WHY DON'T I FEEL BETTER on
thyroid medication?
3 Hidden Reasons Thyroid Replacement
Isn't Helping You
Dr. Eric Balcavage
Rejuvagen Functional Medicine Center
INTRODUCTION
Over the last two decades, I’ve helped thousands of my patients recover
from chronic thyroid symptoms.
The patients that come to me usually already know they have
hypothyroidism. They’ve been tested, diagnosed, and treated with the
“standard of care”—thyroid hormone replacement medication.
Yet, most of them are still struggling with symptoms, despite taking
thyroid medication (sometimes for years).
In fact, almost every single one of my patients will say something like this
to me in our first call:
“Doc, I’m on thyroid medication, but I still feel hypothyroid.”
Or, “My doctor keeps increasing my thyroid dosage, but I feel like it’s making
me worse.”
And a lot of, “I felt better initially on medication, but it isn’t working
anymore. All of my symptoms are coming back!”
Can you relate?
Maybe you’ve also been on the Thyroid Medication Rollercoaster:
Constantly having to adjust your dosage, switching between NDT,
T4, or T3-only medication, chasing elevated TSH lab values...
But you still don’t feel any better. Or perhaps you feel even worse.
You’re not alone. I see this all the time.
www.rejuvagencenter.com
1
If you’re on thyroid medication but feel like it isn’t helping you, it’s
probably due to one—or a combination—of the following:
1. Your thyroid isn’t the problem.
2. Your thyroid medication dose is too high.
3. You’re taking T3-only medication (this is controversial, but I’ll explain
why).
Now, you might be surprised by this list. These things are probably the
exact opposite of what you’ve been taught about the thyroid. Maybe
they even go counter to what your very own doctor has told you.
But here’s the truth:
The current allopathic (conventional medicine) thyroid care model
is a debacle, and it's illogical.
It never addresses the root causes of hypothyroidism. Worst of all, it has
failed to fully understand thyroid physiology, and because of that
incomplete understanding, the standard treatment of care is extremely
flawed.
I’ve spent decades studying thyroid physiology. I’ve read countless
studies. I’ve worked with thousands of patients and helped them reverse
their hypothyroidism—all without following the “standard” thyroid care
model.
All I ask is that, as you read the following pages, try to set aside
what you may have learned, and consider these ideas with an open
mind.
They may just change your life.
PS: Even if you aren’t on thyroid medication, what you’re about to learn will
still be extremely valuable in understanding the root causes of your thyroid
symptoms.
www.rejuvagencenter.com
2
WHY YOUR MEDICATION ISN'T WORKING
Reason #1: Your Thyroid Isn't the Problem,
Your Cells Are.
Most doctors operate under the assumption that if your lab values
indicate hypothyroidism, and you have thyroid-related symptoms, it’s
because your thyroid isn’t working. For some reason, it’s either
producing too little thyroid hormone (hypothyroid) or too much
(hyperthyroid).
But this is a myopic view of how thyroid physiology works. And it’s not
complete.
Here’s what most people—even trained doctors—miss about
thyroid physiology: It's greatly affected by cells and tissues that
extend well beyond the thyroid gland.
Your thyroid gland is only one small part of the picture, and it’s typically
the very last place hypothyroidism progresses to!
In fact, in the early stages of hypothyroidism, symptoms don’t have
anything to do with the thyroid gland, and everything to do with
peripheral cells and tissues elsewhere in the body.
I see this every single day in my practice. I refer to it as “Cellular
Hypothyroidism” and it’s how almost all cases of hypothyroidism
begin.
As you can probably guess, what causes Cellular Hypothyroidism isn’t
actually the thyroid gland…
It’s caused by a phenomenon in cells called the cell danger response
(CDR).
www.rejuvagencenter.com
3
Reason #1: Your Thyroid Isn't the
Problem, Your Cells Are.
The CDR happens when cells sense excessive stress in
the body—either from inflammation, an infection,
pathogen, chemical, or even emotional stress—and as a
response, they switch from “growth mode” to “defense
mode.”
During CDR, cells are basically saying: “Hey, there’s a
crisis here! We need to slow down and protect ourselves.”
As a result, cells will purposely slow the body’s
metabolism and deactivate pro-growth substances
like thyroid hormones.
This means that less thyroid hormone is reaching the
receptors inside your cells—and inside the cell is where
thyroid hormone makes the biggest impact on our
health (not in the bloodstream, which is where most
doctors will test for it).
In other words, even if your thyroid is working perfectly
fine—or you’re taking thyroid hormone replacement—
but your cells aren’t able to receive thyroid hormone,
you’ll still have hypothyroid symptoms.
This is exactly why you might feel worse, or maybe
only temporarily better, on thyroid medication.
Don’t get me wrong. Your thyroid gland is very
important, and medication is sometimes necessary
(those with a damaged or removed thyroid gland will
likely always need thyroid hormone replacement).
www.rejuvagencenter.com
4
Reason #1: Your Thyroid Isn't the Problem,
Your Cells Are.
However, if you have Cellular Hypothyroidism caused by CDR, no
amount or type of thyroid hormone, whether made by the gland or
provided as medication, will restore optimal thyroid physiology.
Thyroid hormone will just get deactivated at the tissue level, and will
never get into the cell—because your cells don’t want it!
Chances are, you'll keep taking more and more thyroid medication.
Maybe you’ll feel better at first (what I call the "honeymoon phase")...
But your symptoms will almost always come back if you never fix
your stressed-out cells.
And that’s what I see time and time again with my patients.
Your thyroid gland is only one small part of the
picture, and it’s typically the very last place
hypothyroidism progresses to!
www.rejuvagencenter.com
5
WHY YOUR MEDICATION ISN'T WORKING
Reason #2: Your Dose Is Too High.
If you’re working with a doctor that doesn’t understand Cellular
Hypothyroidism, they will most likely continue to increase your
thyroid medication as long as you still have symptoms.
Some doctors might keep bumping up your dose even if you feel great but
your TSH is still “too high.”
(I’ve seen many try to drive TSH as close to 0 as possible, which is a bad idea
and I’ll explain why).
Now, it’s not their fault. Most doctors are good people. This is just the
allopathic model of medicine we were taught: To rely on lab values
above all, and when a low dose doesn’t do it, a higher dose will.
But this model of medicine is hurting way more people than it’s helping.
Taking more thyroid hormone than you need, no matter what your
TSH is, sets off a negative feedback loop in the body that causes
cells to become even more resistant to thyroid hormone.
Now in case you’re not familiar with thyroid hormone terms, let me
briefly explain...
T4 (thyroxine) and T3 (triiodothyronine) are the two main thyroid
hormones made by the body. T4 has its own functions, but it must be
converted to T3 before it can bind to thyroid receptors inside your
cells, where it makes the biggest impact.
Therefore, proper conversion of T4 to T3 in the body is critical for
optimal thyroid physiology.
But guess what?...
www.rejuvagencenter.com
6
Reason #2: Your Dose Is Too High.
If you’re taking too much thyroid medication, and your
cells are in a CDR, they will actually deactivate the
enzyme that converts T4 to T3 in cells (deiodinase 2) to
prevent thyroid hormone from reaching cell receptors.
In other words, you can have plenty of T4 in the
blood, but if your cells can’t convert it to the T3 form
they need, you will remain hypothyroid, despite
having lots of available T4 (and maybe even “optimal”
free T4 lab levels).
This is not only confusing, but it can also cause a bizarre
mixture of hyper- and hypothyroid symptoms.
You might have migraines, insomnia, or anxiety, and at
the same time be struggling with low energy,
constipation, and thinning hair. Not fun.
Additionally, taking more thyroid hormone to further
drive down TSH is also a problem. It’s definitely
possible to have a TSH that’s too low.
(I don’t like to see it go below 2.0 if T3/fT3 is also low.)
When TSH is too low, your sympathetic nervous system
can become overactivated, triggering a “fight or flight”
response.
This drives up the stress response in cells, makes CDR
worse, upregulates mast cells, and can create an
excessive histamine response—all of which put you at
risk for more thyroid complications.
www.rejuvagencenter.com
7
Reason #2: Your Dose Is Too High.
Here’s the point: More is definitely not “more” when it comes to
thyroid hormone replacement.
However, finding your optimal thyroid dose can definitely be tricky.
Being on a dose that’s too high sometimes feels similar to being on a
dose that’s too low.
Or maybe a dose that used to work well for you suddenly becomes too
much—perhaps because you’re getting healthier and your cells are
becoming more sensitive to thyroid hormone. This is very
counterintuitive!
So it’s not at all surprising that so many people are still confused by the
contradicting symptoms caused by too much thyroid hormone...
In fact, if you start searching Google and reading blogs, most people
(even thyroid “experts”) will blame your experience on simply
taking the wrong type of thyroid hormone…
But I don't believe that's the case for most people.
This brings us to the next reason your thyroid medication might not be
helping...
Taking more thyroid hormone than you need, no
matter what your TSH is, sets off a negative
feedback loop in the body that causes cells to
become even more resistant to thyroid hormone.
www.rejuvagencenter.com
8
WHY YOUR MEDICATION ISN'T WORKING
Reason #3: You're on T3 Medication.
When someone is diagnosed with hypothyroidism, the “standard of care”
treatment is to prescribe a T4 medication, such as Synthroid,
Levothyroxine, Levoxyl, Tirosint, or Unithroid.
The assumption here is that a person should be able to convert the T4 to
T3 without issue.
(Remember, T4 is the “inactive” form and must be converted to T3 inside
cells.)
Now, you can imagine why that might be a problem for someone with
Cellular Hypothyroidism, who as you just learned, essentially has their
“T4-T3 conversion switch” turned off.
This might be why T4-only medication can make so many people
feel worse.
When this happens, they (or their doctors) will often blame it on the T4.
So they’ll try to circumvent cellular conversion by taking T3-only
medication or switching to a T4/T3 combo.
But this assumption completely misses the point, yet again.
Here’s what we should really be asking: Why are cells not able to
convert T4 to T3?
Some will claim that T4 doesn't work for so many people due to a
polymorphism (a gene defect) that slows their conversion of T4 to T3.
But in my experience, only a very small portion of people with
hypothyroidism have this gene. And yes, those people may actually need
to take T3 medication.
www.rejuvagencenter.com
9
Reason #3: You're on T3 Medication.
For everyone else, however, it isn’t a genetic problem.
It’s a case of CDR causing their cells to purposely
deactivate thyroid hormone.
T3 medication won’t fix this issue. Instead, it can make
you feel worse.
Flooding your body with T3 signals to your pituitary
gland that you are in a hyperthyroid state. That
message prompts the pituitary gland to suppress
TSH, and the thyroid gland cuts back on the
production of thyroid hormones.
As a result, some cells and tissues may still be
hypothyroid despite a normal or low TSH blood level.
This can be a confusing scenario to both doctors and
patients alike.
Many of my patients that have felt better on T3
medication don’t like hearing this. I completely
understand. When something finally makes you feel
better, the thought that it’s a “mistake” feels like a punch
to the gut.
But the truth is, your issue is probably not the type
of medication you’re taking. Your problem is
overwhelming cellular stress that’s keeping thyroid
hormone from reaching receptors in your nuclei and
mitochondria.
Once you reverse the stress that’s causing the CDR, you
won’t need to constantly switch up your medication.
Your cells will be able to easily convert as much T4 into
T3 as they need, and thyroid hormone can do its job
inside the cell.
www.rejuvagencenter.com
10
DOES THIS MEAN MEDS NEVER WORK?
Now I'm not saying I'm completely “anti-medication." Thyroid
hormone replacement can absolutely help in some cases.
If you've had your thyroid gland removed, or your gland is damaged
from severely progressed hypothyroidism, medication is probably going
to be necessary. And if the problem is just with your thyroid gland, and
not your cells, the medication should relieve your symptoms.
However, too many people are given thyroid medication for the wrong
reasons, without knowing if the problem is actually an issue with their
thyroid or their cells. These individuals will continue to have symptoms
on thyroid medication, no matter what the type or the dose.
If you’re on thyroid hormone replacement right now, don’t stress.
I’m not saying you need to stop taking your medication!
But, if it truly isn't helping you, you may want to talk to your doctor
about:
Switching to T4-only
Working on reducing your cellular stress
Strategically lowering your dose to the least amount needed
Your issue is probably not the type of medication
you’re taking. Your problem is overwhelming
cellular stress that’s keeping thyroid hormone from
reaching receptors in your nuclei and mitochondria.
www.rejuvagencenter.com
11
SO, WHAT CAN YOU DO NEXT?
It’s very possible that I just contradicted many things you've been taught
about hypothyroidism. Maybe you’re feeling confused, frustrated, or
helpless.
I hope you know that’s not my intention. In fact, I think this is all great
news!
Your hypothyroid symptoms may not actually be a result of a
broken thyroid or a defective immune system. They’re simply a
cause of your cells protecting themselves from excessive stress.
Your cells are smart. They’re doing what they should be doing.
This means there’s hope. If you can take steps to reverse the cell danger
response, you can bring your thyroid physiology back into balance, get
rid of your symptoms, and greatly reduce (or maybe even eliminate) your
need for medication.
I’ve seen this happen time and time again in my practice. It’s
absolutely possible to reverse Cellular Hypothyroidism.
At this point, you might be wondering what you can actually do today,
right now.
To be honest, you might not like my answer at first. It doesn’t involve a
magic pill, supplement, diet, or “quick fix.”
And anyone that’s selling you a “one-size-fits-all thyroid program” is
sorely mistaken.
www.rejuvagencenter.com
12
One protocol for thyroid disorders doesn't exist,
because everyone's cellular stressors are a bit
different.
Your diet, lifestyle, relationships, and sleep quality will
not be the same as those of your friend or a family
member with hypothyroidism. Therefore, the solution
can't possibly be the same for everyone.
Reversing Cellular Hypothyroidism relies on your
ability to consistently address and reduce the
unique stressors in your life.
Healing can only happen if you also reduce sources of
stress, like:
Poor diet
Lousy sleep habits
Gut dysbiosis or infections
Environmental chemicals
Bad breathing patterns
Metabolic dysfunction
Emotional stress or trauma
Low physical fitness
Maybe looking at that list, you know exactly where you
could improve.
Perhaps your sleep has been crummy for years, and you
have a feeling you need to start there. Or you’re a sugar
addict and you know it’s affecting your energy levels.
Maybe you’re a chronic “mouth breather” and could
work on better nasal breathing techniques.
Great, start there!
www.rejuvagencenter.com
13
If you still have no idea what to do, don’t worry. I won’t leave you
hanging. Here’s a few ways to stay in touch so I can continue to help:
Get my newest book, The Thyroid Debacle.
Keep an eye out for my emails. I regularly share helpful information,
blog posts, and podcasts all about healing your thyroid.
Follow me on Instagram to get more education, connect, and stay
up to date.
And finally, if you want to work together, you can book a free
Discovery Consultation directly with me.
I sincerely hope this information has helped you.
At the very least, I hope it’s empowered you to feel in control of
your health, and to keep asking questions.
Dr. Eric Balcavage
Is the owner and founder of Rejuvagen
Functional Medicine Center. He is widely
recognized around the world as a leader
in Functional Medicine and Thyroid
Physiology. In over 20 years of practice, he
has successfully helped thousands of
people suffering from thyroid problems
and other chronic health conditions.
Learn More
www.rejuvagencenter.com
14