Thyroid Medication: Levothyroxine vs NDT vs T3 – Which is Best?

This post will teach you everything you need to know about thyroid medications, how to use them correctly, how to pick the best medication for your body and other tips and tricks to help you along the way. 

Feel confused about which thyroid medication you should be on? or which one is the best?

You're not alone...

Many patients continue to experience symptoms such as weight gain, fatigue, hair loss and more - even though they are taking thyroid medication. 

This should not happen and is an indication that something is off and it may be related to which medication you are taking

So what is the solution? 

What may surprise you is that the amount and dose of thyroid hormone that each person needs are highly unique and there are no "algorithms" or "equations" that will give you the answer. 

Having said that there are ways to figure it out and it's worth discussing because choosing the right medication and the right dose may be a life-changing experience

More...

Is There a "Best" Thyroid Medication?

It turns out the answer is not that simple. 

Wouldn't it be nice if you could plug your lab tests into a special equation and out popped the type and dose of thyroid medication that you needed?

It would be nice, but that isn't reality (at least not yet)!

The standard evaluation and management of your thyroid do follow a similar pattern which may seem familiar to you and that includes testing for your TSH and basing your dose of T4 medication on that lab result. 

This may sound nice in theory but it doesn't take into account patient genetic differences, the absorption rate of different medications, differences in thyroid conversion in each person and so on. 

The short version is that using a simplified algorithm to try and treat thyroid dysfunction is probably part of the reason that so many hypothyroid patients are unhappy

Instead of taking the standard approach to thyroid management it makes more sense to treat every single patient as an individual. 

It makes more sense to adjust dosing based on more than just lab tests and to assess factors such as peripheral thyroid conversion and genetic variability between individuals. 

So is there a best thyroid medication?

No, because the best thyroid medication is the one that works for you and it will be different for each individual.  

So how do you go about finding which medication and dose you should use?  

How Thyroid Medication Works

It may seem like a silly thing to even discuss, right?

Shouldn't it be just as easy as taking your medication and it works in your body?

It sounds so simple in theory but it's actually more complex than you might think. 

And understanding how the medication works in your body is the first step to understanding which of the thyroid medications may work best for you. 

So let's walk through the steps involved in order for thyroid medication to act in your body:

  • First --> The medication must be consumed. The time of day that you take your medication matters and it also matters if you take your medication on an empty stomach or with food. All of these things influence absorption.
  • Second --> The medication must be broken down and absorbed in your intestinal tract. Certain conditions such as low stomach acid (1) (which can be caused by thyroid disease), SIBO and food intolerances can limit absorption of your medication. In addition, certain thyroid medications are easier to absorb than others because of the inactive ingredients that they contain. This is a big and very important step. 
  • Third --> The thyroid medication must make it into your bloodstream and then be converted in peripheral tissues including your liver (2) to the active thyroid hormone T3. This is another very critical step because most medications only contain the inactive thyroid hormone T4 which means that these medications (examples include Levothyroxine and Synthroid) are not active unless they are converted. Many patients (at least up to 15% (3)) may have problems with conversion and may, therefore, not activate thyroid hormone even if it is absorbed. 
  • Fourth --> Thyroid hormone must travel to your cells and land on thyroid receptors where it has both genomic and non-genomic action (4). Genomic means that it is changing your genes and non-genomic means that it influences changes in the cell directly without influencing genetic function. This process is mediated, at least in part, by another thyroid metabolite known as reverse T3. So in order for T3 to get to your cells and activate your genes, it must compete with reverse T3 for binding.
  • Fifth --> You experience the benefits of thyroid hormone based on the AMOUNT of thyroid hormone that you are taking. Simply put you need to be taking enough thyroid hormone to ensure that all of these benefits occur. 

What's interesting is that you can have problems at each and every step of the way. 

For instance:

Some patients have a difficult time converting T4 into T3 (5). In these patients taking T4 medication may not result in an improvement in their symptoms. 

And other patients may have problems with absorption. Their ability to convert T4 into T3 may work perfectly but if they aren't absorbing the thyroid medication in their GI tract then there won't be any thyroid hormone to convert!

Hopefully, this is making sense. 

The main idea here is that in order for you to feel better when taking thyroid medication each of the steps listed above must be working properly. 

But, more important than all of these steps is that you must be taking ENOUGH thyroid hormone in order to feel better. 

Let me explain:

Even if Armour thyroid is the medication for you, you need to make sure that you are on a sufficient dose. 

If you take a dose that is too small then you will STILL be hypothyroid and still remain symptomatic. 

You can think about it in this way...

If you have hypothyroidism then this by definition means that your body is not producing enough thyroid hormone

This deficiency in thyroid hormone manifests as certain symptoms including weight gain, mood changes, cold extremities and so on

So doesn't it make sense that if you correct this deficiency with the right amount that these symptoms will go away?

It makes perfect sense and it should be your goal when seeking treatment. 

If you are taking thyroid hormone and you only experience SOME relief in your symptoms then the changes are high that you may be on an insufficient dose. 

Ok, so now that you have a solid base of information we can move on to the main differences among thyroid medications. 

Download my Free Resources:

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I've found that these 10 foods cause the most problems for thyroid patients. Learn which foods you should absolutely be avoiding if you have thyroid disease of any type. 

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This list includes optimal ranges, normal ranges, and the complete list of tests you need to diagnose thyroid hypothyroidism correctly!

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The Differences Between Thyroid Medication


The two most important differences between thyroid medications boil down to these points: 

  • ​Active ingredients (Thyroid hormone) - Does the thyroid medication contain the inactive thyroid hormone T4, the active thyroid hormone T3 or both? 
  • Inactive ingredients (Fillers and binders) - Are you sensitive to fillers/binders and if so will that interfere with the thyroid medication in your body? 

Let's dive into each of these in a little more detail...

When it comes to the active ingredients (thyroid hormones) the most powerful thyroid medications will be those that contain the ACTIVE thyroid hormone T3. 

These medications include Cytomel, liothyronine and Natural Desiccated thyroid

Because these medications are considered to be very powerful many Doctors will shy away from their use. 

Instead, they may prefer to use a weaker thyroid medication that includes the inactive thyroid hormone T4. 

Medications in this class include Levothyroxine, Synthroid, Tirosint, etc. 

These medications are considered to be weaker because they are not activated in the body until they are converted into T3 (but more on this later). 

So, in essence, you can break down thyroid medication by how powerful it is based on whether or not it contains T3. 

The inactive ingredients are not quite as important as the potency of the thyroid medication but they are still important. 

Inactive ingredients matter because certain individuals may experience negative side effects to this component of the medication

In addition, the inactive ingredients may result in poor gastrointestinal absorption which may result in decreased thyroid hormone entering the bloodstream. 

So certain patients, especially "sensitive" patients, may do better on cleaner thyroid medications that contain fewer inactive ingredients or dyes. 

A perfect example of this is the 50mcg Levothyroxine Tablet:

levothyroxine added dyes and fillers

The 50mcg Levothyroxine tablet is white and, therefore, does not have any color dyes (6) added to it, unlike the other doses of Levothyroxine. 

Some physicians have noted that certain patients do better simply switching their dose of Levothyroxine to 50mcg increments to eliminate the extra dyes. 

A Simple Guide to Finding the Best Medication for Your Body

When I am evaluating a new patient there are several factors that I use in helping me determine which medication to start with, how to dose that medication and how often to follow up. 

Important factors such as comprehensive lab results, personal history, and current and previous symptoms can help guide the proverbial hand in picking the right thyroid medication. 

But, even with these factors, you may still end up on the wrong medication or the wrong dose. 

In the end, sometimes the best way to determine the type of medication and dose that you need may come down to good old trial and error that is guided by both your symptoms and your lab tests.  

With that in mind, there are definitely some guidelines that you can use to put you on the "right track" that may give you a head start. 

For instance: 

If you've been taking Levothyroxine and your Doctor has played around with your dose for the last 5 years and you've NEVER had any improvement in your symptoms then it might be a good idea to switch medications entirely. 

But if you're someone who hasn't been on Levothyroxine for very long then you might want to consider other formulations of T4 such as Tirosint. 

Let's discuss some important factors and threads that you may want to consider when thinking about which medication to start with. 

Patients who may consider using NDT (Armour thyroid, Nature-throid, WP-Thyroid, NP Thyroid, etc.) medications:

  • Patients who have not felt better on T4 only medications like Synthroid, levothyroxine or Tirosint
  • Patients with mild weight problems (10-20 pounds overweight)
  • Most patients who have not been on thyroid medication before
  • Patients with Low Free T3 and Low Free T4 Levels with relatively normal Reverse T3

Patients who may consider using T3 (Cytomel, liothyronine, SR T3) only medications:

  • Patients with high levels of Reverse T3 (>15) or thyroid resistance
  • Patients with Leptin Resistance
  • Patients with Diabetes, Prediabetes or Insulin Resistance
  • Patients with extremely low body temperatures (< 97 degrees)
  • Patients with a personal history of bipolar disorder or a strong family history of mental health disorders
  • Patients with a personal history of Fibromyalgia or Chronic fatigue syndrome
  • Patients who have failed both T4 medications and NDT medications

Patients who may consider using T4 only (Synthroid, Levothyroxine, Tirosint, etc.) medications: 

  • Patients who find NDT too stimulating
  • Patients with Normal Free T3 levels and Normal Reverse T3 levels
  • Patients who experience palpitations on T3 medications regardless of the dose
  • Patients who are extremely sensitive to all other medications and supplements

These are not hard and fast rules, but they are a good place to start. 

There will always be anomalous individuals who simply don't follow the rules, but you can figure out if you fall into that category through the trial and error method. 

In my practice the breakdown of patients who use thyroid medication goes something like this:

  • 40-50% of people do the best on NDT in some form --> this includes medications such as Armour thyroid, WP thyroid, and Nature-throid
  • 20-30% of patients do well when adding T3 medication to either NDT or T4 only medications --> This includes medications such as Liothyronine, Cytomel and SR T3
  • 10-20% of patients do the best on T4 only medications --> Usually 50mcg of Levothyroxine or Tirosint

T4 & T3 Combination Thyroid Medication - Natural Desiccated Thyroid (NDT)

PROS

  • Includes both the active and inactive thyroid hormones T3 and T4. 
  • Patients who use NDT over T4 only medications experience more weight loss (7).
  • When patients switch from T4 to NDT they show preference for NDT due to quality of life improvements. 
  • Contains less biologically active thyroid hormones T1 and T2. 
  • The medication is cheap. 

CONS

  • May cause a flare-up in Hashimoto's or thyroiditis due to animal tissue.
  • Can be difficult to absorb in individuals with GI issues.
  • Contains static doses of T3 and T4 which makes it difficult to dose in certain people. 
  • Can be difficult to obtain from many providers. 
  • Many physicians erroneously believe that dosing is unreliable (which is not true).

Natural desiccated thyroid or NDT for short is the first thyroid medication we will be discussing. 

NDT is unique among all thyroid medications because of where it comes from and how it is formulated. 

Synthetic versions of T4 and T3 are created in a lab and then formulated into capsules or tablets. 

This should be compared to NDT which is created by crushing or desiccating the thyroid glands of animals - pigs in this case. 

We then take the crushed up glandular tissue, make sure it contains a set amount of T3 and T4 then formulate this as thyroid medication. 

This makes NDT very unique in that it contains special ingredients that other thyroid medications do not. 

WP thyroid is a form of NDT

For example: 

By crushing and desiccating the thyroid gland of animals you are getting all of the thyroid hormones, enzymes and other precursors that exist in the gland itself. 

This formulation process allows for the inclusion of special (but less biologically active) thyroid hormones such as T1 and T2 (8).

For this reason, and because some people consider NDT to be more natural than synthetic medications, NDT is often touted as the "best" thyroid medication out there. 

While it is true that it has special and unique properties that doesn't mean it is the best and it is not without disadvantages. 

The biggest disadvantage of using NDT is that the dosing of T3 and T4 is considered "static". 

So while it is a good thing that it contains both T3 and T4 (in addition to T1 and T2) the dose of each is "stuck" which doesn't allow for individual titration of thyroid hormone. 

The ratio of T4 to T3 in NDT is 38mcg of T4 to 9mcg of T3 which is roughly 4.2:1 or, put another way, each grain contains about 76% T4 and about 24% T3

This works out great for patients who do best on that ratio, but what if the ratio that you require in your body is closer to 10:1 or 90% T4 to 10% T3

The point is you don't have as much control over as many variables when using NDT. 

Another potential issue is that the consumption of thyroid tissue from animals may trigger an immune response and result in destruction or problems when taking this medication. 

This is a theoretical issue but it should still be considered if you have Hashimoto's or some other autoimmune condition. 

Dosing and Starting NDT


Despite NDT not being perfect a large majority of patients do indeed do well when taking this medication. 

Up until about 1970s NDT was the medication of choice (9) but was surpassed in usage by T4 only medications like Synthroid. 

For this reason, many older physicians are more comfortable using and dosing NDT compared to younger physicians which aren't as familiar with this medication. 

When using NDT It's always best to start low and titrate up slowly over time to prevent side effects like palpitations, insomnia, and hyperactivity. 

These symptoms may occur because NDT does contain the active thyroid hormone T3 which makes it more powerful than T4 medications. 

In general, a starting dose may be as low as 16.25mg WP-Thyroid/Nature-throid or 15mg of Armour thyroid, and up to 60-65mg/day.

(*Note: WP thyroid and Nature-throid can be difficult to get in the 2018-2019 timeframe. If you are having trouble getting these medications fuffilled from your pharmacy you can check out alternatives such as NP Thyroid).

The more sensitive (or older) the patient, the slower the dose should be increased and the smaller the starting dose should be. 

Changes to your dose can be adjusted based on your Total T3, Free T3, TSH, and Free T4 levels which will change upon taking NDT. 

Your goal should be to minimize the total dose of thyroid hormone that you need while still achieving symptomatic resolution and without creating supra-physiologic levels of free T3 and total T3 in the serum. 

For many individuals, this "optimal" dose will be around 1.5 to 3 grains or 90mg (97.5mg in the case of Nature-throid and WP thyroid) to 180mg (195mg in the case of Nature-throid and WP Thyroid). 

As a comparison, 1.5 grains contains 57mcg of T4 and 13.5mcg of T3.

While 3 grains contains 114mcg of T4 and 27mcg of T3.

​What to Expect

Up to 15-20% of people may feel an IMMEDIATE improvement in their hypothyroid symptoms after starting NDT (any formulation). 

Patient case study on naturethroid and AIP

The patient above was one of those - she felt better immediately upon switching to Nature-throid and continued to notice improvement with each interval increase in dosing. 

You can read her entire case study here.

​For the other 80% or so of patients, it may take up to 1-4 months before you start to notice serious improvements in your symptoms. 

Most patients by the 4-6 week mark begin to notice changes, but the full effects may not be realized for several months.

Still, some patients will notice an immediate improvement in symptoms upon starting NDT but the benefits will quickly fade - usually around the 2-week mark. 

If you fall into this category it doesn't mean that NDT is the wrong medication for you, instead, it might mean that you need to continue your titration. 

Whenever symptoms arise it's best to assess thyroid status in the body with a complete thyroid lab panel and then treat from there. 

Another important point to discuss is how to transition to NDT from T4 only thyroid medications such as Levothyroxine. 

I previously mentioned that NDT contains both T4 and T3, while Levothyroxine contains only T4 and this difference doesn't make "converting" doses black and white. 

Instead, it may take some time to completely transition from Levothyroxine to NDT but your motto should be to "start low" and "go slow"

We can break NDT into T4 equivalents based on pituitary response to thyroid hormone to try and make the conversion process more simple (we know that T3 is 3x more powerful than T4 at lowering the TSH which will form the basis for our conversion): 

  • 1 grain of NDT (38mcg of T4 and 9 mcg of T3) = 38 + 9(3) = 65 of T4 equivalents
  • 2 grains of NDT (76 mcg of T4 and 18 mcg of T3) =  76 + 18(3) = 130 of T4 equivalents
  • 3 grains of NDT (114 mcg of T4 and 27 mcg of T3) = 114 + 27(3) = 195 of T4 equivalents

If you don't like math you can ignore the numbers and focus on the equivalent portion (I'm just showing my work!). 

Let's put this into practice:

If you were taking 100mcg of T4 and you wanted to switch to NDT then your dose would be somewhere between 1 grain and 2 grains of NDT (probably around 1.5 grains or 90mg). 

In this case, you can identify this as a potential goal when adjusting your dose or changing medication. 

It's not a perfect equation but it works as a starting point. 

When you should consider switching medications

It's important to state that not everyone will do well on NDT.

Some patients simply do not tolerate NDT and no amount of "forcing" the medication will help. 

Patients who do not tolerate NDT will present with one or more of the following symptoms:

  • Racing heart or palpitations
  • Jittery sensation
  • Increased fatigue
  • Headaches
  • Insomnia
  • Increase hair loss

If you experience these symptoms before reaching your optimal dosing (meaning your basal body temperature is still low, your lab tests are suboptimal or your heart rate is continually low) then you may not tolerate the T3 portion of the NDT combination. 

For patients who experience these symptoms you can try a slower titration or swap to a different "brand" of NDT which may help, but for some people, it may be a better option to stick to T4 only medications.  

Side effects to watch out for when using NDT

NDT tends to be well tolerated provided you find the right dose for your body. 

Normal side effects of insufficient doses tend to mimic hypothyroid symptoms while excessive doses tend to mimic the symptoms of hyperthyroidism. 

Side effects that may be specific to NDT medication include: 

  • Headache
  • Exacerbation of antithyroid antibodies
  • Palpitations or racing heart
  • Feeling anxious or nervous
  • Increase hair loss
  • Indigestion or stomach pain
  • Changes to bowel movements

The presence of these symptoms should prompt further work up to determine what the issue is. 

Do you need T3 in addition to your NDT?​

One of the potential downsides of using NDT is that the dosing of T4 and T3 is considered static. 

This is a downside because the total amount of T4 and T3 may need to be manipulated beyond the existing T4:T3 ratio present in NDT. 

Some individuals may need more T3 relative to T4 and vice versa. 

For those individuals who take NDT but still experience hypothyroid symptoms or who still have low serum levels of T3, they may need more T3 relative to T4. 

Using this combination allows for the benefits of NDT (instead of switching to compounded T4 + T3 preparations) while still increasing the amount of T3. 

T3 Only Thyroid Medication

PROS

  • The most potent thyroid medication. 
  • May be preferable in patients with obesity, insulin resistance, and leptin resistance
  • Bypasses T4 to T3 conversion in peripheral tissues. 
  • May be preferable in patients with low T3 syndrome and high reverse T3. 
  • Can be dosed individually and added to existing T4 doses. 

CONS

  • May increase blood pressure and increase heart rate. 
  • More easily suppresses the TSH compared to T4 only medications. 
  • Fewer brands available (only the brand name and generic). 
  • May need to be compounded for certain individuals which may increase cost. 
  • Short half-life of about 3 hours which means you may need dosing throughout the day. 

T3 only thyroid medications include medications such as Liothyronine and Cytomel. 

These thyroid medications are unique in that they contain only the active thyroid hormone T3 otherwise known as triiodothyronine. 

T3 is the biologically active thyroid hormone and, therefore, the most potent of all thyroid hormones. 

T3 is about 3-4x more potent when compared to T4 in its ability to suppress pituitary secretion of TSH (10) (this may be helpful in dosing). 

This hormone (T3) is normally secreted from your thyroid gland (some studies estimate about 20% of total thyroid hormone production may be T3 (11)) in small amounts and is also created at individual tissues through thyroid conversion. 

The point here is that under normal conditions your body is both naturally producing and creating T3 on a daily basis. 

The reason this is important is that in medicine we rarely use T3 even though it seems to be a natural part of thyroid physiology. 

Physicians tend to give preference to T4 medications because they are felt to have fewer side effects and considered to be more stable in the serum. 

One potential downside to this approach is that in the setting of poor peripheral thyroid conversion (which occurs in up to 15% of patients) is that they may experience low serum T3 levels and may, therefore, struggle with weight. 

Some studies (12) have shown that the serum concentration of free T3 and total T3 may determine how much weight you lose during diets and/or exercise regimens:

Patients with higher free T3 levels experience more weight loss than individuals with low t3

These studies show (13) that patients who have high total T3 and high free T3 lose up to twice as much weight during weight loss regimens than those with even normal and low serum T3/total T3 levels. 

This should foster even more attention and concern because further studies show (14) more than 20% of individuals on T4 only thyroid medications are unable to maintain free T3 and free T4 values in the "normal" reference range. 

Depending on your circumstances it may, therefore, make sense to add T3 to your existing dose of thyroid medication if you cannot maintain adequate serum T3/T4 levels and present with symptoms such as weight loss resistance and persistent hypothyroid symptoms. 

Dosing and Starting T3 Medication


Because T3 is the active thyroid metabolite in your body it's also the strongest form of thyroid medication. 

This means that dosing T3 is much different than traditional T4 thyroid medications. 

In general, a guiding rule of thumb should be to use low doses and titrate according to your TSH, total T3, and free T3. 

You don't want to needlessly suppress your TSH (15), but you do want your total T3 and free T3 in the medium to high end of the reference range. 

Following this guide should give you the best results while minimizing any negative side effects (16).

It can also be valuable to monitor two other factors while using T3 and those include your basal metabolic temperature and your resting heart rate. 

Both your basal body temperature and your resting heart rate can be used as a measure of metabolism and energy production in the body. 

T3 is known to have direct a action on cardiac myocytes (which can increase both your blood pressure and heart rate) and it may increase your body temperature through thermogenesis. 

You can track your basal body temperature by checking it in the morning. 

The use of T3 should increase your body temperature (provided it is low) and may follow a pattern similar to the patient below: 

Basal body temperature when hypothyroid

It may take several weeks for this to be noticed. 

You should also monitor your resting heart rate which can help guide your dosing and prevent excessive T3 dosing. 

As a general rule, you don't want your resting heart rate higher than 80-90. 

Your resting heart rate can be assessed each morning (first thing before you do anything else) with a basic monitor: 

Resting heart rate while on T3

Using thyroid serum lab markers along with your basal body temperature and resting heart rate can help guide your dosing and prevent unwanted side effects. 

What to expect when starting T3 medication

T3 thyroid hormone has both genomic and non-genomic effects

Genomic effects take place through genetic transcription and may take several weeks to manifest. 

On the other hand, non-genomic effects (17) may be felt almost immediately. 

Genomic effects include changes such as increased hair growth, weight loss, and increased body temperature

Non-genomic effects include changes such as anxiety, rapid heart rate, heart palpitations and a change in blood pressure

Non-genomic effects may be felt almost immediately while the non-genomic effects may take time to build up. 

Despite this, up to 20% of patients who take T3 may feel an immediate improvement in their symptoms ranging from an increase in energy to weight loss and decreased hair loss. 

​It may take up to 6-8 weeks for the effects of your current dose to kick in completely and for you to notice significant symptomatic improvement. 

If you don't experience symptomatic improvement within this time you can re-evaluate serum thyroid levels and determine if your dose is adequate. 

For those taking T3 for weight loss, you should notice an improvement in your weight in 1-2 months. 

For those taking T3 for insulin resistance, you should notice an improvement in glucose levels in 1-2 months. 

For those taking T3 with GLP-1 Agonists for Leptin resistance, you should notice weight loss in 1-2 months.

When you should consider switching medications

Like other forms of thyroid medication T3 may not be suited for your body. 

Some people may be extremely sensitive to changes in serum T3 levels which may result in characteristic symptoms that don't go away unless the medication is stopped.

Side effects from T3 only thyroid medication include

  • Headaches (most common)
  • Heart palpitations/racing heart (dose dependent)
  • Hair loss (usually temporary)
  • Insomnia (dose dependent)
  • Inability to exercise due to high resting heart rate (dose dependent)
  • Anxiety and/or jittery sensation
  • Weight gain (rare)
  • Rise in blood sugar (usually temporary)
  • Increase in blood pressure (dose dependent)

Many of these side effects may be temporary or reduce with changes to dosing. 

Do you need SR T3? ​

Another potential option for people who experience symptoms of T3 dosing may be to switch to a sustained release preparation of T3. 

This compounded medication helps to slow down the absorption of T3 in the gastrointestinal tract which limits the rise in serum T3 associated with immediate release formulations. 

Sometimes slowing down the absorption is enough to completely eliminate various symptoms. 

This is especially true for patients who experience the non-genomic effects of T3 such as heart palpitations (18) and a rapid heart rate. 

Slowing down absorption may cause a more stable heart rate and reduce or completely eliminate heart palpitations. 

T3 and Weight Loss

T3 is sometimes thought of (and even abused) as a traditional weight loss medication. 

This has to do with the ability of T3 to increase your metabolism and lead to weight loss even in individuals who don't have thyroid problems. 

T3 should NOT be used in this way and it is NOT a traditional weight loss medication. 

Abusing T3 in this way may lead to weight loss but may also have serious side effects along the way. 

Instead, T3 should be thought of as a thyroid medication which can indeed help certain hypothyroid patients lose weight if used thoughtfully and correctly. 

The use of T3 may increase your basal metabolic rate, increase the number of calories that you burn and directly burn fat cells. 

We've previously outlined that up to 20% of hypothyroid patients who take thyroid medication still have low serum T3 and total T3 levels. 

If you are a patient that fits into that category (even if you are already taking T4 thyroid medication with a normal TSH) then T3 may be a useful adjunct therapy to your existing thyroid regimen. 

In this case, it might also help with weight loss as well. 

You can read more about using T3 such as liothyronine and cytomel for weight loss here

T4 Only Thyroid Medication


PROS

  • Generally very well tolerated with few side effects. 
  • Comes in many different formulations and dosages.
  • Long half-life in the body which means that blood levels stay "consistent". 
  • Preferred medication for patients without conversion issues. 
  • Easy to get from a doctor.
  • Different thyroid medications (such as T3) can be added to an existing dose.
  • Easy to monitor through lab tests such as free T4 and TSH. 

CONS

  • Contains many fillers and dyes. 
  • Doesn't work well for patients with thyroid conversion issues. 
  • Does not contain the active thyroid hormone T3. 
  • May result in inaccurate TSH values that make dosing difficult for certain patients.  
  • May take 4-8 weeks before symptoms begin to resolve. 
  • "Cleaner" T4 medications such as Tirosint may be expensive but necessary. 

T4 only thyroid medications include Levothyroxine, Synthroid, and Tirosint. 

T4 only thyroid medications are considered to be the "first line" treatment for patients with hypothyroidism. 

What does that mean?

It means that your Doctor will almost always preferentially use T4 only medications if you have hypothyroidism. 

These medications are used frequently because they are felt to be safer, easier to dose and superior to other thyroid medications. 

Some of these claims are true and some may not be. 

It is true, for instance, that T4 only thyroid medication results in a more stable and sustained serum level of T4 due to their long half-life. 

It is also true that they are easier to dose than other medications and tend to have fewer side effects (but this isn't always true).

Individually these are not necessarily big issues unless you are a patient that doesn't fit the "standard therapy". 

As we've discussed there are several documented conditions that may limit the efficacy of T4 only thyroid medications such as genetic differences (19) and personal history of caloric restriction or excessive dieting (20).

In these situations, T4 only thyroid medications may fall short when compared to medications that contain T3. 

These problems tend to come from the experience and knowledge of your prescribing physician and have less to do with the medication itself. 

As a medication, T4 is a stable and high-quality thyroid medication, but like the others, it should be used only if it works best in your body and your system. 

Dosing and Starting T4 only Medication


Dosing and treating with T4 only thyroid medication is easier when compared to other thyroid medications. 

This has to do with the stability on the medication in your serum and its effects on pituitary and thus TSH secretion. 

Dosing with T4 is dependent upon your TSH and your free T4 levels in the serum

Like other medications, you should also be evaluating both total T3 and free T3. 

Checking these lab tests allow you to determine if the T4 you are taking in your medication is actively being converted to the active thyroid hormone T3. 

Let's consider 2 hypothetical examples to illustrate this point. 

Person #1:

This patient is taking 100cmg of Levothyroxine, has a normal TSH, normal total T3 and normal free T3

This patient has no symptoms of hypothyroidism and feels great. 

Person #2:

This patient is also on 100cmg of Levothyroxine with a normal TSH but this person also shows low serum free T3 and total T3 levels with a normal free T4

This patient also is experiencing hypothyroid symptoms such as fatigue, weight gain, cold extremities. 

We know simply based on these labs tests and symptoms there is an issue, but what exactly is the problem?

This is a common situation and it may point to an issue with thyroid conversion. 

Taking T4 by mouth (Levothyroxine in this case) should be absorbed into the body and turned into free T3 and total T3 in the serum. 

Low serum free T3 and total T3 may be an indicator that the body is NOT actively converting T4 into T3 and may be the cause of these symptoms. 

In this particular patient, it may be prudent to consider the addition of T3 medications such as Liothyronine or Cytomel to help boost these levels up. 

​What to Expect

If T4 works for your body then you will notice an improvement in symptoms within 1-4 months after starting the medication.

If you are taking Synthroid then make sure to check out these 10 tips which will help ensure that your medication is being absorbed and utilized by your body. 

I've found that T4 only medications tend to take longer to take effect when compared to medications that contain T3 and this is normal. 

If, however, you've been on T4 only medications for more than 6 months and have not noticed a difference in your symptoms then that's a good indication it may not be the right medication for you and you should check your serum lab studies and re-evaluate your thyroid replacement therapy regimen. 

When you should consider switching medications

​Patients should consider switching to NDT and/or T3 if they have any of the following signs or symptoms: 

  • Weight gain after taking levothyroxine or Synthroid
  • Increased Reverse T3 levels
  • Worsening symptoms of hypothyroidism
  • Increased hair loss (especially after starting T4 only medications)
  • TSH > 2 despite being on medication
  • Low Free T3 and low Free T4 levels despite being on medication

Thyroid Medication FAQ


Is one thyroid medication better than the others for weight loss?

Medications containing T3 (which means Armour thyroid, liothyronine, and Cytomel) may result in more weight loss when compared to T4 only thyroid medications such as Synthroid and Levothyroxine. 

This isn't always true, however, and people can still lose weight with medications such as Synthroid, provided they are using it correctly. 

In theory, provided you are using a sufficient amount of thyroid medication it should not matter which medication you use. 

Having said that it does seem that weight loss is improved while using T3 containing medication. 

Some of this can be realized with small changes such as adding T3 to your existing T4 medication dose or reducing the amount of T4 you take and adding T3. 

This can be accomplished without causing TSH suppression. 

When is the best time to take thyroid medication?

Most physicians and pharmacists recommend that you take your thyroid medication first thing in the morning and on an empty stomach. 

The idea here is that if you take your medication on an empty stomach then you will increase absorption by limiting competition. 

In theory, this works, but other studies have shown that taking your medication in the evening (21) may result in superior absorption of thyroid hormone. 

The proposed mechanism is secondary to a slower gastrointestinal tract which occurs naturally in the evening. 

You can read more about taking thyroid medication here

How should I take my thyroid medication?

For best results, you will want to take your thyroid medication on an empty stomach 4 hours after a meal. 

You should also wait several hours after taking your thyroid medication before you start eating, drinking coffee, etc. 

Some supplements may also bind to and limit the absorption of thyroid medication - especially supplements that contain iron or calcium. 

To prevent this issue you should not take any supplements at the same time you take your thyroid medication.

Is thyroid medication available over the counter?

T3 and T4 thyroid medications are available via prescription only in the United States. 

T2 can be purchased as an over the counter supplement, however. 

In some countries, you can purchase thyroid medication over the counter, but most will require a physician prescription. 

You can learn more about certain supplements which are available over the counter and which may indirectly improve thyroid function here

Is it safe to take thyroid medication while pregnant?

Yes, provided you are being dosed correctly. 

Thyroid medication should be taken if prescribed to you during pregnancy. 

Adequate thyroid hormone is required for fetal brain development and is critical to normal development. 

During pregnancy, your thyroid should be evaluated every 6-8 weeks to ensure that you have sufficient thyroid hormone in the serum. 

It's also important to know that the demand for thyroid hormone increases during pregnancy (22) which means you will need a higher dose of thyroid hormone for both you and your baby. 

Why do I still have symptoms if I'm taking thyroid medication?

The traditional thought process for treating thyroid hormone focuses solely on the TSH as a marker of thyroid status in the body. 

Newer studies show that certain individuals may have problems that limit the value of the TSH as a marker of thyroid status for the entire body. 

Individuals who have issues with peripheral thyroid conversion, low serum T3 levels, Hashimoto's thyroiditis and so on may fall into this category. 

It is not normal to experience hypothyroid symptoms despite being on thyroid medication and should be a warning sign to look deeper. 

You can learn more about how to properly evaluate thyroid function here

Can I stop taking my thyroid medication if it's not working for me?

It is not a good idea to stop taking your thyroid medication without physician supervision. 

Thyroid hormone is required for life and a complete deficiency leads to coma and potentially death. 

If you were diagnosed with hypothyroidism and given thyroid medication then it is because it was felt that you needed thyroid hormone. 

Please consult with your physician before altering your thyroid dose. 

How come I'm gaining weight while taking my thyroid medication? 

In some cases, you may not be able to adequate convert T4 into T3. 

In these cases, it may be the case that your T4 is instead converting to an inactive metabolite known as reverse T3

If this occurs it may paradoxically slow down your metabolism and lead to weight gain.

You can read more about this process here

It is also possible that even though you are taking thyroid hormone that your dose is insufficient. 

If your body needs 100mcg of T4 but you are only taking 50mcg per day then you are at a deficient of 50mcg per day in which case you might also experience weight gain.  

For these reasons, it's very important that you monitor serum thyroid markers and evaluate the thyroid conversion process. 

The Bottom Line

Finding the right type and dose of thyroid medication for your body will help you to feel normal, lose weight and regain your energy. 

Finding this information should be the result of evaluating your serum lab tests, testing your body with various thyroid medications all while monitoring your symptoms. 

This approach will allow you to find the correct dose while limiting negative side effects which can be associated with excessive thyroid dosing. 

And now... having said all of that...

Now I want to hear from you

What medications have you tried? What has worked, what hasn't?

Leave a comment below and I will respond!​

References (Click to Expand)

This post was most recently updated on February 5th, 2019

Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders.He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances.You can read more about his own personal journey here.

130 thoughts on “Thyroid Medication: Levothyroxine vs NDT vs T3 – Which is Best?”

  1. I had a Total thyroidectomy in September 2013 due to cancer. Was on Synthroid for little over a year. Had brain fog and major fatigue that cost me my job. Doctor wouldn’t add cytomel back. I begged to be switched to NDT. Finally got Naturethroid. The dose is 87.25 2 1/2 times a day. Been on sonce January 2015. It’s like I feel ok in short spurts. I’m 37, 5’4, weigh 250. I’m having trouble finding a new doctor that will help that takes my insurance. This guy said well your numbers are a mess, see you in 6 months.

    I feel like I fit into the T3 category based on your article but can take T3 only without s thyroid?

    • Hey Emily,

      After a thyroidectomy I wouldn’t proceed straight to T3 only. In my patients I will either wean down the synthroid to a lower dose while increasing T3 or simply add T3 to NDT in higher doses.

  2. I started on t4 only medication and put on 10 kilos instantly. I felt worse and worse as time went by. I increased and increased and it would not make me feel better. Eventually I felt like I was dying slowly, I slept all day, was only able to work part time, could no longer think straight and my heart and blood pressure was affected. My heart rate was 200npm
    While resting , 2 abnormal ECGs , arrhythmia with A&e visits and really really low blood pressure! It didn’t make sense. My blood pressure was 80/54 at one point with a 200bpm.
    I was sent for heart studies and no one knew what was wrong. I begged for liothyronine but my end on the NHS refused. I ended up going private abs was diagnosed with thyroidtoxicosis, severe hashimotos abs hypoadrenia. I was only 24. Turned out that the t4 medication was pooling in my blood affecting my heart but not getting to my other organs. I was not absorbing it properly. I was put on T3 only and started taking adrenal dynamite by dr Wilson. Immediately my heart rate decreased and stabilised and my blood pressure increased and stabilised.
    I still take naps in the afternoons, mornings are a big struggle and I cannot exercise more than walking twice a week. I feel better than on t4 but not well enough to enjoy my life yet or get to work on time or stay at work without taking dats for sick leave. Would NDT help me more than the T3 only?

    • Hey Elaine,

      It’s impossible to say just by that history. It’s certainly possible, but you might also have other issues going on that are unrelated to your thyroid causing many of your symptoms.

  3. I started on NDT with my PCP. Started feeling really good. I thought, wow, if I feel this good maybe I should find a specialist and feel fantastic! Found an Endo, he took me off NDT and put me on Levothyroxine. I progressively felt horrible, the way I felt before I was diagnosed with Hashimoto’s. The “specialist” would not budge in putting me back on NDT, and instead kept increasing my dosage on Levo. I felt worse and worse. So I quit taking it and fired him. Went back to my PCP and back on NDT. I feel relatively well. I cannot lose weight to save my life, not even going full on AIP diet/gluten free, etc. I stay within the same 5 lbs, whether I diet or not. Not sure what the key to losing weight will be for me. I do exercise at least 3 times per week, 30 mins on an eliptical. Any advice?

    • Hey Lillian,

      Typically the thyroid only accounts for a small percentage (10-20 pounds) of weight gain. Make sure to look at other hormone imbalance like: leptin, insulin, testosterone, progesterone, estrogen and cortisol.

  4. Dear Dr, Childs,

    It is such apleasure to see and know that you are out there and get this complicated issue of thyroid meds!! So wish you could be my local doctor!! Anyhow I have been on Armour thyroid at 60 mgs for two years now started at 15 for a couple weeks then up to 30 then to 60 so it has been about 3 to 4 yrs medicated but I have been on lots of supplements ne of the best was Dr Bond’s Thyroid Complete which was difficult to get so then I tried Womens Health Network T Balance Gaia Herbs Thyroid Support which i still take and then many other vitamin and nutrient supplements which have worked wonders on almost all symptoms though very little for my stubborn weight no matter how hard I work at it and do weight training and Pilates or HIIT or walking biking etc etc, Tried gluten gree trial and no dairy but finding that challenging – tried no coffee do better without coffee – it is just so individual and complex. I believ I hovered with hypothyroidism since my teen yers and had my wisdom teeth out at 17 yrs now at 49 am struggling to be thin and have good muscle tone ebven with doing weight training and very active lifestyle. After many emotional trials of loved ones passing and in dire circumstances I could literally feel I was in constant fight or flight adrenal fatigue tho general practioners could never explain understand or pinpoint my issues and did the classic insulting regimen of telling me to eat less exercise mopre and nsinuated i wasnt honest to the them and myself about my meeger food intake. I do feel better and several symptoms have left on my expensive regimen but I was thingking maybe I would lose weight finally if I combined Armour with Cytomel? scared to do it if could even get my doctor to prescribe – miracle I got the Armour he wanted synthroid but it never worked for my sister or brother anfd now they are on cytomel; which did help them thin out more. I hate being overweight as do my loved ones and i hate being judged for it when it is not my fault and I pray there is an answer for me. Should I try Chirothin or what holds all the the weight on? I am 5 2 and should be slim but am at over 170 lbs I don’t look huge but I don’t ever look slim or how I want to and work for . Am I needing just a bit of T3 or is this weight with me forever because i am entering the age of menopause? other women are thin even my almost 80 yr old mother in law! HELP1

    • Hey Janine,

      Adding T3 might help you lose a few pounds, but it probably won’t help tremendously. Most hypothyroid patients have 1 or more hormone imbalances that really lead to the weight issues that they struggle with, I would recommend checking the following: leptin, insulin and testosterone in your situation.

  5. I am on 90mg NDT and 25mcg of T3 at lunch and 25mcg of T3 late afternoon.
    I was on Levo for over 22 years and felt worse and worse. Beginning of 2015 I switched to NDT did better first then felt worse. My RT3 went very high and t3 was still not really optimal. Then we reduced NDT to 90mg and added t3, 12.5mcg at lunch and 25mcg at late pm.
    This seemed to work, but I still felt having some hypothyroidism symptoms. My recent blood counts showed that my free t4 is in the medium range and my free t3 is upper medium range – which means not in those 25% of the upper range I have read somewhere to be optimal. (Sorry don’t have the exact numbers yet because I am traveling). I was wondering if this may cause my hyposymptoms?
    I upped the t3 now to 25mcg twice a day (lunchtime and late pm) and kept the NDT as it was (90mg). This was two weeks ago, I feel much better now, more energy, no palpitations or anything. Is this dose ok?
    My TSH was totally suppressed since I started on NDT,. Now I lead that this is very bad. I am concerned, the doses I feel good at seems to be too high to what is on the Internet. I have only half a thyroid left due to surgery. Do you do online consultations? Thank you so much for advice.

    • Hey Heike,

      Your dose will depend on many variables including how you feel on it, how high your resting heart rate is, what your body temp is at and what your labs show. TSH suppression is overlooked by many practitioners who simply increase thyroid dosing if patients don’t feel better – usually in these situations the problem is unrelated to the thyroid.

  6. Fatigue starting in 2009 at age 29.
    Had a baby in 2012 at age 33. Had horrible feet, knee and hand relative arthritis.
    Was diagnosed with Hashimoto’s in 2013 at age 34. All labs done showed within “normal” range but I noticed my TSH fluctuates between 1.2 and has been as high as 3.5.
    Was prescribed Wellbutirn for fatigue and back and hip pain, (probably caused by abdominal separation) as well as ADD (inattentive) has worked wonders but as you know it increases resting heart rate.
    Have a history of palpitations but did not increase on Wellbutrin.
    Was prescribed .025 mg of Synthroid in May. Now age 37. Stopped it 1.5 weeks ago.
    Did not like side effects. Disrupted menstral cycle and started having tingling and numbness in hands and feet.
    Side effects went away within 72 hours of stopping.
    I can’t seem to get any help of value. I’m desperate. Do you see patients? I’ll fly. I just don’t know what to do. Even looking at stem cell therapy.

    • Also, had bladder spasms on Synthroid. Never had them in my life and they stopped when I stopped the medicine.

  7. I am in Canada & was put on a natural prescription by my Naturopath, “Thyroid Hormone” as he said it would balance all my hormones. I have done pretty well compared to some of the stories I’ve read. I lead a fairly natural lifestyle, take necessary supplements, avoid foods that depress my Thyroid, its a bit hard to lose weight as I don’t follow the trend of low fat dieting, never have. Have lost about 27 lbs., in the last few years, got stuck at a baseline of 175 lb., & since I started the “Leaky Gut” program have got my baseline down to 170 lbs., still want to lose more, but in no rush. my problems are swollen feet & ankles, so avoid salt except for a wee bit in my bedtime OJ with salt as it really helps to get a better nights sleep. I do use some Homeopathic & Natural supplements to help. People don’t believe I am 83, my mind is very sharp, do have to work at building my strength.

    • Hey Babs,

      Good for you! The fact that your body is receptive to weight loss is a huge deal and it means you will be able to ultimately lose more weight.

  8. I am 66 and had my thyroid almost totally removed at 21. My dr is rather old school and I’ve been on synthroid only most of that time. 4 years ago we started 10 mcg of generic cytomel AM PM. Along with 100 mcg synthroid. I noticed a bit of improvement but not significant. What I have noticed is a huge increase in heat intolerance and excessive sweating even when it isn’t that warm. My labs are barely in the low normal range. He took me off the T3 a week ago to see if it would help the heat issue. It seems to be slightly better but fatigue worse. He only changed the synthroid to 8 pills a week of 100 mcg.
    What is your opinion? I’d also like to try LDN. Do you ever use this? I really learned a lot from this article and wish I could see you as my Dr.
    Thanks
    Robin

    • Hey Robin,

      Yes, I use LDN frequently. In your case it sounds like you need to consider NDT and/or SR T3.

  9. Thank you Dr Childs for such a helpful article! I’ve tried all of the above over the last 20 years and always end up back on thyroxine (must be one of the few)! Anyway I have a fabulous holistic Dr here in Australia who we’ve done a whole lot of (continued) trial and error over the last 10 years, it’s such a journey. At the moment I’m on a supplement to reduce cellular inflammation which is reducing my anti body levels and the hope it to be able to try the NDT/T3 again. I just wanted to thank you for laying out the options so clearly. Annabel

  10. Dr. Childs you are amazing! Thank you for that tip on the other hormones possibly being unbalanced- thought so but not sure how to get physician to help with that. Pricey too if I can even find one in my area who will look at hormone levels probably not ever covered by insurance certainly either. But would progesterone cream work? Alot of women say that helps but it scares me to do it solo without medical help. Thank you for your advice. Great site and that you truly help others and if I am in the area in Arizona or plan to be I will try to go to your office one day. Many thanks again.

    • Hey Janine,

      Most women can benefit from taking progesterone (especially after age 35), the degree of improvement in the patient depends on how deficient they are and how big of a factor estrogen levels play in their disease.

  11. Dr Childs, there is a lot in this article that is great information. However, I’ve seen first hand in thyroid support groups the consequences of doctors treating thyroid patients transitioning from T4 to NDT by using high doses of NDT in some form of equivalent dose reasoning.It usually ends with the patient in crisis, showing symptoms of overdose and placing great strain on their system. Based on the experience on hundreds and thousands of patients in these groups over the years, going from a dose of as you suggest 150 T4 to 2- 3 grains NDT is dangerous as the body is often overwhelmed with the effects of such a large dose of direct T3 and the patient will suffer the side effects you talk about in your article and more.
    It’s great that you are a doctor who believes there is more to thyroid treatment than just taking a T4 med and getting on with it, but I would also urge readers to proceed with caution with dosing, patient experience has a lot going for it and patients have found beginning dosing at 1 grain split dosed and titrating up from there every 10-14 days, no matter what dose T4 they are on the safest way to go. This is especially true if there are existing issues with cortisol, iron, inflammation etc as is often the case with thyroid patients.

  12. Hi, I’m up to 5 grains of Naturethroid. Although I felt just a tiny bit better the first couple of weeks, I do not feel better at all. In fact, I may feel even worse, I.e.: more tired and more insomnia. I haven’t taken my temperature. How do I take a basal temperature? What should I do next?

    Feeling desperate,
    Carin

    • Hey Carin,

      Your symptoms may not all be thyroid related, you need to get a full evaluation and check other hormone levels/nutrient levels/etc. It’s also possible that NDT isn’t the best medication for you.

  13. I have been on a t3 since I was 14 (12yrs) and all of my blood work are saying my levels are within normal range and everything ‘should’ be fine but in the last few years the symptoms that should no longer be present are quite severe and I have yet to find a doctor willing to push further into it 🙁

  14. Hi Dr. Childs,
    Momentarily I’m on 150 mcg of Thyrax (levothyroxine) and 60 mg of Thyreoidium (a form of NDT). It seems like I have finally found the right dosage for me. It has been a long process… First finding the right person to help me, and then finding the right dose and how to take it, but it has been worth it. I do feel a lot better than I used to, still not 100%, but maybe that’s not possible. Looking into my medical and personal history I started having symptoms when I was about twelve years old, but only got diagnosed properly when I was thirty. I have been on t4 meds for about fourteen years. Felt great in the beginning, but started having symptoms again within a couple of years. The symptoms grew worse but all doctors were reluctant in prescribing t3 or NDT, untill I moved country and finally found myself one who was willing to help me. This was a year and a half ago. Besides all the physical changes for the better I’m extremely happy my brain has started working again! I’m not sure how much of me feeling better is due to the AIP diet, but that doesn’t really matter, does it 😉
    Kind regards,
    Inge (from The Netherlands)

  15. When you say to test leptin, testosterone and insulin resistance, what are the specific tests I should ask my doctor for? I fit into the category of feeling about 80% better on NDT, but CANNOT get rid of 15-20 pounds no matter what I do. I wonder if adding T3 might be what I need but am assuming it would be good to check those other things. When I first started on thyroid medication and BHRT about 6 years ago 25 pound came off like magic. Then it slowly crept back in spite of clean eating, exercise and a healthy lifestyle. I do BHRT so most hormones are checked. But something is missing. So I would like to test the leptin and insulin resistance. Thanks for any info you can give me.

  16. As someone who is seriously sensitive to many things, including medications, supplements, foods, etc. Even reacted to homeopathy, you are the first one I have come across who recognizes and acknowledges this in people. I can so appreciate that. Do you treat the thyroid without putting people on some sort of thyroid medication or do you believe balance can be regained without it by balancing the body in other areas such as leaky gut, stress, toxicities, viruses? I have been told I have hashimoto but want to get to the bottom of why and return my body to balance.

    • Hey Kelli,

      I’m glad you appreciate it and thank you for the kind words! It really depends on the person, some benefit from thyroid hormone and others don’t necessarily need it.

  17. Hello

    Quick question on testing leptin, insulin, testosterone, are there others if still contending with weight issues on NDT and T3? Is blood the best test or saliva, urine?

    Thanks

  18. hello dr. childs,

    i had total thyroidectomy last dec. 2015. my biopsy showed papillary thyroid cancer and hashimoto.

    i’m currently taking my levothyroxine (150 mg).

    i’m overweight. i still experience muscle pains and depression. i am very irritable and i easily get tired. sleeping before 10am is still a challenge even if i feel so tired.

    what other blood test should i take to let me know what other medication or treatments i should undergo. so far my doctors here are just making me do the tsh blood test and they keep on saying it is normal therefore i’m “okay.”

    i feel my condition is so frustrating. after all the treatment and operation i thought i will recover some of my sanity and lose some of the lousy things i feel. there are days that i feel normal but most of the time life is a challenge. i miss my happy and bubbly self.

    but i’m really hopeful that the cure and medical help is out there. website and blogs like these are really helpful.

    may God bless you more for this good work that you are doing for people with thyroid disorder.

  19. Dear Dr. Westin,

    Thanks for sharing this list.

    I only found out in march that I have Hashimotos. And Got Erfa Thyroid from a private doctor. I dont know My reverse T3, but TSH (2,9) free T3, and T4 are within normal
    Range. I cant take more than 30 mg Then I get too High temperature, and more extra Heart beats ( Thoose I also had before taking Erfa) When I first started I felt less pain, and more energy, but now its minimum as bad as it was when I started feeling sick a year ago. Even with 45 mg My temperature gets too High.. Should I considder RT3?

    Till I read this list of yours I thougt to heal My gut/stress and Then see if I felt better or Would be able to raise the dose.

    I just started LDN to help the pains.. But heard My candida should be under control first and it isnt… Actually it helped a bit.. But now I AM Working on the gut..

    Should I keep up this and/or considder RT3?

    Thanks again for your effort 🙂
    Best regards Emily

  20. Hello, Dr. Westin Childs,
    I’m from Finland so the medicins are different here, but I started with t4 medication in 2012, then Armour Thyroid, then T3 + T4 together, with more T4 I got worse all the time. Then only Armour for awhile. My T3 and T4 levels have been low all the time. Now I have been in T3 only since last autumn and my T3 level won’t raise. I have metabolic syndrome, depression, high blood pressure, insuline resistence/diabetes. Those I have managed to handle with diet. I take estradiol and progesteron for the symptoms of menopause that I have had for 7 years. I haven’t been sleeping well for these years for those symptoms. I currently can’t work because of my illness. So… I cannot take enough T3 medication to get rid of hypothyroidism symptoms because it causes heart problems. Body temperature is low. RT3 I don’t have. Cortisol levels ok, fast I have had very much stress for years. I have a good doctor, but she does not understand my condition although we have tried everything.

    • Hey Raija,

      Before you play with other medications/hormones make sure you have addressed the 4 main lifestyle factors: sleep, stress, diet and exercise. If you don’t have a solid foundation it doesn’t really matter what else you do.

  21. After reading your article that spells out which med is best, I am confused. Since I just switched from Synthroid 100 mcg and 5 mcg T3 to Naturethroid about 3 weeks ago, I am having fatigue, sweating on and off, foggy brain, and some insomnia. I’m taking 1/2 + 1/4 grain 2x/day. Is it too much for a 58 year old, or not enough after being on Synthroid for 9 years? Do I wait for my labs (in 2 weeks) or figure out now whether I have adrenal issues (which are low in the morning)? Do I order adrenal supplement? Please advise. Thank you!

  22. Will being on higher doses of T3 say 100-150 mcgs a day raise insulin and blood sugars or is it that I just have insulin resistance now ?

    Thanks

  23. Hello Dr. Childs,
    Thank you for the informative article! My daughter is 11 and has been on levothyroxine since diagnosis two years ago with a tsh of over 560… Yes, 560. She has gone from 50mcg to now 150mcg. However, she is still tired, has low blood pressure and very sensitive feet. Now her tsh is back up to 25.3 and has gained over 10 lbs in the last 6 months. What would you recommend… when her dr gets back from vacation next week I am guessing he will simply up her to 175mcg.
    Thank you for opening my eyes to other options for my daughter!

    • Hey Lisa,

      Some genetic mutations cause thyroid resistance which basically makes T4 medication useless at suppressing the TSH. It sounds like you may want to check your daughter. Even endocrinologists are aware of this condition, it is just very rare. The treatment for which is T3 to suppress the TSH.

  24. Thank you so much for “spelling this out” — in almost 15 years since my diagnosis I have NOT seen anyting presented this way. I was on Synthroid for the first 7 years after being diagnosed with Graves Disease and subsequently receiving Radioactive Iodine in 2002 at 19. In those 7 years I can remember ONE stretch of time where I felt like a “normal kid” — but mostly, it was the reverse of that. In 2009, I started taking a pro-active stance in my healthcare and started researching on my own — THIS is wen I found out about NDT. It took a while to find a Dr who would even CONSIDER putting me on it, but finally my GP did as they knew my long-term struggle with needing to feel better and not finding doctors who would go beyond just Synthroid. I felt GREAT on NDT!! I lost weight, my braing fog cleared, I had legitimate energy to go out out with friends and focus on my school work.

    However, in 2011 my anxiety decided to peak (keep in mind Ive also been through a loss of a younger sister in 2004, a terrible relationship, and two car accidents all nearly on top of one another leading up to 2011.) and my blood pressure decided to leap as well (something that happaned to my father when he hit 30 as well) — and a new endocrinologist immediately took me off NDT without discussing what I might be up against off of NDT. She prescribed Tirosint and “sold” me on it being easier for my system to digest. What she didn’t include is that in 2013 and 2015 my weight would skyrocket (2013 say about 15-20 lbs. Although I hit almost 40 lbs from where I started pre-tirosint), and I’d once again be slammed with extreme fatigue, body aches, brain fog, and total depletion of energy.

    Late 2015, I convinced that endo’s replacement to AT LEAST give my Cytomel w/ the Tirosint because in 3 years I had tried EVERYTHING they recommended. I went GF for months, saw no improvement. I excercised as much as I could, saw no improvement. I played by their rules, at the diets they recommended — and, NOTHING.

    Adding Cytomel has helped quite a bit — but in 6 months, I still haven’t seen much weight loss even though I’m eating much better and we got a dog so I’m now on multiple walks a day with her. The more I read your site and Thyroid Healthy by Suzy Cohen I wonder if I should try simply being on T3, even if just for a short time period. OR, simply go back on NDT. I’m at a loss, really…but feel like I have never done well on T4 in almost any capacity.

    • Hey Casie,

      To be completely honest you are probably not going to lose a significant amount of weight even if you went on T3 only. I have plenty of articles on the site about how to lose weight with hypothyroidism and most people bounce around from medication to medication thinking it will work and it usually doesn’t. The vast majority of the time the weight loss resistance is from some other hormone imbalance, not the thyroid.

  25. I started WP Thyroid (from levo for 2 years) in April at one grain, just increased to 1-1/2 3 weeks ago. My present doc had me take temps for 5 days, just before rising and at noon. The first temps ranged from high 96’s to low 97’s, and the noon readings didn’t get above 97.4. He said based on my labs to keep at the present dose, and that it may take time to get my temps up. Is that true in your experience, or should I be upping the dose? I need to lose about 30 lbs. and am going to be testing hormones and other things soon. (I’m 61.)

    • Hey Jan,

      Yes, temp increases can certainly be delayed but in addition multiple other variables can influence your basal body temp. It’s never a good idea to dose based off of body temp alone for these reasons.

  26. Dr. Childs,
    I was on synthroid for 10 years and did fairly well on it despite weight gain. Then I was noticing fatigue and brainfog and wanted to try armour. I was on a very small dose (16mcg) for about 4 months while decreasing my synthroid. Then when my dr upped the armour he overmeddicated me and I had horrible anxiety and a whole list of other issues. Since then ive tried naturthroid and cytomel but everytime I try anything with t3 I get horrible anxiety, depression, and flu like symptoms. Im now back on t4 only (levoxyl) and feeling horrible. I have anxiety issues and debilitating brain fog. All my symptoms are worse the week before and of my cycle. Do you have any advise to how I can get back to a normal? This has been going on for 2 years now. Thank you.

    • Hey Ashly,

      Unfortunately most people ignore everything BUT the thyroid. You need to have all of your nutrients evaluated, adrenals and other hormones checked and if you treat those you should be able to tolerate the amount of medication necessary to feel better.

  27. I’ve tried all the medications for my thyroid it seems that nothing works for me I’m a retired nurse and lost my husband of 49years two months it seems like nothing works for I’m now on thyroid medicine that contains iodine I research every thing about adrenal glands and the thyroid

  28. Dr Child’s , I just returned from seeing my .Engrognolist . He tells me that I’am hydro. Mt TSH level is .10 t3 is 126 t4 is .99 . The radioactive test show the thyroid is producing the hormone instead of my body. He will check my levels again in 4 months . Is there anything there that you can help me get it working again . I can’t lose weight . He said it doesn’t have anything to do with the thyroid . It doesn’t make you gain weight. My levels in May for the TSH WERE .01 t3 was 192 and t4 was 129 . Not sure what changed it. That’s why he says we’ll wait and check them again in 4 months. Other wise he was giving me three options . Surgery. Radioactive pill or try with a small dose of a thyroid pill to try and raise my levels . I don’t have too many symptoms except being tired and can’t lose weight.

    Please any advise will be helpful or can I be helped.. If you answer this please send to my email . Thank you ..

    • Hey Marilyn,

      Dsyregulation of the thyroid can definitely lead to weight gain, what is causing weight gain in your body needs to be evaluated further.

  29. Can you give me some input I have been on NDT for 4 years starting my dose at 1grain and going all the way up to 3 grains over the years. The issue is the only thing that changes is my TSH that goes down but t3 and t4 stay at the bottom of the lab range even if I’m on 1 grain or 3 grains. I don’t have hashi. Do you think my body just cannot convert the natural meds I want to add in my dr had me take them sublingually too to see if that helped but numbers never changed.

  30. Fibro patient- tested positive for hashimotos but rhuemotologist says no need to treat because thyroid function tests normal. Been diagnosed in past with sjogrens that is not showing active, I take b-2 injections monthly for Pernicious Anemia, as well as other supplements. I deal with peripheral neuropathy as well as adrenal fatigue. Not on any meds… it does not make sense to me to ignore the positive for thyroid autoimmune,does it? Should I pursue some kind of treatment for this? Maybe it would help my fibro issues? I so appreciate your article!

    • Hey Tami,

      In my opinion it would be worth evaluating thyroid function because it does have the potential to improve some of your other issues as well. However, getting the right treatment is easier said than done.

  31. Hello my question is did Erfa fix the problem they had in 2014 and is it back to being like old formulation Armour? I can’t take anything it seems because of fillers since Armour was bought by Activis. Tried all others and have side effects dizzines back and feet pain etc. Thank you. Please reply to my email.

    • Hey Terri,

      Sorry I don’t know if they change/reverted the formula on armour thyroid specifically. With so many options in terms of other NDT medications and compounded formulations of T4/T3 it’s usually better to use a combination of lab tests + trial and error to find the prefect combination.

  32. I have recently switched from Armor to Nature and I experienced a large amount of hair loss. It seems to have rectified itself and I have lots of new growth. Could this have been a result of the switch? Also,why does my Nature medication stick together after a few weeks of having it in the prescription bottle? It seems to change color too. Is it still good at this pint?

  33. I just found this site and all I can say is…wow!!! I have learned more in the past 10 minutes than in the 17 years since I was diagnosed with hypothyroidism (Hashimoto’s).

    I live in a European country where, fortunately, there are Barnes doctors prescribing NDT. I have been on NDT since late 2011, with varying results to be honest. I started on Armour which has had some issues since it was reformulated in 2009. I was later switched to Erfa around the time it too was reported to have some problems (I first found out about this on the STTM website). Neither works optimally for me, so I am now looking into buying NDT from Thailand. There are three brands (Thyroid-S, Thiroyd, and TR TMan), and they have all been getting consistently excellent reviews by users. Also, Thai NDT is incredibly cheap compared to Armour and Erfa…especially Armour which has tripled in price in the past year or so.

    Do you have any experience with Thai NDT? Is that something you feel comfortable recommending? Input from anyone else would also be greatly appreciated:-)

  34. Hello!

    I have a problem that I’ve never seen addressed. I take 50 mg. of Levoxyl but my TSH always registers too high. But whenever my dose is increased,(to 75) I feel terribly jittery. Since I also experience the occasional episode of SVT, (at any dose) I’m afraid to raise the dose again. It seems like NDT or T3 would only make this worse. Do you think it may be a case of my body not converting the t4 into t3? Or the receptor cells not absorbing the hormone? I’ve had Hashimoto’s for 10 years and have yet to get it under control. (I’m gluten free with a pretty clean diet and take a high quality daily probiotic to keep my gut healthy.)

    Thanks so much for reading my post and I hope to hear from you!
    Carol

    • Hi Carol,

      You may be someone that has absolutely no problem converting T4 to T3 in the serum. The best way to evaluate this is to look at your Total T3, free T3, Reverse T3 and TSH.

  35. Dr Childs,

    I would like to ask you if you have come across patients needing very high doses of NDT? I have been on 7 grains of Thai NDT drug Thyroid-S for the past six months, and recent labs showed FT4 levels at bottom of range and midrange FT3 levels. TSH completely suppressed but irrelevant when on NDT as far as I know. So it seems I could take benefit from increasing the dose.

    It is often said that nobody “should” need more than 5 grains a day, with most patients ending up needing 1.5-3 grains daily. That wuold not be enough to keep me functional…do you have a theory as to why some people (like me) seem to need much more NDT (or other thyroid drugs; before switching to NDT, I was on 300 mcg of T4 daily)? than the average hypothyroid patient…?

  36. I was diagnosed with Hashimotos three months ago, have low body weight, 47 kilos, and was put on 25mgs per day of Levoxyl. My bloods a month ago showed tsh had reduced but my symptoms remain the same if not worse. These are severe constipation, painful thumb joints, wrists, and particularly mental tiredness. I appreciate it will take months for my thinning hair and disintegrating nails to recover. I live and work in the Middle East where natural types of thyroxine don’t seem to be considered or available. Having never visited a GP for the last 20 years I feel desperate for a medic to actually listen to me. I have always had a good diet but now have excluded all gluten, take probiotics and mostly eat lean meat, oily fish, fruit, veg and nuts. I only drink green tea and water. Initially mt vit D levels were very low but ok now as are all vit and minerals. I tested negative for gluten intolerance. I have moved on from my GP to an endocrinologist who I see next week. Any advice would be welcome. Many thanks, Brenda.

  37. I was recently diagnoses hypothyroid and started on 1/2 Grain NDT (Armour) daily a few days ago and feel increased fatigue. Is it too early to think about switching to T4 Only medication? I see you recommend trying a different brand of NDT also. I’m surprised increased fatigue can be caused by NDT…

  38. Hello Dr. Childs,
    I was recently diagnosed with hypothyroidism. My TSH is at 7.29 (in July), with normal T4 (1) The only clear symptoms I am experiencing is hair loss which has increased in the last 6-8 months. I do have some fatigue and not so great memory, but I am not sure if it is actually worsened recently and is related to hypothyroidism directly. I will be really thankful if you could help me with some related questions I have:
    1. I have heard, the most common symptoms is weight gain. I have actually lost around 5-7 pounds in the last 6 months. Have you heard of any patients losing weight after being diagnosed with hypothyroidism?
    2. My doctor has prescribed Levothyroxine 25 mcg and I haven’t started taking the medication yet. I keep thinking that once I start the medicine, there is no going back. My body will get used to getting something unnatural and may create more problems than solving. Are there any other natural methods to get the hormone working right- like exercise? I have a pretty healthy diet I think, but can be made better?
    3. I have read that some doctors don’t treat sub-clinical hypothyroidism. Will mine not fall into that category? How can I know whether I need treatment or not?
    4. Can i break the 25mcg medicine and take half the pill to see if gets me desired results in 3-4 months?
    5. I am afraid that I might lose weight. I think my weight is good for my height (122 lbs for 5’4″) and losing more weight may not be healthy for me.
    6. In my case is it better to start NDT. if yes, then how do I respectfully recommend this to my doctor?
    7. If I do start the medicine (12.5 mcg by breaking it or 25 mcg), what should be watch-outs in terms of side-effects.

    Please let me know anything that might be good info in my case.

    thanks so much!!!!

  39. I am taking synthroid and armour. Levels are “optimal” range but antibodies are 28, reverse t3 24., and sex hormone is 37. I’m experiencing weight gain and inches and have brain fog. I do HIIT training 5 days a week and run 1-2 miles and my diet is basically healthy 75% of the time.

  40. Hi! I’ve been diagnosed with Hashimotos thyroid disorder for about 5 years now. My endocrinologist put me on Armour and my neck ended up feeling bruised and sore and it was difficult to swallow. My endocrinologist didn’t test for antibodies so I decided to try a functional integrative medicine doctor here in Boise. I had been on a compound T4 T3 SR 90 mcg Levothroxine 10 mcg T3 for awhile and then after a year
    I started to get maybe a beating in my stomach that was
    really strong. She took me off the T3 and put me on straight Levothroxine 50mcg. When I was on Levothroxine 50 mcg I started having all kinds of problems. Hair shedding and a lot of hair loss, anxiey or something like it maybe adrenaline. I couldn’t sleep and still can’t sleep, weight gain 10 pounds and digestive issues. My labs are a normal TSH but my my body is not converting T4 to T3. What should I do? My doctor has me on a compound T4 T3 90 mcg Levo and 5 mcg T3 but my systems have not changed. My hair is still falling out, I can’t sleep and seem to have adrenaline running through my body all day and my digestive tract is sluggish and slow. I don’t think my medicine is working so if I tried an NDT would it help me? I wasn’t sure because my body is not converting T4 To T3. My doctor now said that pig thyroid can effect people with hashimotos and I wanted to get your thoughts on that? Will my antibodies start attacking my thyroid with NDT? I have a pretty healthy diet, excercise and take multivitamins so I just need some help with deciding what medicine to do because I feel like my body is still hashimotos on medication. Any help would be appreciated!

  41. My thyroid test results 18 months ago (on 26-02-2016)

    TSH: 5.230 (0.3 – 4.5)
    T3: 0.77 (0.80 – 2.0)
    T4: 5.63 (5.56 – 12.2)

    My TSH and Anti TPO test results16 months ago (on 08-04-2016)

    TSH: 4.310 (0.3 – 4.5)
    anti TPO: 133.8 (up-to 34)

    My recent, thyroid, Anti TPO, Lipid, LFT and KFT test results (on 17-08-2017)

    LIPID TEST
    TC: 705 mg/dl (140 – 200)
    TG: 135 mg/dl (60 – 150)
    HDL: 96 mg/dl (40 – 65)
    LDL: 582 mg/dl (50 – 130)
    TC/HDL: 7.0 (less than 5)

    LFT TEST
    total bilirubin: 1.0 mg/dl (0.3 – 1.2)
    bilirubin direct: 0.2 mg/dl (0.0 – 0.4)
    total protein serum: 7.40 g/dl (6.0 – 8.0)
    serum albumin: 4.60 g/dl (3.5 – 5.0)
    globuline: 2.8 g/dl (2.0 – 3.5)
    AST: 26 IU/L (15 – 40)
    ALT: 19 IU/L (17 – 63)
    ALP: 94 U/L (50 – 140)

    KFT TEST
    uric acid: 5.9 mg/dl (2.5 – 6.5)
    urea: 60 mg/dl (10 – 40)
    creatinine: 0.7 mg/dl (0.6 – 1.4)
    sodium: 138.0 mmol/L (136 – 144)
    potassm: 3.6 mmol/L (3.6 – 5.1)

    THYROID TEST
    TSH: 3.40 uIU/mL (0.3 – 4.5)
    T3: 0.51 ng/mL (0.80 – 2.0)
    T4: 5.19 ug/dL (5.56 – 12.2)
    Free T3: 1.9 pg/mL (2 – 4.4)
    Free T4: 1.1 ng/dL (0.93 – 1.71)
    Anti TPO: 138.0 IU/mL (up-to 34)

    I am feeling healthy happy and perfectly fine. I do not have, nor have experienced any symptoms usually associated with hypothyroid or hashimotos. am following “zero carb meat only raw” diet for more than six months. I do not consume salt, iodine or any other supplements. I do not know if taking any medication to improve my thyroid numbers would be beneficial to me. Your opinions are most welcome. Thanks.

  42. Dr Child’s- I’m newly diagnosed hypothyroid. Tsh level:5.2, TPO: 1. Starting dose of synthroid is 25mcg. I’m having a very difficult time with this med. I e tried it a few times, and by the second day, I’m so dizzy I can hardly walk! Tried lowering it to 12.5, same thing!!! Dizzy, vertigo spells! I just can’t make myself keep taking it I feel so bad… I did get a script for Armour but am afraid to take it! I am super sensitive to meds.. so not sure what to do. Is this a normal start up side effect? And should I just push through it?? Help!

    • Hi Julia,

      You should not have negative symptoms when starting thyroid medication (as those you describe), you will want to discuss those changes with your doctor.

  43. Hi Dr. Childs,
    Thanks for continuing to keep us educated and inspired. I’ve gained quite a bit of knowledge that has been very helpful in working with my Endo to treat Hashi’s.

    I am curious if it’s possible to have a T4/T3 conversion issue as the primary driver of ‘thyroid’ issues – and if in that case t4 only tx would cause more issue, and even t4/t3 tx might be impeding improvement as the added t4 may not be needed and/or just convert to more rt3?

    I’ve been on t4 generic for 15 years but tsh has never stabilized for more than about 90 days. docs were only testing tsh and rarely tested ft4 and ft4 was always normal. Last year i started seeing an endo who did full thyroid testing along with adrenals, cortisol, sex hormones, leptin etc…only abnormal results were in thyroid. high antibodies, very low ft3 and high rt3. tsh and ft4 were ok. switching from generic to brand synthroid brought on sudden weight gain and crushing fatigue, ft3 decreased, rt3 increased. an increase in synthroid dose made things even worse in terms of ft3 and rt3 but ft4 again stayed the same. adding the lowest dose of t3 affected fatigue sympptoms positively, but ft3/rt3 continued to get worse. 2 more adjustments up in t3 saw ft3 get a bit better, but rt3 stayed high. recently t3 was adjusted up one more increment, and synthroid adjusted down. labs FINALLY show solid improvement in ft3/rt3 but there is much room for continued improvement. my tsh is not suppressed, and yes, good old ft4 remains stable.

    Seems to me my body can convert t4, but it appears to convert to the wrong thing. Does this assessment seem reasonable?

    I asked the endo if we can continue to up t3 and reduce synthroid but got rejected. i was offered to switch to a different brand or go back to generic. i’m going back to generic since switching to brand correlated to significant weight/fatigue symptoms, but also enlisting a local functional md and actively seeking a new endo. You’ve always said its not likely that a doc with an established protocol will change their protocol based on patient input so i see no point in fighting the endo.

  44. Hi Dr. Childs – I have been struggling for 8 years with pain, exercise intolerance and fatigue after a total thyroidectomy. I was taking 112 mcg of Synthroid and 5 mcg Liothyronine two times a day without any improvment. I just switched to 112 mcg Synthroid once a day and 16.25 MG two times a day. I am wondering what you think of this combination? You do not mention it on your site. I am still in allot of pain and also have insomnia. Thank you

    • Hi Susan,

      The combination, dose and ratio of T4:T3 is based on the individual, so it’s hard to say without further information.

  45. Greetings Dr. Childs,

    My 15 yr old has been on synthroid for 2 years. In that time she has never been free of hypothyroid symptoms. Her T3 has always been low as well. When she was first diagnosed with hypothyoid she did not have thyroid antibodies. However, her last labs show she now does have antibodies (the number is 51), signaling Hashimotos. In the past 6 months her hypo symptoms have gotten worse, resulting in patchy hair loss and very low energy, dry skin, etc. She is normally athletic (in cross country) and can barely finish her runs at this time. Her labs showed she is low on T4 and T3 (at the very bottom of the “normal” range). Her Dr’s first inclination was to just increase Synthroid dosage from 50 mcg to 63 mcg and call it a day. However, I asked to address also her T3. At that point we were given the option of trying to add some Cytomel (25 mcg) to the new dosage of Synthroid (63 mcg) or quit the Synthroid and go on Naturethroid (at 65 mg per day). She dosed the Naturethroid according to my daughter’s weight of 103 lbs.

    I am unsure which road to take regarding a Sythroid/Cytomel combo or Naturethroid. If you could offer me any feedback I would be so appreciative.

    Sidenote: I am on Synthroid/Cytomel combo myself for an underactive (not Hashimotos). I go through peaks and valleys with my energy due to the way the Cytomel is absorbed. I am concerned about having my daughter experience the same if we do take the Synthroid/Cytomel route. However, the Naturethroid I am unsure of as well.

    Thank you very much for your time and look forward to hearing from you!

    -Jia

  46. Good afternoon I’m confused like most about my thyroid medication! I’m 57, when I was 30 I had half my thyroid removed due to non cancerous nodules! They put me on Synthroid ! I never had any symptoms of thyroid problems,but after 26 years they said it wasn’t working, they switched me to Armour 90 mg. my hair is falling out like crazy, and it’s weird I feel more tired! I told my doctor so they lowered it to 60mg,,but I feel the same,my hair is still falling out! I have been taking Armour for 6 months now! I have always been active, I’m 5’5 and weigh 118, so weight isn’t a problem! I have also been in menopause for 7 years, just kinda going through it naturally! I would really appreciate your opinion I’m ready just to stop taking anything but I know how important the thyroid is and am a little scared to do that! Thank you for your time,have a good day

  47. I was diagnosed with hashimoto’s in 2012. I started taking Naturethroid right away and took it for 4 years. I was able to get my TSH stable quite easily. I didn’t feel great, but my numbers were stable. After treating adrenal fatigue I finally felt some relief. In 2016 my functional MD suggested I try compounded T4/T3. I felt pretty great but my TSH was really high at the comparable dose to the amount of NT I was taking. My free T4 went up considerably and my doc liked the numbers despite the high TSH. We’ve finally gotten my TSH to start coming down but it’s taken a huge dosage increase. I”ll post my numbers below. My questions are 1) why am I having to take such a high dose? 2) is this a signal of another issue? 3) is it ok to continue at this dose? 4) I’m ttc so will likely need to increase again once I’m pregnant. Thank you so so much for any knowledge that could help.

    We’ve only increased by 20mcg of T4 each time. As of my last test a couple weeks ago, I’m considering raising it by 40mcg to get TSH below 2.78 // so my new dose is 180/18

    Thyroid levels 2017
    Dosage (T4/T3)

    April (60/18 since ~Jan)
    TSH 5.73
    T4 TOTAL 7
    T4 FREE 1.3
    T3 FREE 3.4
    T3 TOTAL 92

    June (80/18 since April)
    TSH 4.63
    T4 TOTAL 6.1
    T4 FREE 1.2
    T3 FREE 2.9
    T3 TOTAL 82

    August (100/18 since June)
    TSH 3.47
    T4 TOTAL 5.4
    T4 FREE 1.0

    Sept (120/18 since August)
    TSH 2.91
    T4 FREE 1.0
    T3 FREE 3.0
    T3 REVERSE 12

    Nov (140/18 since September)
    TSH 2.78
    T4 TOTAL 6.4
    T4 FREE 1.2
    T3 TOTAL 81

  48. Is there an adjustment period when starting NDT during which adverse side effects may be experienced that will eventually go away? I started on 15 mg Armour four days ago but it makes me jittery 24/7 – I’m not able to sleep as deeply and don’t feel as replenished after yoga or meditation. I’m wondering if I should stick it out, or if this is a sign that I’m not tolerating NDT. Thank you for any feedback.

  49. I had a Thyroid problem long before it was diagnosed. Was put on Synthroid, it got worse, then Cytomel(am unable to stand dyes & do not deal well with chemicals),same & then went to Thyroid Hormone(60 mg every morning, half hour before breakfast)& have done well except for hair loss. Have had to take supplements for years & that helped, my hair got thicker & bald spots repaired. But now I am losing hair again & it is thinning. Would adding half a tablet help with this? I have no other symptoms or problems & could lose a few pounds, maybe 10.
    Sincere thanks from Canada.

  50. I had a complete thyroidectomy about 20 years ago due to Graves’ disease, and have finally found a doctor that has tested more than just my TSH, however, I still feel like there is something missing. My feet/hands are freezing all year long, my hair/skin is dry, and I could stand to lose about 20 pounds. I do not currently check my resting heart rate regularly, but according to my fitness tracker it is pretty low at rest normally (60’s). My Dr. tests my T3, FT3, T4, FT4, but not my leptin or RT3…I am currently on Synthroid .175, and also Armour 120 but I think I have some leptin resistance which makes it impossible to lose the last 10-15 pounds despite lowering calories and exercising. And my latest labs were after I had taken my meds that morning instead of fasting. Any information on where to go next would be appreciated. Finding a proactive Dr. in Oklahoma is difficult to do.

    • Hi Kelli,

      It can definitely be difficult to find the right doctor but it is absolutely worth the effort and energy! One thing you might consider is going to a near by compounding pharmacy and asking for a list of physicians that prescribe hormone replacement therapy.

  51. Good evening doctor,
    I honestly have to much history with hypothyriodism to put in this comment but I have so many questions regarding my thyroid. It was back in 2002 or 2003 when I was seven that I started having the symptoms but I wasn’t diagnosed until I was 11 years old with hoshimotos disease/hypothyrodism. Being that I went so long without medicine I gained a lot of weight, I was 4’11 weighing 153 pounds. My body hurt so bad it was hard to get out of bed some mornings. My vision started changing, I had migraines everyday, my feet felt like I was walking on glass and it affected my heart. The list goes on but as I started on medicine things got better. But in 2011 when I was 14 going on 15 my throids got much worse and my body stopped reacting to medicine the way it used to. I had chest pains the doctors couldn’t explain. I started creating breast milk as if I was in the first trimester of a pregnancy, my eye sight got even worse and my weight was hard to control even though I was very athletic. The worst of it was my memory. Some days I could barley remember what I was just saying five seconds ago. Once again the doctor up my medication which now was happening every few months of me seeing my doctor. Now I’m only 21 taking 200mg of levothyroxin and my thyroids are still in my opinion not stable, and I say they because now my weight is the worse it’s ever been and it’s impossible to lose. Im always tired, my feet are always hurting and swollen to the point where I can’t fit my shoes, my eye sight is progressively getting worse, I stay bloated , my memory is so bad that sometimes mid sentence I forget what I was saying. My body temperature stays off, it can be freezing cold outside and I’ll be sweating. I’m sorry there’s so many things wrong it would take to long to tell you but my question is what can I do because the doctors I try to see don’t help me they just brush it all off. They tell me to work out more, eat better, sleep more, cut out salt.. And so on. But I’ve actually completely changed my way of eating, I try to work out 3 days a week. I eat three meals a day, two small, and 1 larger meal. I don’t eat salt and I basically just don’t know what more to do…. Is there any advice you can give me?

  52. Dr. Childs, Thank you so much for providing all the information for those of us struggling with both the disease and the medical establishment.
    I am a 59 yr old Hashimoto’s patient, finally feeling like my old self after fighting the established protocol for this disease for three years, but I have a concern: After a very typical story of being dosed with levo based only on TSH levels, changing drs until I found one who would prescribe an NDT and being referred to various specialists, etc. I finally found a nurse practitioner who is prescribing a much higher dose of nature-throid than anyone would previously prescribe. FINALLY, I feel a normal energy level again, fewer aches and pains, etc. My concern is that the TSH level is at 0.010 last time with free T3= 4.38 and free T4= 0.92, both normal. I worry that the very low TSH will be seen as a reason to lower my dose again (currently at 97.5 mg in the morning and 65 mg mid-afternoon).
    Any thoughts on this?
    Sincerely,
    Beth R.

    • Hi Beth,

      TSH suppression can be a problem for women who are post menopausal or over the age of 50. That being said I believe that the degree of TSH suppression is what really matters but that is currently up for debate. If you are not at 100% despite relatively normal thyroid lab tests then your problem may be elsewhere (other hormone imbalances, inflammation, etc.).

  53. My daughter is 17 and has struggled with her hypothyroidism for the last three years. She has had to go to online school and stop all sports. She is currently on 1 1/2 grain nature thyroid. Her T3 is 3.8 and her TSH is .67 but free T4 is .80. She still has hypo symptoms and her temperature is only around 97.2 when she wakes up. We tested her leptin and it is 24. Since the start of this she has gained 40 pounds. She has been eating clean and following the hypothyroid revolution and that has allowed her to lose 15 of that. We are thinking she should try adding T3 med to her current. Her doctor thinks she will be over medicated? Her RT3 since doing the hypothyroid revolution has dropped from 20(July)to 11(December)so seems in range too. Her rev T3 ratio has also improved too. Would adding T3 help or is there something else we should look at?

  54. Hi Dr Childs,
    Thank you for your timely article. Lately I have been contemplating switching thyroid medications after 30 years, so the information you wrote is very informative. I have been taking Synthoid for that amount of time with doctor adjusting my dose throughout the years. I am currently on 100mcg. I have had an increase in cardiac issues including PVCs, increased hair loss, anxiety, weight that wont budge, inability to focus, brittle nails, blurry vision, coordination and managing my day. My reluctance to trying NDT is that i am a strict vegetarian and I do not care for the way pigs are treated and killed. My other thought is, When with the scientist tell us how to create our own adult stem cell so we can heal our own thyroid so it performs optimally? I learned a long time ago that with the right ingredients, the body can heal itself. With that said, does colloidal silver help heal the thyroid? can eating Kombu, Wakame or dulse harm the thyroid?

    I will be getting my lab results tomorrow and will update you with those results.

    Thank you for your time.

    Thank you.

  55. Hi Dr. Childs, I was on Levothyroxine for 3 years and was constantly feeling dizzy and nauseous until stopping it. I’ve been on WP thyroid since last April, but feel that I’m one of those people that shouldn’t be on a glandular. While working with a functional medicine doctor, I was able to get my Hashimoto antibodies down from the 300s to the 20s, but after starting WP Thyroid my numbers have been steadily increasing and my throat feels swollen. I’m luvky to have found a very open-minded endo who may switch me to a compounded formula with Tirosint and some T3. Have you had many Hashimoto’s patients who couldn’t take glandulars?
    Thanks so much!
    Best,
    Christine

  56. Hi, Dr. Childs,
    Thanks so much for all the great info. I was on 25 mg. of Levothyroxine for three years but always felt nauseous and dizzy until stopping that medication. I switched to WP Thyroid last April and my labs are now all in range, but I feel that I’m one of those people who can’t take glandulars due to aggravating my Hashimoto antibodies. I’ve been working with a functional medicine doctor since last spring and have gotten my antibodies down from the 300s to the 20s with diet and supplements. However, my antibodies have been steadily rising since I started increasing the WP. They’re now in the 80s and my throat has felt swollen for a while. My awesome endocrinologist ordered a thyroid sonogram to see if there’s any change since my last one in Aug. He said that I could change to a T4/T3 compounded mix of a clean synthetic if it seems that the NDT is making my Hashimoto’s worse. Have you had many patients who couldn’t take NDT’s because of this reason? Do you find that these autoimmune reactions are temporary?

    I also have tried the bovine supplement ThyroGold and an adrenal cortex and both made my throat feel swollen the entire time I was on them.
    Thank you so so much!
    Best,
    Christine, NYC

  57. Happy New Year, Dr. Childs!
    Thank you for all of your videos and blogs. I have seen and read them all.
    I have hypothyroidism. My functional doctor put me on armour thyroid in 2005. I am now on nature-throid. After reading your article on T3, I would love to try that. How do you ask your doctor to give you this, but HE is the doctor? I maintain a healthy diet, supplement, and get a lot of sleep.
    Thank you, Ruthie

    • Hi Ruthie,

      I don’t know of any good way to get your doctor to try and change up your medication. I’ve heard from other patients who have tried that it can be very difficult and it is often times better to simply search for a new provider.

  58. Dear Dr. Childs, I am totally at a loss of what to do. I could not even read all the information you so graciously put on your blog for people to read. It is very confusing for me. I have been taking Levothyroxine , for hypothyriodism, which is generic form of Synthroid (correct?) for several years actually over 20 years i would say, 50 mg. In recent months my dr raised it to 75 briefly , but lowered it because i had heart fluttering. My recent labs have shown a high level of antibodies and my symptoms are extreme fatigue. I also am anxious. I am very discouraged and really am at a loss of what to do. I would appreciate any input. thank you in advance. PS i believe the dr is saying it is hashimoto.

    • Hi Nada,

      The single best thing you can do is find a physician or health coach that is willing to work with you and guide you through this process. I definitely understand that it can be confusing, but you want to find someone who understands what is discussed here and who can help apply it to your situation.

      • Thank you . I am now considering doctors who practice integrative medicine. The process is started with a Integrative consultant. Do you believe this would be a good choice to find help with what is discussed here?
        Thank you.

        • Hi Nada,

          It’s impossible to say for sure because each provider practices in a different way. It’s definitely a step in the right direction but I can’t say if they will treat you in a way that is consistent with what is discussed in this post.

  59. I was originally on levothroid and then my Dr, without even telling me, switched me to levothyroxine about 5 yrs ago. I have consistently gained weight over the past few years, about 30 lbs! I can’t lose it to save my life. I’m at 150 m right now and am seeing no positive results results. My GP Dr. is useless. I think he thinks i’m a hypochondriac. I’ve been diagnosed with IBS as well. Aside from getting a new dr, what can i do? All my labs are within ‘normal’ range, so why do I still feel sluggish and horrible?

  60. Hi Dr. Childs
    I am 60 yr old woman who has suspected thyroid issues for many years. But i could not get a doctor to give me thyroid medication until we recently moved to a new state and new doctor. I have many hypo symptoms including severe fatique, weight gain and major hair thinning/breakage, etc. My doctor started my “sluggish” thyroid on low dose Naturethoid a year ago. Felt worse first week but then got a bit more energy and a bit less brain fog. But thats only improvement. My TSH dropped from a little over 3 to almost 1. But my free T4 and free T3 numbers have not changed. Staying very low normal range. Given now “normal” TSH my doctor is thinking dosage is adequate. But my symptoms have not resoved. I do take beta blockers due to high blood pressure and occassional SVTs. I do think my doctor would work with me but I am not sure what next step should be. Should I try higher dose of Naturethoid or will that increase SVTs/blood pressure?or try something else? Or combo? Just cannot continue as is with no improvement. I appreciate any input.

  61. Hi Dr Child’s – I presently take 60 mg ndt and 2 – 25 mcg t3 daily. I feel good on this dose and I’m able to have a small amount of carbs without gaining weight. Before I could go up 2-3 lbs over night – not normal! It’s still not perfect but better then before on ndt only. My liver enzymes are elevated and I’m wondering if having too much thyroid meds can cause this? I’m gluten intolerant so possibly that could be the cause too? Do you have any openings to book a appointment with you perhaps? Thanks

  62. Doctor Child’s your information on thyroid treatment was very useful….I was on t4 meds for nine years and then switched to ndt for a year and a half and in spite of having good lab results I continued to have low basal temperatures 96-97 and insomnia,palpitations etc…I was on one grain dosage at that time…what is the cause of my low temperature and also developed antibodies

  63. Dr. Westin,

    I took your thyroid/adrenal reset supplements for 6 months and I am now taking the T3 supplements. I have more energy in my thyroid from taking these supplements. I just wonder how long I should take the T3? I am currently taking 15mcg of Armour Thyroid. I was also diagnosed with Hashimoto’s a year ago and I have been researching leaky gut. I have taken different probiotics with not much improvement so I will start taking your probiotics as well. I must say it is very comforting finding out (from trial and error) about how my body reacts to supplements/ treatments for my thyroid condition. Thanks for sharing all your research and giving us hope for better living in the future!

    • Hi Lynn,

      Glad it’s worked out well for you! Thanks for sharing your story 🙂

      T3 conversion booster should be used as long as it is helping to reduce your symptoms or until you can fix whatever issue is causing reduced conversion in your body.

  64. Hi there, I am a healthy 33 yo physical therapist. I was recently diagnosed with hypothyroid, likely hashimotos although they havent tested my antibodies yet because they want me to be on t4 longer. I had no symptoms prior to diagnosis other than not being able to conceive for the two months my husband and I tried. Since giving me t4,my hair has been falling out very quickly. I am starting to see more and more scalp. I was given Levothyroxine them switched to unithroid with no dye or gluten fillers. The endocrinologist refuses to add any t3, since I haven’t been on a consistent dose of t4 long enough for levels to come down. However, after researching and also my own intuition, it seems to me that my hair loss should at least be slowing down as my tsh approaches a more normal value. It began at 59.9, then on a high dose of t4 (100 mcg) in three weeks dropped to 4.9, then on a low dose ( 50 mcg) of t4 raised again to 16.9. I am on a medium dose (75 mcg) now and my md refuses to make any adjustment until I am on this dose consistently for another 5 weeks. Meanwhile, they found 4 nodules on my thyroid, biopsies suggested two were benign, the other two Hürthle cell neoplasms. Those were biopsied again and sent to genetics lab. Awaiting results for them to tell me percentage risk for cancer and whether or not they are going to suggest removal of thyroid. I do not want to lose my thyroid and have to be on medication forever. Should I at least push for a combo t3/t4 like nature throid or should I try an only t3 protocol first? Would it make any difference if I do end up having partial or full thyroidectomy? I realize you cannot provide too much feedback on an online forum, I just want to stop losing my hair and start growing it back.
    Also just to add, I have been taking multiple supplements ( including your hair re growth, and t3 conversion) and herbs to treat any nutritional or malabsorption issues, all of which should be helping. I was already dairy free, but recently went no gluten and no eggs as well. That’s also why I think this t4 is the culprit that’s making me sicker. My body went from no thyroid with a tsh 59.9 to 100 mcg of t4 it doesn’t know what to do with and likely isn’t converting.
    Thank you in advance,

    • Hi Kim,

      If T4 is not working well for you then the next step would be a trial of T3. From there you can determine how to proceed.

  65. Up been on levothyroxine for 20 years. I feel sluggish and gaining weight. I have changed my eating habits and no weight loss. I also crave chocolate. I was going to an endocrinologist and talked about the T3 and how I feel and she would not budge to add T3 and I stopped seeing her. I take 150 mcg daily. I need advice on what my primary doctor needs to test it who should I go to see to look at my panel. I am at a loss and the endocrinologist did me no good. Thanks.

  66. This was amazing information, I am currently taking ndt pig glands thyroid meds one a day after a partial thyroidectomy and was good for the first year but then started getting severe upper back tightness and headaches. I just started taking my med at lunch instead and so far I feel better but its only been a couple of days. I am very sensitive and have gi issues but take drugs for that. Can you please give me your input as far as muscle tightness with ndt meds and if you recommend anything better. The lab is looking into getting bovine as an option as my chiropractor said patients seem to do better on bovine?

  67. Hi–I had a complete thyroidectomy, 2/11/2019 was prescribed 125mcg LEVOTHYROXINE which gave me horrible side effects, fast pounding heartbeat, headache every day, couldn’t lie down, shallow breathing, a cough as if I had a chest cold. I stopped taking the pills and finally, after several days I felt like myself before the pill.

    The endocrinologist dropped me to 3/21/19 100mcg and it was worse if you can imagine than the first time and the side effects kicked in even sooner. Again, headache the very next day, sick, body aches and pain to which I had to reach out via Teladoc to get a prescription for headaches and pain (Tylenol, ibuprofen, etc. wasn’t helping at all) I stopped taking the pill 3/23/19 was off until3/25/19 until I felt okay enough to return to work. I informed the dr. of this and they wanted me to continue with the LEVOTHYROXINE cut in half but I haven’t. I have an appointment with a new dr. today 04/01/2019 and hopefully they will look at the whole of me, my symptoms and not just one part of my blood panel.

    I get I need to take a med however, I also need to work and seeing as the current pill doesn’t allow for that I need a dr. that will look into other options.

  68. I have been taking 2 65 mg tabs of Naturethoid/WP (depending on what’s in stock) in the AM + 2 5 mcg liothyronine in the afternoon. I think I need more T3 based on my symptoms I am still having & labs (though my labs aren’t making a ton of sense), so how would I switch out some of the NDT for T3 only? But that would have me taking 1 65 mg NDT & 3 5 mcg (15 mcg) T3 in the AM + 10 mcg in the afternoon which is much higher than the 20 mcg daily you mentioned in the article. How does the T3 in NDT compare to T3 only? Last year I was on 10 mcg T3 twice daily and my labs were the best they’ve been other than my T4 plummeted, which I’m now wondering if that wasn’t a bad thing after reading many of your articles. Maybe I need to work my way back to that. My antibodies are also higher on NDT. I recently bought 3 of your supplements and will soon be starting your recommendations for SIBO. I have Hashimoto’s with my main s/s being severely low stomach acid, gas and bloating. My functional NP that I’ve been seeing for 1.5 yrs has been great about ordering full thyroid panels, hormones, prescribing T3, etc but has never brought up SIBO even though I think that is the main source of my problems. I can’t convert T4 because my gut is so messed up so I’m stuck in the awful cycle of low T3/low stomach acid. Thanks for all your research and guidance on these complex and confusing issues.

  69. My doctor recently put me on 112mcg levothyroxine. I took one pill and within 15 minutes could feel the energy literally drain from my body. It felt like I had taken a muscle relaxer and had to head to bed. I slept two hours and literally had to drag myself out of bed to get on my exercise bike. I struggled to get through my 1 hour work out I’d been doing for three months.. it was like my body just had no energy to move. The next morning my muscles in my legs were so sore as though I’d never exercised a day in my life. And it made me feel weighted down. I had just lost 30 pounds on a diet and was feeling great. I told my husband I’m not gonna take it any more. If it makes me feel this way from one dose. I’d rather be dead than feel like that the rest of my life. I thought it was supposed to give you energy? I haven’t gone back to my doctor because I know she’s gonna want me to take it. Do you have any suggestions? Why would it make me so tired?

  70. I have been taking levothyroxine 25 mcg for 15 months. My TSH dropped to 2.25. I eat what I want & the only change to my diet has been adding celery juice & cilantro does this have anything to do with TSH? I am a 79 year old man in good health except for cold hands, feet, itching scalp & tired in the afternoon. Is there any chance I can quit levothyroxine & get back to normal?

  71. Dr. Childs,
    I have been on a standard dose of Levothyroxine (50 mcg) for 20 years. I have no real complaints. My T4 is always in the normal range (last one was 2.11)
    However, I recently had a Bone Density Scan, just turned 65, and I have learned I have osteoporosis in my spine (-3.0). Femoral neck and arm were in the osteopenia range and fairly typical for my age. I am concerned that the Levothyroxine has caused the significant bone loss in my spine. Outside of being post menopausal there should be no reason for this as I walk, run, swim and bike. I eat very healthy foods, mostly organic. I have scoured the internet and found a few studies (NIH) on Levothyroxine and low bone density but there is very little out there and want to make my case with my doctor. I have wondered if I should move to NDT if there is a chance this synthetic is the problem. Have you run across any solid research studies? Do you think I would be a good candidate to move to a NDT.

    • Hi Melinda,

      Both levothyroxine and NDT contain the same ingredient (Thyroxine) but the NDT contains triiodothyronine as well. Bone loss, as described here and if related to your medication, is dose-dependent and not necessarily medication dependent. So switching medications probably wouldn’t have any real impact unless you changed your dose as well (assuming that the two are related which may not be the case).

  72. I can not seem to stabilize my dosage of NatureThroid because about every 3 to 6 months, I start getting symptoms, so my dr. changes my dosage slightly. It’s hard to find NatureThroid now, so I have to take a 32.5 pill and cut it up to add to 3 other pills to make the desired dosage. My TSH is very low at .006 and free T3 is 3.7. A switch to Armour might help?

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