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7 Clear Signs Your Thyroid Medication is Actually Working

Two thyroid experts explain what to expect from hyper- and hypothyroidism treatment.

By Rebekah Harding
January 26, 2024

30-Second Takeaway

Signs that your hypothyroidism medication is working to replace missing hormones include improved mood, reduced joint pain, weight loss, and increased energy.
If your hyperthyroidism treatment is targeting excess hormone, you may notice reduced anxiety, weight normalization, and improved energy levels.

hyroid disorders like hyperthyroidism and hypothyroidism can be debilitating—emotionally and physically. If you’ve been prescribed treatment for your thyroid disorder, you’re probably eager to rid yourself of common symptoms like depression and anxiety, weight changes, and fatigue. So, what are the signs your thyroid medication is working?

Two hormone experts dive into the nitty gritty of how it all works.

About the Experts:

Steven Wise, M.D., is an endocrinologist and contracted physician with Broad Health, Hone Health’s partnered medical practice. He specializes in thyroid disease, parathyroid disorders, and adrenal disorders.

Susan Linder, M.D., is a contracted physician with Broad Health, Hone Health’s partnered medical practice. She specializes in physical medicine & rehabilitation, and medical interventions for chronic pain and anti-aging.

What Causes Thyroid Disorders?

The thyroid is a butterfly-shaped gland in your neck that produces the thyroid hormone, made up of T3 and T4.

The thyroid plays a major role in cell function, Steven Wise, M.D. says. “In the simplest terms, thyroid hormone affects the rate at which all cells do their jobs.” It’s involved in functions like metabolism, energy production, and body temperature (1).

However, sometimes thyroid hormones can be thrown off balance due to conditions like Hashimoto’s (autoimmune) thyroiditis, other types of thyroiditis (chronic inflammation of the thyroid), thyroid surgery, nutrient deficiencies, and certain medications (2, 3).

An imbalance in thyroid hormones can produce one of two conditions—hypothyroidism or hyperthyroidism—and the treatment plan for each is completely different.

When Does Thyroid Medication Start Working?

“Most people will start to see improvement in their symptoms within a few days to a few weeks after starting thyroid medication,” Susan Linder, M.D. says. However, what symptoms that resolve first will depend on the individual and the condition.

“For almost all hypothyroid patients, there is noticeable improvement in some symptoms within about 2 weeks on levothyroxine (T4) therapy,” says Wise. “Although severely hypothyroid patients may have to wait as much as 3 to 4 weeks before having any noticeable change.”

If you’re taking thionamide for hyperthyroidism, you’ll likely see improvement after six to eight weeks of treatment (4).

“Changes in mood, energy, alertness, sleep, and mental state tend to occur before physical changes in weight, temperature, heart rate, and bowel function,” Wise notes. “Structural changes to the body such as weight and joint stiffness generally improve by four to six weeks, but may take several months to fully resolve on therapy.”

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Medications for hypothyroidism

Hypothyroidism occurs when thyroid hormones are too low or missing, resulting in a slower metabolism and heart rate (2). As a result, you may notice symptoms like weight gain, fatigue, hair loss, and joint or muscle pain (2).

Medication for hypothyroidism replaces the hormone that is missing, Wise says. Hormone replacement for hypothyroidism is generally prescribed as one of these:

T4 (levothyroxine): produced synthetically to be identical to human T4
T3 (liothyronine): also produced synthetically to be identical to human T3
T4/T3 combinations: often produced from extracts of dried animal (pig) thyroid glands

Medications for hyperthyroidism

If you have hyperthyroidism—aka, an overactive thyroid pumping out too much thyroid hormone, you may experience symptoms like weight loss, anxiety, excessive sweating, and muscle weakness (3).

Your doctor will order a series of blood tests to figure out the cause of the hyperthyroidism and prescribe treatment accordingly, Susan Linder, M.D. says. “For example, if there is a thyroid nodule that is the cause, antithyroid medication can be prescribed to prevent the gland from making too many hormones.”

Doctors frequently treat hyperthyroidism with drugs called thionamides, which interfere with natural production of thyroid hormone, Wise explains (4).

Signs Your Hypothyroid Medication is Working

Improved mood

Your hormones and mood are tightly intertwined, which is why your mood takes a nosedive when thyroid hormone is out of whack. Thyroid hormone influences the level of neurotransmitters like serotonin, which helps improve mood, memory, learning, and cognition (5). Makes sense then that too-low thyroid hormone levels can lead to depression and poor sleep (6).

Starting medication for hypothyroidism can start to boost your mood in one to two weeks, says Wise.

Reduced joint pain

Hypothyroidism can contribute to joint pain in several ways including increased fluid retention and inflammation, and muscle weakness (7, 8, 9).

Fluid retention: Low thyroid levels reduce metabolic activity, which can lead to fluid hanging around your body longer than it should (7). This can cause swelling and discomfort in your tissues and joints, making them feel pressured and painful
Inflammation: An imbalance in thyroid hormones can lead to an uptick in pro-inflammatory cytokines, which contribute to inflammation in your joints (8).
Muscle Weakness: Thyroid hormone is like a personal trainer for your muscles, keeping them toned and strong (9). If you’re lacking in thyroid hormone, muscle weakness can make everyday tasks tougher, and put extra strain on your joints.

If fluid retention is to blame, your joints may start feeling better four to six weeks after starting hypothyroid treatment, according to Wise. However, rebuilding muscles to support your joints may take longer.

Weight loss

Low levels of thyroid hormone can slow your metabolism, which can lead to frustrating and stubborn weight gain—even if you’re eating well and working out (10). Starting hormone replacement therapy can help regulate your metabolism, making it easier to keep your weight in a healthy range (10).

That said, medication isn’t a silver bullet for excess pounds.

“Weight gain may not resolve without other interventions, like diet and exercise,” says Wise. “As most people already know, you can spread weight on with a butter knife, but you need a crowbar to pry it off.”

If you gained weight due to hypothyroidism, you should start to see a difference in your fitness results about six to eight weeks into treatment, according to Wise. If you’ve got the green light from your thyroid specialist to start losing weight, work with a certified personal trainer to come up with a plan to rebuild strength.

Increased energy levels

Your metabolism doesn’t just regulate how your body converts food into fuel—it also plays a role in how energetic you feel. Hypothyroidism can reduce your metabolic function, leaving you sluggish and fatigued (9).

Hypothyroid treatment boosts your hormone levels so you can make more energy at the cellular level. As your thyroid levels increase, you’ll likely start to feel an uptick in energy as early as two weeks, says Wise.

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Signs Your Hyperthyroid Medication is Working

Less anxiety

Elevated thyroid hormone levels can amp up activity in your sympathetic nervous system, which controls functions like heart rate and sweating (11, 12). Overstimulation of this part of the nervous system can make you feel revved up, anxious, or irritable (13).

Normalizing your thyroid levels helps your sympathetic nervous system chill out, reducing anxiety and hyperactivity (11). You should begin to notice significant improvement around six to eight weeks into treatment (4).

Healthy weight gain

Hyperthyroidism can speed up your metabolism, which can make you lose weight, even if you aren’t trying to (13). Some of that weight loss could also be from bone loss.

As your levels normalize, your hyperactive metabolism will slow, making it easier to keep the number on the scale from dropping (14). According to the American Thyroid Association, most post-treatment weight gain occurs within the first six months of treatment (15).

However, Wise suggests waiting until your thyroid levels are under control before you try to rebuild muscle in the gym.

“Because of the increased risks for heart rhythm abnormalities, heat stroke, dehydration, and other issues due to hyperthyroidism, we usually advise against strenuous exercise until hyperthyroidism is controlled,” he says.

More energy

While hyperthyroidism commonly causes hyperactivity, excess energy expenditure can also contribute to fatigue, according to the British Thyroid Foundation (16). Think of it as your body internally running marathons everyday without the ability to rest in between.

By bringing your thyroid levels to a normal range, your metabolism will level out as well, making you feel more energized (17). You may begin to notice improvements in your energy levels six to eight weeks into treatment (4).

Signs Your Thyroid Medication is Too High or Too Low

Thyroid medication is a safe and proven way to balance your hormone levels, and is regularly prescribed by physicians. But, if treatment for hyperthyroidism or hypothyroidism is too aggressive, it can cause more issues.

“Overmedicating for hypothyroidism can creates hyperthyroidism, and overmedicating for hyperthyroidism creates hypothyroidism,” Wise warns.

Without testing, there are no clear signs or symptoms that indicate your thyroid medication needs to be adjusted.

“If you do a Google search for symptoms of just about any other chronic illness, you will find that they all share at least 50 percent of their symptoms with a thyroid condition,” Wise says. “That makes symptoms extremely unreliable as an indicator for adjusting thyroid medication.”

Thyroid hormone levels should be adjusted based on results from frequent hormone testing. Most doctors will schedule a follow-up lab six weeks after you start treatment. If your symptoms persist after starting treatment, your doctor may need to adjust your dose.