Find out how to treat hypothyroidism.

How to Treat Hypothyroidism With Hormone Replacement Therapy in 5 Steps

by Charlotte

Sarah was used to dealing with minor health issues. She’d gained a bit of weight in recent years and figured the occasional muscle and joint pain she felt was somehow related. She grew familiar with constant, nagging fatigue. She’d always assumed it came from the minor depression that seemed to run in her family. She didn’t realize anything was really wrong until she received word after her yearly physical that her cholesterol levels were off balance. Sarah’s doctor ran more tests over the following weeks and they discovered that all of her symptoms were indeed related—to hypothyroidism.

Because these symptoms are so varied and often develop slowly over time, many individuals who struggle with an imbalance of thyroid hormones never get diagnosed. Conditions like hypothyroidism can fly under the radar for years as these seemingly small issues increase in severity and frequency. Diagnosis can feel like a major relief, as it finally provides answers and offers a way forward. For those with hypothyroidism, that way is typically hormone replacement therapy (HRT). So how do you treat hypothyroidism with HRT? Often, 5 simple steps can get you started on the road to recovery.

Step 1: Document Your Symptoms

Before discussing the health problems you’ve been experiencing with your doctor, it’s important to know exactly what you’ve been experiencing, how severe those symptoms are, and how long they’ve lasted. This information will help you communicate more clearly with your doctor and make the diagnosing process easier and faster.

The most common symptoms associated with hypothyroidism are listed below. Take careful note if or when you experience the following, as well as any other symptoms you experience even if they may seem unrelated:

  • Persistent and increasing fatigue
  • Dry skin
  • Constipation
  • Weight gain
  • Elevated blood cholesterol levels
  • Depression
  • Obesity
  • Joint pain or swelling
  • Infertility
  • Muscle weakness or stiffness
  • Impaired memory
  • Lowered heart rate
  • Hoarseness
  • Puffy face

Step 2: Receive a Thorough Evaluation

Before diagnosing any type of thyroid issue, an expert hormone health practitioner will discuss your symptoms in detail and perform a thorough physical examination. This step is primarily when goiters may be discovered, and these usually benign but abnormal enlargements of the thyroid can provide further clues as to the lowered function of your thyroid gland.

At this time, your doctor will also submit bloodwork for a variety of lab tests. The most basic of these tests for high levels of thyroid stimulating hormone (TSH) and low levels of thyroxine (T4) in the blood, a combination which usually indicates an underperforming thyroid. However, many patients who receive a negative result from this test still experience symptoms and all too often remain undiagnosed. That’s why the best doctors are taking further steps to isolate markers of thyroid function. Practitioners in the BodyLogicMD network measure TSH, free T4, and free T3 levels in the blood as well as testing for thyroid antibodies to form a more accurate assessment.

Note that some medications and dietary supplements can affect thyroid-related blood testing. Let your doctor know if you’re taking antidepressants, blood pressure medications, vitamins, or supplements before testing to ensure you receive accurate results.

Step 3: Understand Your Diagnosis

Thyroid dysfunction comes in many different forms, and hypothyroidism is only one of many possible explanations for the symptoms you experience. As was the case with Sarah, hypothyroidism may be caused by a genetic autoimmune condition called Hashimoto’s thyroiditis, which requires lifelong treatment and careful monitoring. It can also be caused by radioactive iodine treatment (RAI) for hyperthyroidism, or by thyroid-related surgery. Rarely, hypothyroidism is the result of a nonfunctioning pituitary gland, which normally creates the TSH that’s needed for thyroid hormone production.

It’s also possible to develop hypothyroidism during or after pregnancy. This condition increases your risk for miscarriage, preeclampsia, and premature delivery, and can create serious birth defects. It’s incredibly important that you understand the complexities of this diagnosis and treat prenatal or postnatal hypothyroidism carefully with the help of your medical team.

Subclinical hypothyroidism is another diagnosis you could receive. This condition is sometimes detected through blood testing and comes with few or no symptoms. Individuals with subclinical hypothyroidism often have normal blood levels of thyroxine and triiodothyronine but elevated levels of TSH. Other individuals will have normal, but suboptimal blood levels with positive symptoms of hypothyroidism.

Step 4: Begin Taking Thyroid Medications

Doctors typically prescribe a standard dose of 50-200 mcg of levothyroxine (a synthetic T4 hormone) once per day to treat cases of hypothyroidism. Each dose is determined by a careful consideration of age, weight, symptom severity, and medical status, and will be closely monitored over time to determine if changes need to be made. This treatment is usually effective and produces few side effects as long as the right dose is administered.

Before levothyroxine became popular, doctors also prescribed desiccated thyroid extracts made from crushed thyroid glands taken from pigs or cows. This option is still available as a dietary supplement or with a prescription, but it isn’t widely recommended. Animal thyroid glands do contain T3 and T4 hormones, but in a ratio that’s extremely different from that observed in the human body.

A popular alternative to these traditional treatments is bioidentical hormone replacement therapy. There are no standard drugs or doses with this treatment option because each case is treated according to the unique medical needs of the individual. These hormones are compounded in a ratio and dose that is unique to you. That means BHRT may be more effective and come with fewer side effects than other therapies.

No matter which treatment option you choose, doctors generally recommend taking thyroid medications at the same time each day on an empty stomach. If you prefer to take pills in the morning, it’s best to wait at least an hour before eating or drinking so as to not interfere with hormone absorption. Be sure to discuss with your doctor what should be done in the case of a missed dose.

Step 5: Manage Your Ongoing Treatment

Many people begin experiencing relief from the symptoms of hypothyroidism within two weeks of starting hormone medications. For others, it may take up to 6 or 8 weeks to notice major changes. This is the point at which the body’s levels of TSH tend to stabilize.

Though hormone replacement therapy is typically incredibly effective at treating hypothyroidism, some people may still not feel “normal” with the first medication prescribed. If your doctor chose a T4-only medication, it’s possible that your body requires a combination of T4 and T3 hormones to function at an optimal level. Ask your doctor about the possibility of trying a combination drug or adding a separate T3 medication to your regimen. Do not change brand names or generic forms of your medication without consulting your doctor first, as different brands may contain different doses of hormones.

Finding the right dose can take time, and it’s important for you to notice and report any side effects you may experience along the way. Symptoms of too-high dosage could include headaches, heart palpitations, shakiness, increased appetite, or insomnia. But with the right dose and the right medication, you should feel much better and have few side effects. Continue taking medication even after you’ve started to feel better. Many thyroid conditions are lifelong, and symptoms will return if you stop taking your medication.

In the meantime, be sure to discuss with your doctor any other medications, supplements, or dietary changes you are considering. Some medications can impact the effectiveness of thyroid hormones and should only be combined with caution. Supplements like fiber, iodine, calcium, and iron can also have a major impact on thyroid function and should be discussed with your doctor.

Understanding How to Treat Hypothyroidism With BHRT

Thyroid hormones are necessary for the health of cells in all parts of the body—including the heart, brain, bones, and other organs. Millions of men and women who struggle with the symptoms of hypothyroidism are ready to find a solution. Hormone replacement therapy can be that solution and provide life-changing relief. Bioidentical hormones, in particular, are a powerful and effective treatment option for those looking for an alternative to conventional treatment.

If you are struggling with hypothyroidism, BodyLogicMD can help you find relief through bioidentical hormone replacement therapy. BodyLogicMD expert practitioners complete extensive education and certification to be included in the BodyLogicMD network and are specialists in hormone treatment. They create comprehensive treatment plans for each individual based in grounding principles of natural integrative medicine and holistic hormone health—which means your hypothyroidism regimen includes much more than pharmaceuticals. BodyLogicMD-affiliated practitioners work with you to achieve your wellness goals through a combination of medication, nutrition, and lifestyle counseling so you can maintain a healthy balance for years to come. Contact a local practitioner to discover how BodyLogic and BHRT can help with hypothyroidism, or take the BodyLogicMD Hormone Balance Quiz to learn more.

Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended diagnose, treat, cure or prevent diseases.


  • Charlotte

    Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.