Q. I have hypothyroidism and Hashimoto's and feel fatigued after a year of treatment. Why?

Answered by
Dr. Zulfiqar Ahmed
and medically reviewed by Dr. Hemalatha
This is a premium question & answer published on May 03, 2020

Hi doctor,

I have hypothyroidism and Hashimoto's. My doctor currently only tests my TSH and treats me with Levothyroxine. I feel extreme fatigue after a year of this treatment, even with my TSH in the normal range. My doctor says free T4 and reverse T3 are not important labs to run. I am wondering if I should see an endocrinologist or just continue the treatment I am on. My TSH started at 9.8 last year, got down to 0.08. I feel great when it was that low. Mow my TSH is 3.8 and I feel extreme fatigue. I am taking 112 mcg Levothyroxine daily. Thank you.

Dr. Zulfiqar Ahmed

Diabetology Endocrinology


Welcome to icliniq.com.

Good day and thanks for your query.

Some people treated for hypothyroidism may still experience symptoms even if blood tests show that their thyroid-stimulating hormone (TSH) levels are well within the normal range. The reasons for this are complex, but the bottom line is that having a normal TSH value does not necessarily mean that all of your symptoms will go away.

Evidence suggests that situations like this are not as uncommon as one may think. Even when placed on Levothyroxine, the drug considered the gold standard of hypothyroid treatment, many people fail to reap the physical benefits of treatment.

So, first, you can lower down your TSH target if you are still having symptoms. For that, we can increase your medication. If still symptomatic, the next choice is to change the brand of Thyroxine, and if still not feeling well, then think to go to T3 supplement rather than T4, that is Thyroxine.


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