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8 Reasons Why Your Thyroid Meds Might Not Be Working

Thyroid meds can be life-changing. While I still don’t believe in the magic pill, I do believe that thyroid hormone replacement can really be beneficial when taken correctly at the appropriate dose for the appropriate reasons. But … what if you are taking them and they are not working? Or they were working and now they are not?

I had my thyroid surgically removed due to cancer when I was 26; since then, I have experimented with pretty much every type of thyroid drug in the market and learned a few things along the way that may hinder its effectiveness as well as the extent of its efficacy.

Therefore, I am here to tell you that sometimes the meds are not working due to the user’s error!

Yep, so, before asking for upping your dose, troubleshoot below! (Trust me, higher is not always better, “Goldy locks” is key! I know you fear that lowering the dose will make you gain weight, but I promise you that that is not the case.)

1 Fasting

Yes, thyroid medication is a DIVA. It wants to be the only thing on your stomach for about an hour! It takes around 30 to 60 minutes for the meds to hit your small intestines where they will be absorbed. And food may interfere with the absorption and affect how much of the dose taken you are actually absorbing.

Pro tip: Keep your pill and a glass of water ready on your nightstand, if you wake up to use the restroom, take it then and go back to bed. It will guarantee a fasting state before and after you have taken it. (Yes, even if it is 3 am…)

But on the days you do not wake up at dawn, take it first thing in the morning and go get ready for life while making time for it to go down. Ideally, you should wait 1 hour before having breakfast, but a minimum of 30 minutes of fasting is required.

Which takes me to reason #2...

2 Coffee

I am not here to tell you to quit, so don’t worry! Only to delay gratification, girl. Coffee interferes with thyroid meds absorption big time, it speeds up motility, and, again, you may not get your full dose as intended. So, yes, you must wait 1 hour before enjoying your java… I know, it sucks, but you will survive! On the bright side, waiting to consume your caffeine until a little later will force your body to learn how to wake you up by itself and makes you a bit less dependent on any substance to be able to function. It also allows you to rip the benefits of the external added focus until later in the day by delaying your AM caffeine boost. Yes, there is research on this!

3 Supplements

Again, thyroid med is a Diva and her stardom lasts about an hour, so, take no other supplements when taking your meds, especially minerals like calcium, iron, and magnesium (I usually suggest waiting around 3 to 4 hours for those…) They bind to the thyroid meds and you don’t get the full dose or consistency of dosage which is extremely important when taking thyroid supplements.

So, if you are currently chugging your thyroid meds with coffee and your multi first thing in the morning, it might be time to revisit your AM routine….

4 Biotin

Although Biotin will not affect your thyroid health per se, it can skew test results, by making them seem better than they are. And you need to know exactly how much your body is actually producing or your doctor might change your dose based on skewed results and you don’t need that! Therefore, make sure to stop taking it for at least 3 days prior to drawing blood.

5 Brand Consistency

This is a biggy since we don’t usually think about or have much control over this, but your pharmacist may change the medication without telling you… I am a fan of going with the brand name for many reasons, and this is one of them! But not all insurances cover them. So, make a point to your pharmacist that you want to be alerted of any changes on the generic brand and that you would like to be consistent with the same one. They usually fill your prescription with whichever generic brand they have in hand or that is about to expire first, but if you ask them, they may fill your request. Therefore, if you feel that the dose was working before you got a new prescription filled and now something is off, check if it is really the same brand. I have had this kind of issue more than once and learned my lesson the hard way. Since I used to chew my meds, I could tell right away when they changed the formula! So, wise up.

PRO TIP: Ask your doctor to write “dispense as written” on the prescription so that the pharmacist cannot change and give you a different brand every time and your insurance may cover part of the brand name prescription. But still, always double-check what you are getting anyway because I have had the pharmacist change to generic even when my doctor prescribed a brand name.

6 Be Aware of Recalls, Ingredients Change, and Expiration Dates

Again, it sucks, we should not be responsible for checking all this, but better safe than sorry. I had to call CVS on a recalled item that they should have notified me of, but I ended up notifying them instead…. As sad as it sounds, remember that no one has a more vested interest in your own health than you.

7 Testing Properly

It is important to compare apples to apples, therefore, a few things to consider when drawing blood:


Always do it fasting and first thing in the morning. Yes, before taking any meds, including the thyroid ones, so you know how your body is without any interference.


I recently learned that it is ideal to avoid testing during ovulation, since that may skew results. Therefore, ladies, draw blood within the first 9 days or the last 8 days of the menstruation cycle. (If you have no clue, it is time to start learning this stuff, get a free app, and track your cycle asap!)


I have already said it before, but just a reminder, you must stop Biotin and probiotic 3 days prior to drawing your blood since they may interfere with the results of the test.

No, I am not exaggerating, and you should follow those advices properly! You must test in a way that gives you meaningful results to ensure you are making the proper adjustments and determining the right way to approach your thyroid medications.

8 Other Reasons

If your thyroid medication simply isn’t helping with your symptoms, maybe IT IS NOT YOUR THYROID! It may be that your symptoms are coming from other causes.

There are a lot of other root causes that share similar symptoms as thyroid problems, and that is why only chasing symptoms, and even lab values for that matter, are not the best approach for overall health and wellbeing.

For example, iron deficiency shares a lot of similar symptoms and so does Perimenopause. Find a provider who will listen to you and who will look at all the systems in the body as the whole unit as you are. We are not like cars that we can just change parts around and hope for the best!

Remember that getting more thyroid hormones is not always the answer. Just using the car analogy once again. If you have an issue with transmission, pumping more gas or changing from regular to unleaded will not make the car run better, rather, you will have to address the spark plug or whatever is malfunctioning instead. In this case, our bodies are exactly the same! Understanding where the problem is going on is fundamental and, as good as thyroid medication may be, it is definitely not the answer to all your issues.

Thyroid problems may occur on the level of the brain signaling, can be an issue at the gland itself, may be an autoimmune response and the thyroid is just a bystander, it may be an issue on the periphery outside the gland causing a cell danger response, it may be detoxification issue, and since thyroid hormones impact every cell in the body and understanding the feedback loops and which system is malfunctioning is important. Is your thyroid the cause or is your thyroid responding to something else as a means to protect you?

Therefore, if you are on medication and your symptoms are not going away there is a good chance that something beyond your thyroid, even if perhaps influenced by it, is causing symptoms and disrupting your health. Taking more meds or changing from synthetic to desiccated will not make much of a difference until you figure out the underlying cause.

Don’t give up, if you don’t feel well, keep digging and do not settle for “you are getting old” or “it is all on your head BS”. I started being told that story in my mid 20’s, so if your doctor is not listening to you, find someone that will. (and FWY, if the only gage of your thyroid health is a TSH & Total T4 markers, you are not getting the full picture).

If you feel that you need some individual attention, feel free to apply for a complimentary 30-minute Discovery Call to see how can I help you! Apply here.

Isabela Fortes is a

Board Certified Holistic Health Expert, Functional Diagnostic Nutrition Practitioner

Certified Iyengar Yoga Teacher Level II

Certified Yoga Therapist

She teaches and works with clients in Southern California and Virtually anywhere in the world.

APPLY HERE to work with Isabela 1:1

Get to the bottom of your fatigue. Get your energy back and feel like yourself again!

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