The Best Thyroid Medication: How to Find Exactly what your Body Needs

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

You're not alone...

There are many people out there willing to tell you what worked best for THEM.

But that's just it - it's what worked for them.

And it's not necessarily what will work for YOU. And that's what matters the most.

I can tell you that from working with hundreds of patients I am still surprised at how much medication certain patients need, or what type of medication they do best on.

Through this trial and error I've come up with some guidelines that I use on my patients that you can use to find the best type and dose of thyroid medication for YOUR body.​..


Is There a Best Thyroid Medication?

It turns out the answer is not that simple. 

If you start reading around on the internet you will probably find most people talking up Natural Dessicated Thyroid as the best medication around.

And that if you don't tolerate this medication or it isn't working for you it's because of some other problem in your body​. 

​I even fell victim to this trap early on in my career. 

But after treating so many patients I can tell you that some people just do NOT respond well to medications containing T3 or natural dessicated thyroid medication of ANY type.

​And these people shouldn't feel bad about it, they just need some guidance from an experienced physician to help find the right medication for them...

But the question is:

How do you do that? ​

​Finding the Right 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. 

​Even with these factors I still come up incorrect and I have to go back to the drawing board. 

In the end the best way to determine your type of medication and dose is a combination of Trial and Error that is guided by your laboratory results.

It's also important to use family history and personal history as well.

Let me give you some examples...

​Patients who should consider using NDT (Armour thyroid, Naturethroid, WP-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 should 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 ​should 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
The right thyroid medication for your body

​Generally I prefer to start patients off on Natural Dessicated Thyroid unless their history suggests that they will do much better on T3 only medications. 

In my practice the breakdown of medication goes something like this:

  • 60-70% of people do the best on NDT
  • 20-30% of patients do best of T3 only medications
  • 5-10% of patients do the best on T4 only medications

​It's unusual to find someone that does better on T4 only medications, but it definitely does happen. 

Dosing and Starting NDT

If you're like most people (about 60-70%) then NDT may be the right medication for you.

​Your starting dose really depends on the degree of your symptoms, how sensitive you are to medications and if you are switching over from levothyroxine. 

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

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

The more sensitive (or older) the patient, the slower you should increase the dose.

​I will often have patients slowly increase the dose by 16.25mg every 10-14 days on their own and recheck labs/symptoms/heart rate/basal body temperature at pre determined intervals. 

​What to Expect

Up to 15-20% of people may feel an IMMEDIATE improvement in their symptoms right after starting NDT.

Patient case study on naturethroid and AIP

​The patient above was one of those - she felt better immediately upon switching to naturethroid 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. 

This is why I recommend increasing the dosing every 10-14 days to prevent this from happening. ​

If you fall into this category it doesn't mean that NDT is the wrong medication for you, instead it might mean you need MORE medication. ​

When transition over from Levothyroxine I recommend starting lower but titrating up more quickly:

  • 50 mcg of Levothyroxine -> Start with 1 grain and titrate up by 16.25mg
  • 100 mcg of Levothyroxine -> Start with 1.5-2 grains and titrate up
  • 150mcg of Levothyroxine -> Start with 2-3 grains and titrate up quickly

​Quick titration will help offset the lower amount of T4 in these medications while still preventing the side effects from increasing T3 levels quickly (heart palpitations). 

When you should consider switching medications

Not everyone will do well on NDT.

​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 are likely not tolerating the T3 in the medication. 

​For these patients it's reasonable to switch to another brand of NDT to see if the symptoms subside, but for some patients they may actually need T4 only medications. 

Side effects to watch out for

​If used in the right doses you should NOT experience adverse side effects. 

Remember that NDT is bioidentical to the hormones that your thyroid creates.

As long as you are replacing what your body is deficient in you should not have negative side effects.

If you do, it may be due to cellular sensitivity, untreated adrenal fatigue or untreated iron deficiency. ​

Do you need T3 in addition to your NDT?​

Are you doing well on NDT but feel like you could still improve?

If you fall into this category then it may be time to consider adding additional T3 to your current NDT dosing.

Many of my patients feel the best when combining NDT + T3.

Dosing ranges from 1-2 grains of NDT + 12.5-37.5mcg of T3.

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

These combinations work especially well for patients who have undergone a thyroidectomy because most are treated with T4 only medications!​

Dosing and Starting T3 Medication

T3 only medications are probably my favorite to start patients on. 

T3 is the ACTIVE hormone in the body and therefore the most potent of thyroid medications that you can get. 

Now let me be clear: 

Not everyone tolerates pure T3, but for those that do - it can be life changing. 

Because T3 is more powerful the dosing you should start out with should be lower.

I've found that patients with weight loss resistance, leptin resistance and insulin resistance seem to tolerate higher doses of T3 without many side effects.

If patients have been on NDT in the past they also seem to tolerate T3 much better than thyroid naive patients.

Typical starting doses for non sensitive patients:

​10-12.5mcg x10 days, followed by 20-25mcg x10 days, followed by 30-37.5mcg x 1 month. 

Whenever using T3 containing medications ALWAYS follow the resting heart rate and basal body temperature.

Basal body temperature when hypothyroid

Do not let your resting heart rate exceed 90. ​

Resting heart rate while on T3

​What to Expect

​Again as many as 20% of patients might feel an immediate reduction in symptoms when taking T3 including: increase energy, reduced brain fog, improved weight loss, decreased hair loss, etc. (see more symptoms of hypothyroidism here). 

​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.

​The other 80% of patients will notice an improvement in symptoms over 2-4 months as the dose is titrated up. 

When you should consider switching medications

​The most common side effect I see from T3 containing medications include:

  • Headaches (#1 by far)
  • Palpitations/racing heart
  • Hair loss (Too much T3 can cause rapid hair turnover and hair loss)
  • Insomnia
  • Inability to exercise due to high resting heart rate

​If you experience any of these side effects consider lowering your dose or switching to NDT. 

Side effects to watch out for

To prevent the side effects listed above I recommend following basal body temperature and resting heart rate. 

If you base dosing off of these parameters then you should NOT experience negative side effects. 

If you are unable to alleviate your symptoms due to side effects then you should consider switching medications. 

Do you need SR T3? ​

Many patients do need T3 containing medications but may experience heart palpitations.

Palpitations and racing heart come from the effect of T3 on the heart.

T3 has direct effect on the heart which leads to an increase in the heart rate which some people feel as palpitations.

This occurs when blood levels of T3 hormone increase rapidly.

To prevent this side effect you can try taking SR T3 which allows for slower absorption into the body and therefore more sustained levels of T3 in the blood (no immediate rise).

This is usually enough to prevent palpitations.

Dosing and Starting T4 only Medication

Believe it or not some people actually do quite well on T4 only medications!

I am not going to touch on this point very long because most of these people are satisfied with seeing their PCP or endocrinologist simply because the medication is working. 

It is worth pointing out that some people who have done well on T4 medications might do even better by adding a little extra T3 to their dosing. 

Doses as small as 10-20mcg per day can seriously reduce symptoms and improve quality of life in many patients. 

What's better is that some endocrinologists and GP's are actually receptive to adding liothyronine or cytomel to your regimen. 

You will have much better luck in asking for liothyronine than asking to switch medications to NDT or pure T3 in this setting. 

​What to Expect

If T4 works for you (about 5-10% of the population), then you will notice an improvement in symptoms within 1-4 months after starting the medication.

I've found that T4 only medications tend to take longer to take effect and some patients don't give them enough of a chance.

If 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!​

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

​If you fall into these categories don't waste time with a physician who isn't willing to work with you. 

There is a chance you might feel COMPLETELY better on T3 containing medication and life is too short to feel terrible forever!

The Bottom Line

Finding the right type and dose of thyroid medication is HIGHLY individualized. 

Please, please, please avoid the pitfall of asking what worked for other people and trying that. 

No two people are alike and the thyroid is much more complicated than that!

It's best to work with a knowledgable physician who can help guide you through this process but realize that there is a big component of trial and error. 

​In general most people that will be reading this blog will do better on some form of T3 medication. 

For many of you that means either T3 only or a combination of NDT + T3.

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

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!​

Dr. Westin Childs

I'm Dr. Childs and I write these posts. I'm a physician that specializes helping patients lose weight, have more energy and FEEL better. My practice focuses on hormone imbalances, thyroid issues and weight loss resistance. My goal is to provide the BEST information out there on the internet that is both actionable and trustworthy. Get my free ebook: Hashimoto's Diet Guide here. You can also find more about my personal journey back to health here.

Click Here to Leave a Comment Below 70 comments
Emily Mraz - July 5, 2016

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?

    Dr. Westin Childs - July 5, 2016

    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.

Elaine - July 5, 2016

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?

    Dr. Westin Childs - July 5, 2016

    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.

Lillian - July 5, 2016

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?

    Dr. Westin Childs - July 6, 2016

    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.

Janine - July 5, 2016

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

    Dr. Westin Childs - July 6, 2016

    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.

Heike - July 6, 2016

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.

    Dr. Westin Childs - July 6, 2016

    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.

Tiffany Vernon - July 6, 2016

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.

    Tiffany Vernon - July 6, 2016

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

Tiffany Vernon - July 6, 2016

Meant to say reactive arthritis.

Babs - July 6, 2016

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.

    Dr. Westin Childs - July 6, 2016

    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.

Robin - July 6, 2016

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.

Annabel - July 6, 2016

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

Janine - July 6, 2016

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.

    Dr. Westin Childs - July 6, 2016

    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.

Nic - July 6, 2016

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.

Carin - July 7, 2016

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,

    Dr. Westin Childs - July 7, 2016

    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.

Meagan Morin - July 7, 2016

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 🙁

Inge - July 7, 2016

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)

Janice - July 7, 2016

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.

Kelli - July 7, 2016

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.

    Dr. Westin Childs - July 7, 2016

    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.

Corrie - July 7, 2016


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?


Claire - July 8, 2016

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.

Emily Bergstrøm - July 8, 2016

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

    Dr. Westin Childs - July 8, 2016

    Hey Emily,

    Palpitations can be a side effect of too little thyroid and/or too much thyroid, so you will need to figure out which it is before proceeding with your dosing.

Raija - July 10, 2016

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.

    Dr. Westin Childs - July 10, 2016

    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.

Barb - July 10, 2016

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!

Joan - July 11, 2016

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 ?


Lisa - July 16, 2016

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!

    Dr. Westin Childs - July 16, 2016

    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.

Casie - July 31, 2016

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.

    Dr. Westin Childs - July 31, 2016

    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.

Jan - August 27, 2016

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.)

    Dr. Westin Childs - August 27, 2016

    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.

Ashly - September 17, 2016

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.

    Dr. Westin Childs - September 17, 2016

    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.

Carolyn Rider - September 18, 2016

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

Marilyn - September 19, 2016

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 ..

    Dr. Westin Childs - September 20, 2016

    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.

Karla - November 28, 2016

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.

Tami - December 27, 2016

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!

    Dr. Westin Childs - December 27, 2016

    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.

Terri Woodham - January 2, 2017

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.

    Dr. Westin Childs - January 2, 2017

    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.

Erin - January 27, 2017

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?

Cathy - January 29, 2017

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:-)

Carol Ludwick - January 30, 2017


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!

Cathy - February 5, 2017

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…?


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