Thyroid Medication Dosage & Conversion Chart (All Medications)

Thyroid Medication Dosage & Conversion Chart (For All Thyroid Medications)

Are you taking one type of thyroid medication but considering switching to another?

If so, then this is the article for you. 

The truth is that while many thyroid medications contain similar ingredients the switching process is not as straightforward as you might think. 

We are going to talk about switching from T4 only medications (levothyroxine & Synthroid) to NDT medications (Armour thyroid, NP thyroid, etc.), and also how to convert between T4 only to T3 only and vice versa. 

More...

Switching & Converting Between Thyroid Medications

Is it possible?

Yes, absolutely. 

Is it easy?

Not usually. 

Does that mean you should avoid it. 

No! 

There are a number of factors which should always be considered when you are transitioning between thyroid medications and each of these factors may influence how that transition goes. 

From my own experience in treating hundreds of thyroid patients, I find that most patients do the best on a combination of both T4 and T3 medications. 

Unfortunately, most patients (including you reading this) are probably taking a T4 only medication such as levothyroxine

While T4 medications can be helpful in many situations, they aren't always enough to get patients back to the 100% that they were accustomed to prior to their thyroid disease. 

This has to do with a number of issues including your own personal genetics, factors which influence thyroid conversion, and cellular receptor sensitivity of thyroid hormones. 

We aren't going to go into detail on these specific topics but you should be aware that they exist and they can all influence how well you transition or convert between thyroid medications. 

I also think it's important for you to understand that while conversion charts can be helpful, they are not always 100% accurate!

I understand why you may want to look at something like this and even though I am going to provide the information I would encourage you to not go by the charts listed below. 

Why?

Because they are flawed!

It will be possible, but very unlikely, for you to be able to look at the chart to help pinpoint your dose. 

Even with the charts it will still take some degree of trial and error to get to that ideal dose. 

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Conventional and Conservative Thyroid Conversion Chart 

You should be aware that there are several different charts that I'm going to show you. 

I know you were probably hoping that it would be one simple chart and that you'd be done, but, unfortunately, that's just not how it goes. 

You have to understand that there isn't a consensus on what a good conversion is (due to the controversy that I've listed above) and you will hear different versions depending on who you talk to. 

I'm going to include 3 basic charts for you to take a look at. 

The charts will vary in how conservative or aggressive they are and I will link to studies which support their use when appropriate. 

What you are probably already accustomed to is what I will refer to here as the conventional or ultra-conservative thyroid conversion chart. 

This is the chart that you will see in major pharmaceutical textbooks and the chart that most doctors are probably using.

There's one big problem with this chart:

It isn't necessarily the best and using this chart does result in underdosing in many patients. 

Why?

Well, because most doctors would rather underdose you than overdose you. 

The more aggressive the conversion you use, the more likely you are to experience symptoms, even if this rate is probably only around a few percent (2-3%). 

thyroid conversion chart between medications

You can click to enlarge the image here to look at the details. 

The first thing you will notice from this chart is that it includes information which allows you to convert from T4 only medication to NDT medication to T3 only medication to synthetic T4 + T3 combinations

What you might not realize is that these conversions don't really make a lot of sense once you start to break them down. 

The information suggests that 1 grain of NDT (which is 38mcg of T4 and 9 mcg of T3) is equal to 100mcg of T4 only which is equal to 25 mcg of T3 which is equal to 1 grain of synthetic T4/T3 (which contains 50mcg of T4 and 12.5mcg of T3). 

Let's break this down by looking at a couple of these individually. 

Based on the numbers here the chart suggests that T3 is about 4x more potent than t4 as a thyroid medication. 

This tracks somewhat closely with my own real-world experience but is still slightly more conservative than what I see in real life. 

They are suggesting that 25mcg of T3 is equal to 100mcg of T4. 

25 times 4 would be 100mcg so if you are taking 25mcg of T3 you can consider that to be 100mcg of T4 equivalents. 

Now let's look at the NDT to T4 conversion. 

The chart suggests that 1 grain of NDT (which is equal to 38mcg of T4 and 9 mcg of T3) is equal to 100mcg of T4. 

If we multiply T3 by 4 (remember we already found that T3 is about 4x more potent than T3) in NDT then we get that the 9mcg of T3 found in 1 grain of NDT is equal to 36 mcg of T4 equivalents. 

Then if we add the 38 mcg of T4 found directly in the NDT in addition to the 36 mcg of T4 equivalents from the T3 component we get a total dose of 74 mcg of T4 equivalents in 1 grain of NDT. 

Do you see the problem here?

The chart is suggesting that 1 grain of NDT is equal to 100 mcg of T4 but we just found that NDT only contains about 74 mcg of T4 equivalents!

Using this chart will result in underdosing by about 25% if you use it to transition from T4 to NDT! 

That is just one of the issues with the standard conversion chart but there are plenty of others as well. 

The next most obvious problem is that the chart suggests that 1 grain of NDT (which, again, contains 38mcg of T4 and 9 mcg of T3) is equal to 1 grain of synthetic NDT which contains 50mcg of T4 and 12.5mcg of T3. 

What?...

How can 38 mcg of T4 and 9 mcg of T3 be equal to 50 mcg of T4 and 12.5mcg of T3?

It doesn't make any sense and this is part of the reason that I really don't suggest using this standard conversion chart. 

Does it have value?

Of course, but I find it's best used as only a very rough estimate to help you get on track. 

But don't be surprised if you use this chart and find that your hypothyroid symptoms return as you transition. 

This chart leans heavily in favor of T4 which is why this may occur. 

T4 tends to have much less biological activity than T3 (1) so if you use more T4 you will have a smaller effective dose of thyroid medication. 

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I've seen a number of patients who use this chart and then are surprised when they find that their TSH increases after the switch. 

Of course this will happen if you are switching to a lower effective dose of thyroid medication! 

It doesn't matter if you are switching from T4 to NDT or NDT to T4 or any combination. 

If you provide your body with a lower effective dose of thyroid hormone then you will feel it and you will see a rise in your TSH. 

Are there other more effective charts to look at?

Yes! And we are going to dive into those next. 

Updated Thyroid Conversion Chart Based on Newer Studies

What's interesting is that newer studies have suggested that the conventional chart (the one I listed above) is probably not as effective as we once thought. 

Most physicians who use it are aware of this but there aren't really many other options to go by so they use it anyway. 

More recently, however, there have been newer studies which suggest a newer conversion schedule based on the results of these studies. 

This study (2), for instance, compared patients taking NDT and T4 and looked at how these medications influence thyroid labs. 

They concluded, based on the results of their study, that there is a better way to convert between NDT and T4. 

newer conversion chart between NDT and T4

Instead of suggesting that 1 grain of NDT is equal to 100 mcg of T4, they found that 1 grain of NDT is more equal to 88 mcg of T4. 

So, this pushes their chart away from the T4 bias that exists in the original chart that I showed. 

They also created this information based off of studying patients taking both T4 and NDT and looking directly at their lab tests

One of the downsides to the original chart that I showed is that it is purely theoretical and based on what we believe is happening. 

This chart is better, in my opinion, because it is founded on REAL results and REAL patients. 

You can find a more complete version of the chart that I created below for you (based on their results):

Armour Thyroid

NP Thyroid

Synthroid (T4 only)

Cytomel (T3 only) 

30 mg

30 mg

44 mcg

12.5mcg

60 mg (1 grain)

60 mg (1 grain)

88 mcg

25mcg

90 mg

90 mg

132 mcg

37.5mcg

120 mg (2 grains)

120 mg (2 grains)

175mcg

50mcg

The study did not include conversions for T3 but I extrapolated from the original table which said that 100mcg of T4 was equal to 25 mcg of T3. 

If that is true, then 88 mcg (the new 100mcg equivalent in this table) is also equal to 25mcg of T3. 

You can see that the numbers are shifting away from being T4 centric and giving T3 more value. 

Even though this chart is still better than the original, and based off of newer studies, I find that it's may still leave a large number of patients underdosed. 

Because of that, I've created my own conversion chart which is less conservative and based on my own experience. 

My own Conversion Chart

I find this chart to be more useful for most people as it makes the claim that T3 is around 3x more potent than T4 and this idea is supported by studies. 

These studies tested the relative effectiveness of T3 and T4 at suppressing TSH from the pituitary. 

They found that T3 was slightly more than 3x more potent than T4 (3) (which is similar to the calculations below). 

You can find the conversions below:

Armour Thyroid

NP Thyroid

Synthroid (T4 only)

Cytomel (T3 only) 

30 mg

30 mg

37.5 mcg

12.5mcg

60 mg (1 grain)

60 mg (1 grain)

75 mcg

25mcg

90 mg

90 mg

112 mcg

37.5mcg

120 mg (2 grains)

120 mg (2 grains)

150 mcg

50mcg

You'll notice here that I am suggesting that 25 mcg of T3 is roughly equal to about 75 mcg of T4. 

That makes T3 about 3x more potent because 3 times 25 is equal to 75. 

It still isn't perfect from the perspective of NDT to T4 conversion but it's a good starting point. 

If you run the numbers on NDT you will find that this chart still underdoses you slightly when you transition from T4 to NDT. 

If 1 grain of NDT contains 38 mcg of T4 and 9 mcg of T3 and if T3 is 3x more potent than T4 then 1 grain equals 65 mcg T4 equivalents (38 + (9x3)). 

This 65mcg of T4 equivalents is slightly lower than the 75mcg of T4 that you may be converting from. 

The difference isn't big but it's still there. 

For these reasons, don't use these charts as ABSOLUTE guides! They are only rough estimates to help you figure out what your body needs. 

Factors which may Affect your Conversion

I mentioned before that it wouldn't be as easy as just plugging in your current dose and then transitioning to a new dose. 

Why?

Well, many factors impact how well your body is able to utilize thyroid hormone and which thyroid hormones you do better on. 

Some factors, such as genetics, are out of your control but there are others which you should be aware of. 

Unfortunately, many of you reading this probably struggle from at least a handful of these other factors because of how they interact with the thyroid. 

For instance:

It's fairly common to see people with hypothyroidism struggle with their weight. 

For this reason, many hypothyroid patients undergo extensive dieting programs which can negatively influence thyroid metabolism. 

This changes what type of thyroid medications you may do best on and your conversion table! 

It would be impossible for me to create conversion tables based on each factor below but you should be aware that these things DO impact your thyroid function and therefore your conversion. 

Here are the most common things that do this: 

  • Your weight (4) - The more weight you have the more thyroid hormone you are likely to need. Your thyroid controls your metabolism and the more weight you have the more energy you may need to burn. We use to dose thyroid hormone based on weight alone (some doctors still do this) for this reason. 
  • Recent weight gain - A recent change in your weight is going to impact how your body utilizes thyroid hormone. This will probably result in an INCREASED demand for thyroid hormone in your body. 
  • Recent weight loss - Recent HEALTHY weight loss will mean you need less thyroid hormone but recent UNHEALTHY weight loss may require more. I know you probably want to lose weight but you MUST do it the healthy way or you risk damaging your metabolism and thyroid. 
  • Inflammation - Inflammation, commonly found in thyroid patients with Hashimoto's, can cause conversion issues (5) and may impact how much T4 or T3 you need. 
  • Prescription Medications - Prescription medications can block the effects of thyroid function (such as T4 to T3 conversion). Sometimes medications can positively impact your thyroid so don't be afraid to use them but do be aware of them. 
  • Supplements - Supplements, especially if you use the right ones, may positively alter the type and dose of thyroid medication that you need. If you haven't already, be sure to look at thyroid-specific supplements which may help. 

Conclusion

There you have it!

3 thyroid conversion charts which range from conventional and conservative to more modern and aggressive. 

You can get away with using any of these charts, but you should always be prepared to make adjustments to your thyroid medication based on your lab tests. 

As long as you don't assume that the chart will be enough and it will get you where you need to go you will do well. 

I find the best results with my own personal chart but feel free to use the one that suits your philosophy and personal preferences. 

Now I want to hear from you:

Are you thinking about converting between thyroid medications?

Have you tried to convert between thyroid medications?

If so, how did your conversion go?

Did you notice a rise in your TSH? A drop in your T4 or T3?

If you used any of these tables, or something else, please comment and shared what worked for you! 

References (Click to Expand)

How to Convert From One Thyroid Medication to Another

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About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 70,000+ people have used them over the last 6 years. You can read more about my own personal health journey and why I am so passionate about what I do here.

P.S. Need more help? Check out my free thyroid downloads and resources.

69 thoughts on “Thyroid Medication Dosage & Conversion Chart (For All Thyroid Medications)”

  1. I have been struggling for over 6 months to get my thyroid medicines regulated. While I am a petite person I have about 10 lb of added weight since being diagnosed. My leptin and was 26.8! I am currently taking 1.25 grains of compounded NDT and also an additional 15 MCG of T3 on top of what is in the NDT. At what levels of T3 do you see people have success with weight?

    Reply
  2. Hi Dr. Westin, I am so enjoying your articles. My question is regarding my elderly 95 yr old mother. Can she safely take oral micronized progesterone oil to help with her thyroid systems? She has been on T4 Synthroid only for many many years. Currently, on a diuretic, blood pressure, depression meds, etc and recently told her kidneys are at stage 3. Thank you for your reply.

    Reply
    • Hi Pam,

      Progesterone probably won’t have a huge effect on her thyroid function. It probably won’t hurt her to take it but it probably won’t help either.

      Reply
  3. I’ve put on armor thyroid meds they were doing ok. But she also gave me DHEA 25 mg and I was on 5. The problem she tested my DHEA and it was out of range… Now I gained 15 lbs in I year and I do eat right and dance 3 x a week. No one is listening I was praying you could help me. Thank you, Teresa.

    Reply
  4. I have Hashimotos and I recently started Armour thyroid after being on Synthroid for many years. My Labs are normal on Synthroid ( titrating between 100mcg and 112mcg) however they are not optimal.

    TSH- 1.3
    Free T4 – 1.6
    Total T3 – 87

    I recently started Armour 15 mg and I can’t seem to tolerate more than that without feeling palpitations and more anxiety. Is it possible that I can’t tolerate Armour Thyroid or that I only need a lower dose on Amour in comparison to Synthroid?

    Thanks,
    Melissa

    Reply
  5. Hi Dr. Westin, first off thank you for all of the work you do. I’m always referring to your site for information that I know I can trust!

    I’m looking at your conversion chart because I’m considering going from NP thyroid (due to the current issues with quality) to a compounded option. I noticed yours doesn’t show an option for that conversion, can you help me out with what 3 grains of NP thyroid would look like in a compounded option?
    Also, would you recommend a synthetic or NDT version of a compound? I’ve always been a fan of NDT in the past but with all of the issues I had with Naturethroid during their supply problem and now NP with quality I’m seriously considering synthetic…
    Thanks in advance, I look forward to speaking with my doctor very soon about this change.

    Reply
    • nicole, did you change to synthetic? I also am on 3 grains Armour thinking of changing. What was the conversion?? thanks!

      Reply
  6. I have no thyroid and on 3 grain of NT. Live in a small town and doctors aren’t very understanding of my situation. I would like to be on T3 only but doubt that could happen. I do not convert t4 to t3 very well.I am 74 rather active for my age. Do you think t3 alone could work for me? Doctor only want to do TSH only and I know that’s not right. I know I need Free t3, Free t4 and many other test but they won’t do. I have been fighting this since age 38.

    Reply
    • Hi Elba,

      I would look to other therapies before moving to T3 only at your age. It’s not that you can’t do it at all, but it is more likely to cause issues given your age.

      Reply
  7. I was diagnosed with Hashimoto’s when I was 19. I’m now 42. I have only ever taken levothyroxine. However it has been years since I felt good. I was always told its because of your lifestyle. I had 4 small kids worked as a nurse on swing shifts and was 20lbs over weight. In the last 7 months I have finally managed to loose 30lbs with an elimination diet. My kids are grown, I have moved to days but still struggle with low energy and just not feeling great. My dose has not changed in years but I’m curious if moving to a combination medication would help with my energy levels. I have no other medical conditions to complicate matters. I just can seem to find a doctor that wants to help me find a way to feel bette rather than blaming my life choices. Any advice would be so appreciated.

    Reply
  8. Thank you Dr. Childs for all the great information. It’s really been a helpful guide. I was on Naturthroid but it wasn’t working for me. My issue was low T3 with high RT3. My RT3 was 16 when I started Naturthroid and it kept increasing when my dose was increased to 1.5 grains (up to 21). And my TSH was very suppressed with FT3 still low (2.4). I did have some improvements but also started having side effects as not being able to sleep through the night. I recently switched to T3 only. Your chart was a good guide. I had to titrate up to 50 mcg. I feel like my old self again! I still need to focus on healing adrenals more but switching to T3 only has been a lifesaver! Happy to report I’ve lost 15 lbs of the 20 lbs I gained quite fast without adding in a lot of exercise.

    Reply
  9. Hi Dr. Westin, I was on 25 mg of Cytomel for a few years and felt good. After doing my labs and finding my TSH had shot up to 5 something, my primary Dr. sent me to see an endocrinologist. She switched me to 50 mg of Levo. My hair has really thinned and is so dry. My energy is low also. I have a hard time getting a good nights sleep. I felt so much better on the Cytomel. Sooo long story short, I went back to my primary Dr. and after telling her I felt better on the Cytomel she has added 5 mg of Cytomel to my 50 mg dose of Levo. I still feel tired all the time. Do you think I need more Cytomel?

    Reply
    • Hi Noreen,

      You will want to look at both your lab tests and put those into context with your symptoms to help determine your dose.

      Reply
  10. Hi Dr Childs:
    I am 65 years old and I had a total thyroidectomy in my early 20’s, I was put on T3 only and I was fine for ten years until I migrated to Australia and they switched me to T4 100 mcg and I was just ok for many years. the last 4 years is been a battle to keep the levels right .
    I was on 100mcgs, then 75mcgs Monday to Friday and 100 mcg Sat and Sun. Then 75, back to 100 and finally I was on alternate 100mcg and 75mcg. Hypothyroid symptoms, and high RT3.
    For 3 months I am taking 75mcg of Oroxine and 10 mcg of Liothyronine. I tolerate this well, but the symptoms persist, and weight continue to increase very slowly.
    Am I doing the right thing? Is this treatment not working for me?
    I will appreciate your help, thank you very much
    Kindest Regards
    Maria Leighton

    Reply
    • Hi Maria,

      If you are feeling more hypothyroid with the changes (and your labs are not showing signs of improvement) then you are most likely on the wrong dose. With the kind of dosing you are using it looks like your doctor is following only the TSH which is not ideal.

      Reply
  11. Hello again Dr Childs:
    Thank you very much for your reply, on my previous post I forgot to add my labs results (typical memory fog )
    18/10/19 TSH 0.24 (0.4-4.0) Free T4 16.4 (9.0-19) No Free T3 (??)
    20/11/19 TSH 0.17 Free T4 16.0 Free T3 4.3
    I am still taking 75 mcg of Oroxine and 10 mcg of Liothyronine (Tetroxin) with no improvement.
    My GP is thinking to reduce the Oroxine to 50 mcg becouse of the decreasing TSH…but that It’s expected isn’t it?
    Thank you very much again
    Kindest regards
    Maria Leighton

    Reply
  12. My dr is switching me to Nature throid and Levothyroxine. I’ve been on 30 mg of NP Thyroid and no change in weight. I’ve gained 30 lbs in 1.5 yrs and I’ve been thin my entire life. Same with my mom.
    However, I have Lyme, coinfections, Mold mycotoxin illness, Sibo, leaky gut, candida, marcons…. and I’m told mycotoxins can contribute to weight gain. Same with inflammation from lyme, though it could take years and years for that to be solved or handled, so while I wait, I need a solution for the weight issue.

    Reply
  13. Dr. Childs,
    Can you please help me decipher my tests and advise me on what I should be taking. My tests results are TSH <0.006 T4 7.0
    T3 UPTAKE 21 FREE THYROXINE INDEX 1.5 My TSH has been this low for the past several blood tests. My Doctor has had me on Amour 3 gram for a few years and now he dropped it down to 2 grams 6 months ago. I am to the point that I can't even function. I am so super tired all the time. I do not know of another Dr. to go to. Please help me out with your suggestions and supplements. My Dr. says I have Hashimoto's.

    Reply
  14. Dr Childs:
    I can see many questions unanswered, I believe that people that follow you are desperate for some help, suggestions or understanding of what they going through .
    I have thoughts and questions myself, but I would feel worst if my mail gets ignored .
    Cheers

    Reply
    • Hi Sylvana,

      I do my best to answer questions but there’s a bit too many for me to answer every single one 🙂 Especially when you include facebook, youtube, my blog posts, and so on.

      Reply
      • that’s a crappy excuse. People are buying your products and looking to you for answer but you just basically told them you don’t have time. WOW!!!

        Reply
        • Hi Melissa,

          It’s not meant to be an excuse, by any means, just an acknowledgment of a logistical problem. There are more questions asked than I have time in a day to answer. I still do answer questions every single day, though, I just can’t promise that I will be able to answer them all. If you have a question feel free to post it, though and I will do my best to answer it 🙂

          Reply
        • No one owes you anything Melissa. How rude of you to demand this kind and generous man give you special attention. He’s already gifting all of us with knowledge we would have to pay $1000’s for otherwise. Your warped sense of entitlement is the problem, not the number of his replies.

          Reply
  15. Great article, but you have a confusing typo
    “The chart suggests that 1 grain of NDT (which is equal to 38mcg of T3 and 9 mcg of T4) is equal to 100mcg of T4. “

    Reply
      • Ginny is correct – I noticed this too.

        1 grain of NDT contains 38 mcg of T4 and 9 mcg of T3 – not 38 mcg of T3 and 9 mcg of T4 as is stated.

        Reply
        • Hi Jeanne,

          Yes, I just realized what Ginny was saying. I thought she was suggesting the T4 equivalent calculation was off but you are correct that 1 grain of NDT equals 38mcg of T4 and 9 mcg of T3. The opposite was a typo but it should be fixed now!

          Reply
  16. Thank you for this information. I’m not sure if I am interpreting it correctly however. It Appears the conversion is from NP to T4 or T3 only. If I switched from NP 120 mg per day to T4 (Tirosint) and T3, how can I determine the best dosage for that combination? Thank you

    Reply
  17. I believe your chart is closer to the real conversion, although I’m terrible at math. I only know from recent experience based upon my symptoms. Recently switched from 88mcg generic Levo(taken for ten years) to NP Thyroid and instructed to take 1-2 grains daily. After four days on 1 grain my hands and feet became painfully cold. I went up to 2 grains today. Perhaps that’s a tad bit much. Maybe I should have bumped up to 1 grain and 1/2 of 1 grain.

    I just started seeing a clinic that treats people based on symptoms rather than numbers. In a week I’ll be doing some blood work along with reverse T3.

    I’m not asking you to tell me what dose of NP I should take but based on the chart you created what would be the estimated conversion of 88mcg of synthetic T4 to NP Thyroid be? My issue is that no one seems to make a conversion chart for this dosage amount. Just like my foot size I always seem to be in between dosages and I’m also only 103 at 5’1.

    It’s trial and error but it would be nice to get close to the target. Who knows, maybe 88mcg was no longer my target dose but my test results are always similar but for the past four years I’ve had symptoms of muscle aches, fatigue and crashing so I didn’t know where to go from there if everything “looks normal.” What makes it even worse is that the symptoms for hypo and hyper are so darn similar.
    Thanks for the articles. They’re very relevant and helpful.

    Reply
  18. I’m not sure how to convert it to a 4:1 ratio, because I am on the combo. I am close to optimal, but not quite.

    I currently take:
    – 125 mcg Synthroid
    – 130 mg / 2 grains Naturethroid

    T4 = 6.1
    FT4 = 1.47
    T3 = 90
    FT3 = 3.1
    RT3 = 17
    TSH = .04 (my tsh is always at nearly zero and doc has been ok with it because I had cancer and she wants it suppressed… also when ever it is in optimal range, all other levels are out of whack and I feel super hypo)

    Reply
    • Also, another question, because I think you might have mentioned this in another post, but do you prefer your patients to be on Synthroid + Cytomel over NDT?

      Reply
  19. Thanks for providing such detailed information. It helps me understand my doctor and nutritionists approaches, and also motivates me or suggests helpful tweaks my lifestyle. Thanks!

    I’ll be talking with my doctor soon and she will be adjusting thyroid dosage/medication. I was looking back at my lab levels over the years and I noticed that my free T4 levels have always been under 1.0 pg/dL seemingly regardless of medication level & type. Have you seen this before? I’m trying to understand what this might mean. Depending on medication type/dose, I have seen TSH and free T3 levels adjust.

    Reply
  20. Thank you for this information. I’m going to share it with my doctor. After the roller coaster this year has been with NDT (I’ve been Nature to Armour to NP), we have decided that I am going back to liquid Tirosint and supplement with a synthetic T3. Converting back from two grains per day of NDT to 100 mcg of Tirosint and 3 tablets per day of Liothyronine at 5 mcg per his suggestion. What I find the hardest about this are the heart palpitations if we get the conversion wrong. I don’t mind being underdosed, it’s the overdosed that scares me.

    Reply
    • Hi Cheryl,

      I wouldn’t worry too much about heart palpitations as they are typically just a sensation and are not associated with changes to heart rate/force of contraction.

      Reply
  21. Hi Dr Childs,
    One of your case study articles states that when you increase T3, you are supposed to lower T4 a bit. I am on 100 mcg Tirosint/30 mg Armour/5 mcg Liothyronine combo. My labs are showing FT4 at mid range, FT3 at lower normal, and Total T3 below normal. Because I’ve been experiencing fatigue and gradual weight gain, my doctor raised Liothyronine by another 5 mcg. Based on your case study, what prompted the need to lower the T4 dose? Would lowering T4 (from 100 mcg of Tirosint to 88 mcg) somehow help with weight loss? Thank you!

    Reply
  22. Due to Medicare’s refusal to cover Armour, which I have taken daily for 53 years, I have switched to generic Synthroid. I was on 120 mg Armour, and using the standard chart, my doctor started me at 200mcg T4 only last month. 3 weeks into it my TSH had dropped too low (I was having anxiety, nausea, and heart palpitations; I already have a heart murmur) it was .048 (with a reference range of .270-4,2). Now she has lowered the T4 dose to 175mcg, which seems still too high on your chart. I am dreading the experimentation and the effects on my health at this stage of life. She has agreed to test free T3 and T4 later on this month, but it took some talking and compromising. I am wondering if I should ask for a referral to an endocrinologist?

    Reply
  23. Hi dr I am a concerned mom my daughter has been having a lot of issues they say she has Hashimoto’s Overactive but all of her symptoms don’t match She hasn’t been sleeping she also passed out and was in the hospital I’m trying to find a doctor in my area that may be able to help me I’m the bay area in California Do you have any suggestions or what I can do to help my daughter

    Reply
  24. Hi Dr.Childs, v. Interesting -thank you. I was taking 175 mcg synthroid and 15mcg Cytomel and found a Dr. who would use NDT and he switched to 2 grains NDT. If each grain has 38.8 mcg T4, then surely now I am only taking 77.6mcg T4 v 175mcg.
    Not feeling good on it-getting hot flashes again( 65 yr old female), waking every 2 hrs in night, and energy not great( all the usual symptoms I get when hypo. Confused re: conversion, although understand the equivalents method. Thanks

    Reply
  25. Hi Dr. Childs,
    I’m having a really tough time. I was taking Naturethroid 1.5 Grain daily for many years but as you know it’s not available at this time. My TSH had been up and down on the NatureThroid requiring dosage changes from time to time. Recently I went on a locally compounded capsule that contains 30MCG Levothyroxine (natural T4 was not available at this time) and a natural T3 4MCG which I take 2 x daily. I started this medication about 6 weeks ago. I had my labs done yesterday and my TSH is 24.58 yikes…I do my best when it’s just under 1.0. What the heck is going on? I feel awful to say the least.

    Reply
  26. Dr. Childs,

    Over and over I see and talk to so many, self included, who are not getting reasonable treatment from endocrinologists and other physicians they have access to. Inordinate amounts of time are being spent by people trying to find answers that should be more available to them.

    What can we do to address 1) the lack of endocrinologists 2) the over-reliance of them on TSH and TSH reflex at the expsense of those of us who have conversion issues or central hypothyroidism?

    I believe the chemicals we are exposed to in the environment and in our foods coupled with the ionizing radiation my generation was exposed to NATIONWIDE during the above ground nuclear tests in the 1950’s and 60’s has wreaked havoc on our endocrine systems, and instead of addressing it and looking for root causes, we are suffering with under-treatment of or non-treatment of conditions that ultimately lead to “metabolic syndrome”, a major health issue today.

    What do we need to be asking for from our elected representatives to help correct this major health issue?

    Reply
    • Hi Cynthia,

      I’m not sure I have a good answer for you. I do what I do here to try and push that cause forward but if I had any other better answers I would happily provide them. One thing that you can do is to get as educated as possible so you can be a better advocate for your own health. Never blindly trust a doctor, they are well-intentioned but following their advice, in my opinion, is not always the best option.

      Reply
  27. Dear Dr Westin

    I’m late to this article, but like most, my personal circumstance is the impetus. It appeared when I searched for ‘transition from NDT to synthetic T4 and T3’; which I’ve decided to do because of the recent instability and quality issues in the NDT market. Your stated goal of this article was: ‘We are going to talk about switching from T4 only medications (levothyroxine & Synthroid) to NDT medications (Armour thyroid, NP thyroid, etc.), and also how to convert between T4 only to T3 only and vice versa.’ I think that you demonstrated the non-sensical aspects of the equivalency chart and how to convert T3 to T4. However, I remain unclear as to how to determine initial strength of both hormones combined due to the potency of T3 relative to T4. Like commenter Beth Gan above, I’ve gone from NDT to Tirosint and Liothyronine. If you have addressed this elsewhere I would greatly appreciate it if you would share that link. Also I would have found inclusion of a few examples from your practice, especially the converting of those on T4 only to NDT, from which I could then reverse and apply to my own situation, most helpful. Thank-you for all the information you have and continue to provide.

    Christy

    Reply
    • Hi Christy,

      There isn’t a way to perfectly convert from one thyroid medication to another due to certain variables. This information is mostly meant to be used as a guide but not a scientific resource to help determine exact dosing. I used to determine thyroid dosing on an individual basis.

      Reply
    • Hi Christy,
      Did you ever find a good resource or guide? I’m looking to do the exact same thing and haven’t found any good resource on how to make the switch from NDT to an equivalent dose of synthetic T4 and T3.

      Reply
  28. Hello,
    I have been taking NDT for the last few years but the supply in the US stopped so I bought sone from Thailand- my blood test last weeks showed my TSH was 14 and T4 at 10
    So I think the Thyroid S was a dud supply. I have never tried Levothyroxine but I am now as I don’t have supplies and want to see if it works for me. I have started taking 100mgs previously was taking 2.5 grains NDT but factoring in that the last batch may not have been working at all I thought I’d start on 100 for a week then take 50 more so would that be about 2 grains.
    I wonder if my body hasn’t liked the T3 in NDT all this time.I’ve never had the energy like I had before Hashi but recently I had cold hands very hard to walk far so I think I have been on nothing- the duds otherwise the TSH would not be so high…

    Reply
    • Hi Maria,

      It sounds like either the supply doesn’t contain thyroid hormone or you aren’t absorbing it. Even small amounts of thyroid hormone are usually enough to drop the TSH rapidly.

      Reply
  29. Hi Dr. Childs,
    I’m trying to make the switch from NDT to synthetic T4 and T3 and there doesn’t seem to be a great deal of information on determining an equivalent dose. There are some people who advise taking the exact equivalent of you take in the NDT (So for 2 grains it would be 76 mcg of T4 and 18 mcg of T3). I know you’re not able to make dose recommendations but is that ever a calculation you would use? It seems too easy to break it down like that to determine the dose. I am doing fine on my current dose of NDT but there are supply issues so I’m trying to find the synthetic equivalent of what I’m taking now.

    Reply
    • Hi Ash,

      Swapping over like that is fine, you’d just need to keep an eye on how you are feeling to see if you need to make adjustments. It doesn’t really matter where you start because there will be a lot of trial and error since there is no perfect conversion between the two.

      Reply
  30. Dr child’s,

    First off. Love all your work! I wish there were more doctors like you.

    I am currently on Armour 120 mg and I loved it until recently over the last few months i feel hit or miss and wanted to make the switch to Tirosint/liothiroine.

    My endo tried putting me on 125/10 T4/t3 and felt awful. Then 75/25 and felt the same so I went back on Armour which is ok.

    Reading your work and doing some research and talking to folks who were on the same dose of Armour transitioned to 125/50 T4/t3 to start and didn’t miss a beat.

    Is that a reasonable dose to go back to my endocrinologist on? He and my General practitioner use the same chart ( 1 GR= 100 mcg T4/25 mcg t3). My logic to them is if you’re using that chart, why were they under dosing me on t3? Are they that nervous to use 50?

    To be fair ever since I went from synthroid only at the end of 2019 to armour, that t3 treatment has normalized my Blood pressure and lowered my resting heart rate from 74 to 56 BPM. So I’m not sure of the concern of t3 treatment is to me.

    Thoughts on if 125/50 is a good suggestion to my endo to transition from 120 mg of Armour ?

    Reply
  31. Hello Dr Childs,

    If you are changing medications from compounded T4/T3 to Tirosint Sol and compounded T3 and you aren’t feeling well on prior compounded meds, shouldn’t your new dosage be increased to reflect the fact you’re not feeling well, such as weight gain/fatigue? It shouldn’t be a simple equal conversion should it?

    Reply
  32. I’m considering switching from Armour to Tirosint-sol, as we suspect some of my gastro and other issues may be reaction to fillers. What is the correct conversion from 2 grains Armour? And will you be adding Tirosint to the conversion charts?

    Reply
    • Hi D. Wiggles,

      The conversion is similar to that of levothyroxine or other T4 only thyroid medications but please note that sometimes Tirosint can feel more powerful because it’s usually better absorbed compared to the others so a lower dose may be necessary.

      Reply
  33. Hi, I have been on 60 mg of Armour and 15 mcg of t3. Last labs were:
    TSH- .01
    T4 free- 1.2
    T3 free- 4.4 (over range)

    My Endo switched me to 45 mg armour took me off the extra t3 completely and added in 50 mcg of levothyroxine bc she said my t3 is too high and t4 and TSH too low. However I felt better than I have in over a year with those numbers. Finally had energy. Switched 3 days ago and I’m already so tired and sick. Will this level out and I’ll get back to feeling better?

    Thank you

    Reply
    • Hi Peytn,

      It can take a good 4-6 weeks for thyroid medication changes to take effect so if you haven’t waited that long it’s difficult to make any definitive conclusions.

      Reply
  34. Hello! I take 100 Eltroxin one day alternating with .88 mcg the other day. My T4 sits at 20. What do you think?

    Reply

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