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Factors that can lower the effectiveness of thyroid medication for hypothyroidism include 72: Reduced stomach acid (from a Helicobacter pylori infection, PPI use, antacid use, autoimmune gastritis, or history of gastric bypass) Leaky gut Malabsorption (common in ulcerative colitis, Celiac disease, autoimmune gastritis, and other gut disturbances) SIBO (small intestinal bacterial overgrowth) When taking thyroid hormones for hypothyroidism, a gut-centered approach can help to improve the absorption and effectiveness of the medication and potentially reduce the necessary dose