Hypothyroid Patient Checklist

On thyroid medication and still feel rubbish? Wondering if there’s anything else you should try/investigate to see if it would help how you feel? 


Here’s some ideas:

Thyroid Levels Optimal?

Optimal thyroid levels are: A TSH below 2, a Free T3 in the top quarter of the range, a Free T4 mid-range or higher, a Reverse T3 ratio over 20 and antibodies within range.

If yours are not optimal, it could well be why you still don’t feel well and have ongoing issues. Work to get them optimal.

Thyroid Medication.

Not everyone does well on T4-only medication like Synthroid and Levothyroxine. Some require T3 medicine or Natural Desiccated Thyroid, to feel well.

You can also try taking your thyroid medication at a different time of day e.g. Levo can be taken at night instead of in the morning, and NDT and T3 meds dosed several times a day instead of all in one go. You should also ensure that you take your thyroid meds on an empty stomach and leave at least one hour before eating or drinking anything, as it can affect its absorption and effectiveness. You should also leave four hours between thyroid medication and iron, calcium, oestrogen containing pills and magnesium.

There are also different brands of thyroid medication. You could try another brand of Levothyroxine. It’s also worth noting that some patients report generic Levo not being as effective as their usual branded Levo, so make sure the pharmacist always gives you the same type if you do better on it.

Adrenal Function.

Adrenal fatigue is very common with hypothyroidism. If you have any symptoms of adrenal fatigue, such as fatigue, weight gain, sleep disruptions, craving salt and sugary foods etc. then you need to complete a 24 hour four-point saliva test to check for adrenal fatigue. Addressing any adrenal dysfunction helps many people to feel well again.

Vitamin Deficiencies/Low Levels/Supplementing. 

Having hypothyroidism and also Hashimoto’s, it’s likely you have one or more low/deficient vitamin levels. These include Iron, D, B12 and folate. Most doctors will test for these. You want to make sure that these are optimal and not just in range. Being optimal has made a lot of different to many thyroid patients. It’s worth checking these especially if you are tired a lot, have hair falling out, bruise easily, get fatigued easily etc.

If you’re wondering what vitamins to consider supplementing, have a read here. It’s advised not to supplement iodine until you’ve confirmed you’re low through testing.

Sex Hormones.

I’m starting to realise that sex hormone issues and imbalances are seemingly pretty common with thyroid patients and those with adrenal fatigue. Low progesterone (also called oestrogen dominance) seems the most common issue, which creates symptoms such as irregular periods, PCOS, migraines, acne, PMT, struggling to conceive etc. You should test your progesterone at its peak, around day 21 of your cycle (this may differ or be difficult to predict if you have an irregular cycle), and Estrogen Days 3-5. Testosterone can be tested at anytime during the month. Checking FSH is also often beneficial.

Hashimoto’s Antibodies. 

Have you checked if you have the autoimmune disease Hashimoto’s Thyroiditis? Hashimoto’s causes around 90% of hypothyroidism cases, yet often goes untested. It’s good to know if you have this because if you do, there are things you can do to lower the antibodies, and keeping antibodies low is important if you want to stop any further damage being done to your thyroid gland, and want to feel well. Things that often help, include: going gluten free, taking selenium and vitamin D and working on a leaky gut.


Your diet can play a big part in how you feel. Many thyroid patients state they feel better when they cut out gluten. Others include alcohol, all grains, going paleo, the AIP, eggs and dairy. It’s worth trialing cutting out some of these and giving it a month or two (preferably even longer) to see if you notice any improvements in how you feel and antibody levels.

Goitrogenic and soy foods should also be avoided where possible as they inhibit thyroid function.

Avoid/Eliminate Toxins.

There are certain substances such as fluoride and mercury, which as toxins to the body and are known to interfere with thyroid function. Filters can be put on showers and taps to remove the fluoride. You should talk to your dentist about removing mercury fillings if you have them, as these are known to be linked to hypothyroidism.

Using only organic and natural cosmetic and beauty products is also a good idea. Bathing in Epsom salts is also not only a good source of Magnesium, but it can help draw out the toxins.

Meditation and Acupuncture. 

Some patients report good results with meditation and acupuncture. The good news with meditation is that it can be done for free, in the comfort of your own home, and at whatever time it suits your lifestyle.


You could also try LDN. Due to Hashimoto’s being an autoimmune disease, LDN can be beneficial for those with the condition, by reducing their high antibodies, stopping the progression of the autoimmune disease or even reversing the disease. Besides improving endorphin production, LDN can also help reduce inflammation and encourage healing.


This probably sounds obvious, but make sure you have a good bedtime routine. Get 7-9 hours of sleep a night and stop electronics 1-2 hours before bed. Have a bath, with Epsom salts preferably, and have a warm drink (though not too close to bedtime or it will wake you up!) There are also herbal supplements which can help such as holy basil, ashwagandha and Seriphos. Always consult a pharmacist or doctor before starting any supplements, though.

Investigate Other Possible Health Conditions/Issues. 

Lyme Disease, EBV, exposure to mould, MTHFR defect, H. pylori, Candida, leaky gut, balancing blood sugar etc. can also all be fairly common with thyroid patients, so worth exploring.

Use these ideas to work with your doctor and uncover why you may still be feeling unwell.

Even more info here.

Find This Site Helpful? Donate To Keep it Here:

The Invisible Hypothyroidism Paypal Donation Button

Get real, helpful advice directly from another thyroid patient. Me!


Leave a Reply

Your email address will not be published. Required fields are marked *