Feeling tired, gaining weight, or suddenly anxious? Those can be signs your thyroid needs attention. Treatment depends on whether the gland is underactive (hypothyroidism) or overactive (hyperthyroidism). Below I’ll outline the main options, what they do, and simple steps you can take every day to make treatment work better.
For hypothyroidism the standard is levothyroxine (synthetic T4). It replaces the hormone your body lacks and usually requires a single daily pill. Your doctor will check your TSH about 6–8 weeks after starting or changing dose, then less often once stable. Some people still feel off despite normal labs; in certain cases liothyronine (T3) or a combination of T4+T3 is tried, but that needs careful monitoring. Desiccated thyroid extracts exist, but doses can be less predictable.
If the thyroid is overactive, first-line drugs are antithyroid medicines like methimazole (commonly used) or propylthiouracil (PTU) in special situations such as early pregnancy. Other options include radioactive iodine to shrink the gland or surgery to remove part or all of it. Radioactive iodine isn’t used in pregnancy or when you’re breastfeeding. Surgery may be recommended for large goiters, suspicious nodules, or when rapid control is needed.
Take levothyroxine on an empty stomach, usually 30–60 minutes before breakfast or at bedtime at least 3 hours after your last meal. Don’t take it at the same time as calcium, iron, antacids, or certain supplements—these reduce absorption. If you use any of those, separate them by 4 hours.
Keep a simple record of symptoms and weight, and share that with your clinician. Labs matter, but how you feel matters too. Expect dose changes early on; most people need several adjustments before hitting the right level.
Pregnancy changes thyroid needs — many people need a higher dose and closer monitoring every 4 weeks in the first half of pregnancy. If you’re pregnant or planning pregnancy, tell your provider early.
Selenium supplements have shown some benefit in reducing thyroid antibody levels in certain autoimmune thyroid conditions, but results vary. Don’t start supplements without checking with your clinician.
Watch for warning signs: fast heartbeat, chest pain, severe weight change, extreme fatigue, fainting, or sudden temperature intolerance. These need prompt medical attention.
Finally, find a clinician who listens. Thyroid care is often a mix of lab checks, symptoms, and small lifestyle adjustments. With the right plan, most people get back to normal routines and feel better.
