Hypothyroidism treatment: what actually works

Feeling exhausted, cold all the time, or noticing steady weight gain? Those are common signs of an underactive thyroid. The good news: most people respond well to treatment. This page explains the basics you can use right away—what doctors prescribe, how to take medicine, what to watch for, and simple daily steps that help.

Medical treatment — clear, practical steps

The standard treatment is levothyroxine, a synthetic form of thyroid hormone (T4). Doctors pick a starting dose based on your age, weight, heart health, and how low your thyroid levels are. Younger, otherwise healthy adults often start on a full replacement dose; older adults or people with heart disease usually start lower and increase slowly.

Take levothyroxine on an empty stomach—30–60 minutes before breakfast or at bedtime at least three hours after your last meal. Certain supplements and medicines interfere with absorption: calcium, iron, multivitamins, antacids, and some cholesterol drugs. If you take any of those, separate them from your thyroid pill by 4 hours.

After starting or changing dose, your doctor will check TSH and free T4 about 6–8 weeks later. That’s when you’ll find out if the dose needs to change. Once your levels and symptoms are stable, testing often drops to every 6–12 months, unless you’re pregnant, trying to conceive, or switching meds.

Some people still feel unwell on levothyroxine alone. A few may try liothyronine (T3) or a combination of T4+T3 under specialist care. Desiccated thyroid extracts exist too, but they can cause uneven hormone levels and aren’t the usual first choice.

Daily tips, monitoring, and when to call your doctor

Track symptoms: energy, sleep, weight, hair loss, mood, and bowel habits. Expect some improvement in energy and cold sensitivity within 2–6 weeks; full recovery of symptoms like high cholesterol or slowed thinking can take months.

If you become shaky, have a racing heart, trouble sleeping, or sudden weight loss after starting or changing dose, contact your provider—those can be signs of too much hormone. Also call if you miss multiple doses or start new medicines that might interact.

Pregnancy needs special attention: most pregnant people with hypothyroidism need a higher dose and closer testing. If you have autoimmune thyroid disease (Hashimoto’s), your doctor may check antibodies and tailor follow-up more often.

Simple lifestyle steps help: regular walking or resistance exercise, protein-rich meals to support energy, and keeping a consistent routine for taking meds. Avoid jumping between brands without checking your TSH first—small differences can matter.

Questions about symptoms, dose changes, or drug interactions? Bring a list of all your meds to appointments. Good communication with your clinician plus consistent testing and the right daily habits will keep your thyroid under control and help you feel like yourself again.