The Tired Thyroid Trap: Why You Still Feel Off Even on Medication

June 11, 2025

You’ve been told you have a thyroid issue. Maybe it was after months of fatigue, weight gain, brain fog, or feeling like a stranger in your own body. You were prescribed thyroid medication, maybe Synthroid or levothyroxine, and told, “This should fix it.”

But here’s the thing: you still don’t feel like yourself. And you’re not alone.

At our practice, we meet patients every week who are technically “treated” for hypothyroidism—but still feel exhausted, foggy, bloated, and completely out of sync. If that’s you, let’s talk about what might be going on, and what you can do about it.

You’re Not Crazy. You’re in the Tired Thyroid Trap.

The most common medications for hypothyroidism contain T4, the inactive form of thyroid hormone. The idea is that your body will convert T4 into T3, the active hormone that fuels your metabolism, energy, mood, and more.

But here’s the catch: that conversion doesn’t always happen smoothly.

And if you’re only being treated with T4 (like Synthroid or levothyroxine), but your body can’t convert it properly? You’ll still feel off, even if your labs look “normal.”

So, What Blocks T4 → T3 Conversion?

A few common culprits:

Chronic stress (hello, elevated cortisol)
Inflammation and autoimmune activity
Nutrient deficiencies (especially selenium, zinc, and iron)
Gut imbalances that impair absorption and conversion
Liver dysfunction (your liver plays a huge role in this process)
Excess reverse T3, which “blocks” the good stuff from working

In short, it’s not just about having enough hormones. It’s about what your body can do with it.

Why “Normal” Labs Don’t Always Mean Optimal Function

Most conventional testing only checks TSH—your brain’s signal that tells your thyroid to get to work. But this doesn’t show us whether your body is effectively producing or converting hormones, or how your cells are actually responding to them.

At our clinic, we run comprehensive thyroid panels that include:

TSH
Free T3
Free T4
Reverse T3
TPO and TG antibodies (to screen for Hashimoto’s)
Nutrient markers that support thyroid function

This gives us a much fuller picture—and helps us understand why you might still be feeling off, even on medication.

So What Do You Do If This Is You?

If you’re in the “I’m on meds but still feel terrible” camp, here’s the good news: there are options. And they don’t all involve increasing your dose.

In our practice, we help patients:

Identify and remove conversion blockers (stress, gut imbalances, toxins, inflammation)
Support their adrenals and nervous system (you can’t out-supplement chronic stress)
Optimize nutrients like iron, selenium, and B vitamins
Explore different medication options, including combination therapy with T3 when appropriate
Look at the full hormone picture, including sex hormones and insulin resistance, which often play a role

The result? A personalized plan that supports your thyroid and the rest of your body—and helps you feel like yourself again.