Why am I still exhausted with hypothyroidism at 34?

Question

Hello doctor,

I am a 34-year-old female and have been dealing with hypothyroidism for almost three years. I have been taking Levothyroxine 75 mcg every morning, but over the past five to six months, I have been feeling extremely exhausted even after sleeping for nine hours. I have also been gaining weight despite eating less than before.

My recent TSH level was 8.9, which my doctor said was still high, so my dose was increased to 100 mcg two months ago. However, I still feel the same. I am experiencing severe hair fall, very dry skin with cracked heels, and irregular periods. Sometimes my periods come after 45 days, and when they do, the bleeding is very heavy.

I also had a thyroid antibody test, and my anti-TPO level came back very high at 480 IU/ml. My gynecologist mentioned that hypothyroidism could be the reason for my irregular periods. My husband and I have also been trying to conceive for the past year without success.

Additionally, my cholesterol levels have increased recently, and my LDL is 168. Here are my concerns:

Is my current dose of Levothyroxine enough, or could I need any additional treatment?
Will properly treating hypothyroidism also help improve my fertility and menstrual cycle?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query.

I understand how frustrating and exhausting this must feel, especially when you are taking your medication regularly but still dealing with fatigue, weight gain, hair loss, and fertility concerns.

Your reports are strongly suggestive of autoimmune hypothyroidism, most commonly Hashimoto's thyroiditis (a chronic autoimmune disorder in which your immune system attacks the thyroid gland, gradually destroying the cells responsible for producing thyroid hormones). The significantly elevated anti-TPO (thyroid peroxidase) antibody level supports this diagnosis. A TSH (thyroid-stimulating hormone) of 8.9 indicates that your thyroid hormone levels were still not adequately controlled, so increasing the dose of Levothyroxine to 100 mcg was an appropriate step.

However, thyroid symptoms often improve gradually. Even after a dose adjustment, it can take around 8 to 12 weeks for TSH levels to stabilize and for symptoms such as fatigue, dry skin, hair fall, and menstrual irregularities to start improving. In some patients, further dose adjustment may still be required based on repeat thyroid function tests.

Hypothyroidism can absolutely contribute to:

Persistent tiredness and low energy.
Weight gain despite reduced food intake.
Hair fall and dry skin.
Irregular or heavy menstrual cycles.
Elevated cholesterol levels.
Difficulty with ovulation and conception.

Since you are trying to conceive, thyroid control becomes especially important. In women planning pregnancy, we usually aim for a TSH below 2.5 because poorly controlled hypothyroidism can interfere with ovulation and fertility. Proper treatment often helps improve menstrual regularity, ovulation, and the chances of conception.

In most cases, no additional thyroid medication is needed beyond Levothyroxine, but the dose must be optimized carefully. It is also important to take the tablet correctly:

On an empty stomach.
At the same time every morning.
With a gap of at least 30 to 60 minutes before food.
Avoid the simultaneous intake of iron or calcium supplements.

Because your symptoms are still significant despite treatment, your doctor may also consider checking:

Free T4 (free thyroxine) and repeat TSH (thyroid-stimulating hormone).
Iron levels and ferritin.
Vitamin B12 and vitamin D.
Ovulation status and reproductive hormone profile.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.