T4 treatment for hypothyroidism is not enough

T4 medication has been the accepted gold standard to treat hypothyroidism.  Yet many patients still feel the symptoms despite their labs being normal and taking their T4 thyroid medication.  New research found that the T4 treatment for hypothyroidism is not enough, and doctors need to personalize treatment plans according to each patient. 

t4 treatment

When I was diagnosed with an underactive thyroid in 2003, my doctor gave me a script for synthetic T4 medication levothyroxine and sent on my way.

Every year, and in the last decade, every 6 months, I had the thyroid labs done, and we adjusted the dosage if needed. But my doctor never suggested that I include T3 medication or talked about how I am actually feeling. It was always a quick chat, checking the labs, and I left with a new script.

In 2012, a friend mentioned that she is on a T4/T3 combination treatment called Diotroxin, and she was feeling great. At my next update, I asked my doctor about it, and she included it in my script. I didn’t really understand the value of T3 medication at that time.

Then, in early 2016, Diotroxin was discontinued, and slowly my symptoms returned – fatigue, weight gain, and brain fog to name a few.

To make a long story short, it was only in 2019 when I started working with a functional medicine doctor that I started feeling better again. She immediately included T3 hormones in my treatment plan, and slowly the process of feeling better started.

The standard T4 treatment for an underactive thyroid is not enough

What is the problem with T4-only medication? 

The issue is that while synthetic T4 medication is the standard conventional approach to treating an underactive thyroid, the experience from patients, including myself, is that this approach is rarely enough. 

If you are on a synthetic T4 medication (levothyroxine) treatment, and still not feeling SIGNIFICANTLY better, it may be that this approach is not enough for you. 

But why is it that so many doctors are reluctant, or sometimes even outright refuse, to prescribe T3 or NDT?


READ MORE: 5 Questions to ask your doctor when you have an underactive thyroid


Research takes a long time to reach doctors

It is here where I do have a huge amount of sympathy for doctors.

When I spoke with my functional medicine doctor a few weeks ago, she mentioned that she is overwhelmed with trying to stay up to date with the research on covid-19 and the developments in treatments. That is a lot of pressure on our doctors.

So, my approach is to take ownership of my health, do the research, and then talk with my doctor about it and help her as well. She really cannot know everything about hypothyroidism and Hashimoto’s given all the other things she needs to stay updated on as well.

In his book The Autoimmune Fix, author Tom O’Bryan quoted research that it takes 17 years for research to get through to your doctor.

“Yet it takes an average of 17 years for research findings to work their way down to your local doctors.”

Do you have 17 years to wait for your doctor to get the information you need?

I guess not.

That is why I believe it is important that you are educated about thyroid health and treatment options, and that you have a great doctor who is willing to work with you. Basically, a doctor who is willing to put their ego aside and partner with you on your health journey.

An important meta-study on individual requirements for optimum treatment

I want to get back to the research. A research paper was published online in Drugs In Context, on 13 August 2019, titled “Individualised requirements for optimum treatment of hypothyroidism: complex needs, limited options.”

This is a huge study!

In a nutshell, the researchers looked at the efficacy of the standard T4 treatment for hypothyroidism, as well as the effectiveness of using TSH as a stand-alone measurement for thyroid health in the treatment approach.

Here are more details.

In April 2019 the researchers did a meta-analysis (a study of studies), looking at 225 published prospective and 287 retrospective studies done over the last 10 years.

The researchers looked at a few key themes, including:

  • The pharmacological properties of T4 hormones,
  • The disease definition of hypothyroidism,
  • The laboratory-based definition of hypothyroidism (using TSH as a measurement tool)
  • Assessment of a patient with hypothyroidism,
  • Lack of generality and requirement for individualization,
  • Drug selection in the treatment of hypothyroidism,
  • Dose adequacy of T4 hormones,
  • Adverse drug effects, and
  • Future directions.

Like I said, a huge study. But what is important, is what this meta-analysis highlighted for me, as a hypothyroid and Hashimoto’s Thyroiditis patient:

Surveys done by the American Thyroid Association showed that many thyroid patients are dissatisfied with the standard T4 treatment. The ill-founded one-size-fits-all approach and the TSH blood test as a marker for the thyroid’s function or effectiveness of the T4 treatment have failed. There is an assumption that patients who receive T4 hormones would effectively convert these hormones into active T3 hormones. Fortunately, this assumption has been proven incorrect, as there are many factors that impact the conversion of T4 to T3. This is why many thyroidologists and practitioners are using other treatment options, such as combination T4/T3 preparations or T3-only approach. We need more interest in the development of modern T3-based treatments.

If your doctor still only prescribes T4 only and uses only TSH

So, what do you do if your treating doctor is still only using TSH to measure your thyroid health status and are still only prescribing T4?

Send your doctor the link to this article, and talk with your doctor about trying alternative approaches.

What if your doctor is not willing to consider alternatives?

Well, you have two options then. Accept it and stay with your doctor. But you may continue to feel the annoying and often debilitating hypothyroid symptoms.

Or, I am sorry to say, it is time to find another doctor who is willing to work with you.

The important fact is this: your health is in your hands. You and you alone are accountable and responsible for your own health.


  • Individualised requirements for optimum treatment of hypothyroidism: complex needs, limited options. Hoermann R et al, 13 Aug 2019.
  • Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104(12):510-520. doi:10.1258/jrsm.2011.110180. https://pubmed.ncbi.nlm.nih.gov/22179294/ Accessed 18 June 2022. 
Adele du Rand

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