroidism is diagnosed with a simple thyroid blood test and treated with thyroid hormone replacement medication

The importance of accurately dosing thyroid hormone medication

Thyroid hormones are responsible for regulating cellular metabolism, as well as your growth and development. While you can live for many years with too little thyroid hormone, you will likely feel unwell or sickly and may experience other health conditions. Therefore, it is imperative for people with hypothyroidism to take thyroid hormone replacement medication for the rest of their life.  

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What are the different thyroid hormone medications?

Thyroid hormone replacement is not a one-size-fits-all process. Your thyroid test results, age, other health conditions, and symptoms will determine the type and dose of medication your thyroid doctor prescribes for you. Sometimes, your dose will need to be adjusted to reach a therapeutic level. 

Ahead, some of the different kinds of thyroid medication.

T4-only thyroid medications

Levothyroxine is the first line of treatment for hypothyroidism. This medication is a synthetic or human-made form of thyroxine (T4), one of the thyroid's primary hormones. People taking levothyroxine may take a generic form or a name brand like Synthroid, Unithroid, or Tirosint. 

T3-only thyroid medications

Triiodothyronine (T3) is the other hormone made by the thyroid. For the few patients for whom T4 alone is insufficient, the addition of T3 may be of benefit. Sometimes, a thyroid doctor may prescribe T3 replacement medication if a patient has a hard time converting T4 to T3 or if they take an interfering medication. T3 may be prescribed when a person's TSH levels or symptoms do not improve despite an increase in T4 levels. 

T4/T3 combination therapies 

Natural desiccated thyroid (NDT) is a medication derived from the dried (desiccated) thyroid glands of pigs and provides both T3 and T4. Name brands of NDT include Armour, Nature-Throid, and NP Thyroid. 

Compounded medication

Compounded thyroid medication is custom-made in specializing compounding pharmacies to provide the strength and T4:T3 ratio to suit patients' needs. It gives the most flexibility to those who need a precise dosage or who have adverse reactions to the fillers in other thyroid hormone replacement medications. 

Signs that you're taking too little thyroid hormone medication

Being undermedicated is problematic when you are treating hypothyroidism. If your dose is too low, you will still struggle with hypothyroidism symptoms.

Your thyroid needs to work overtime to meet the demands of your pituitary.  The pituitary gland in your brain releases thyroid-stimulating hormone (TSH) to signal the thyroid to make more thyroid hormones. When your TSH is high, the pituitary is not detecting enough thyroid hormone in your bloodstream. 

You should frequently check your TSH levels when you start or switch to a new medication to ensure you are getting an adequate dosage. 

You may experience the following symptoms if you are on too little thyroid medication:

  • Fatigue
  • Sluggishness
  • Sadness and depression
  • Changes in your period
  • Constipation
  • Muscle weakness
  • Dry skin

The symptoms of too little thyroid medication may feel similar to getting a cold. For example, you may feel a sudden surge of shivers, cold hands and feet, and even a sore or swollen throat. One of the signs of low thyroid hormone is brain fog. Subtle changes in your thyroid hormone levels can make it hard to concentrate and may impair your memory. 

What to do if you think your thyroid hormone medication isn't working

Consider absorption

If you find that your thyroid medication is no longer helpful, absorption may be an issue. Unfortunately, many things can affect how your small intestine absorbs your medication. To increase your intestinal absorption, take your thyroid medication on an empty stomach with water. Avoid other beverages like juice, coffee, tea, etc. Also take your thyroid medication separately from other drugs and supplements. Certain medications and supplements contain ingredients that block thyroid hormone absorption, including calcium.

Monitor your weight

Thyroid medications are often prescribed based on your weight. Therefore, even subtle changes in your weight can affect your thyroid hormone levels. If you lose or gain weight, track your weight and symptoms so your doctor can adjust your dose accordingly. 

Stay consistent with the brand and type of medication

There are subtle differences between thyroid medication brands. For example, there may be different fillers, coatings, preservatives, and coloring agents that may create inconsistencies. If you switch brands, check your thyroid levels every 4-6 weeks until they stabilize. 

Practice patience and test regularly

You may not be undermedicated! It may just be too soon to tell if you're on the right type and dose. Some people may feel their symptoms start to dissipate within a few weeks of starting a new thyroid hormone medication. However, it may take longer. We recommend testing your thyroid frequently and staying in close communication with your thyroid doctor to get your dose just right. 

Avoid over-the-counter thyroid glandular supplements

Some over-the-counter supplements claim to contain tissues from animals' thyroid glands to replace your thyroid hormones. However, these over-the-counter thyroid glandular supplements can be dangerous as they are not predictable. Treating your hypothyroidism with prescription thyroid hormone medication is an exact art. Unfortunately, thyroid glandular supplements that contain these hormones can alter your levels in unpredictable ways as they may contain too much thyroid hormone, too little, or none at all. 

Make your medication part of your daily routine

Timing matters, especially if you take T3 only, or a T3/T4 combination medication, as they are shorter-acting in the body. Take your thyroid hormone medication at the same time each day. Associate taking your thyroid medication with another daily habit, like turning off your alarm or brushing your teeth.  

If you think you are undermedicated, partner with a thyroid doctor to determine a personalized treatment plan. The sooner you find your therapeutic dose of thyroid medication, the sooner you can get back to feeling healthy and energized!


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Julia Walker, RN, BSN

Clinical Nurse

Julia Walker, RN, BSN, is a clinical nurse specializing in helping patients with thyroid disorders. She holds a Bachelor of Science in Nursing from Regis University in Denver and a Bachelor of Arts in the History of Medicine from the University of Colorado-Boulder. She believes managing chronic illnesses requires a balance of medical interventions and lifestyle adjustments. Her background includes caring for patients in women’s health, critical care, pediatrics, allergy, and immunology.

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