Thyroid Medications That Still Work - What I am recommending in 2020

Thyroid Medications That Still Work – What I am recommending in 2020

Big Problems with Thyroid Medications in the Last Few Years

It's been a tough few years for thyroid patients. 

Within the last 3-4 years you have had to deal with changes in the formulation of several types of NDT medications, recalls of various types of thyroid medications (including NP thyroid (1) and levothyroxine (2) recalls), and problems with shortages with several types of NDT. 

I'd be lying if I said that these problems didn't affect me, and I know that they certainly affected you guys. 

I see almost daily reports from thyroid patients who continue to have problems with thyroid medications that USED to work well for them

These problems have even caused some people to declare statements like "all NDT formulations are terrible". 

And while I do agree that the current state of thyroid medication is certainly not optimal, it doesn't mean that there aren't options available that still work. 

And I'm not someone to let changes such as these prevent me from helping thyroid patients, so with that in mind, I want to talk about thyroid medications and formulations which I am still seeing GREAT results with. 

Yes, I've had to change some of my preferred combinations up but these new combinations are working quite well and can still help MOST thyroid patients feel better. 

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Thyroid Medications and Regimens that are still working very well

My preferred combination of thyroid medication has always been a combination of T4 and T3

I occasionally have patients who require T4 only or T3 only thyroid medications but these patients represent the ends of the extremes and are certainly not "typical". 

At any given time, I see these recommendations working for probably around 70-80% of thyroid patients:

  • Option #1: Tirosint + SR T3 - Tirosint is a T4 only thyroid medication in a gel cap that is highly absorbable. SR T3 is a sustained release T3 thyroid medication that comes from a compounding pharmacy. 
  • Option #2: Tirosint + Cytomel/liothyronine - This combination replaces SR T3 (sustained release T3) with an immediate release version of T3 in Cytomel and/or liothyronine
  • (Potential option for some) NDT + Cytomel/liothyronine - Finally, if you are someone in whom NDT is still working well, you can use the combination of immediate release T3 in conjunction with your NDT dose. I find the most success with NP thyroid but I still see that Armour thyroid and Nature-throid work for certain people. 

If you are new to the thyroid game, then these medications might look completely foreign to you. 

The medications that I recommend are often not prescribed and may not even be anywhere on the radar or in the wheelhouse of traditionally trained doctors such as endocrinologists and family practice doctors. 

Having said that, there are still ways that you can get them as long as you go to the right type of doctor. 

Why I recommend these combinations:

Let me go into a little more detail on why I like these particular combinations of thyroid medications. 

#1. Ability to titrate individual T4 and T3 levels

One of the biggest benefits of using individual T4 and T3 thyroid medications is that you can easily adjust the dose of each one. 

I find that the T4 and T3 levels that each person needs vary quite a bit. 

I have seen two people who are very similar in terms of their history need completely different doses of T4 and T3. 

thyroid meds that are still working in 2020

Someone might be able to get away with 75mcg of T4 and 25mcg of T3 while another person may need 25mcg of T4 and 5 mcg of T3. 

The good news is that you can easily adjust doses on each thyroid medication to accommodate. 

Individual tweaking of Tirosint and SR T3 allows for adjustments and titrating for thyroid patients. 

#2. These thyroid medications are cleaner than many alternatives

One of the biggest problems in recent years is the contamination of thyroid medications with fillers that can cause serious problems for thyroid patients. 

For instance:

Even small changes in these inactive ingredients can result in inflammation in the gut, inflammation in the body, and reduced absorption of thyroid medication in sensitive patients. 

For this reason, I often recommend just starting right away with Tirosint because most patients feel much better. 

SR T3 is not the most easily absorbed thyroid medication out there but it is cleaner in terms of inactive ingredients. 

The reason being, the inactive ingredients can be closely controlled by the pharmacy which compounds the medication. 

The combination of SR T3 and Tirosint means you get fewer inactive ingredients which can interfere with your gut and thyroid medication absorption. 

#3. Tirosint is highly absorbable compared to other thyroid medications

Another benefit of using Tirosint is that you don't have to worry as much about interference in thyroid medication absorption. 

Tirosint is a T4 only thyroid medication but is the second cleanest thyroid medication on the market (second only to Tirosint-Sol). 

It only contains 4 ingredients in total. 

Thyroid patients are conditioned to constantly think about when they need to take their thyroid medication and what other things may interfere with its absorption. 

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If you are taking Tirosint then these issues are not nearly as important. 

Because Tirosint contains so few inactive ingredients, and because it comes in a gel cap, it's highly absorbed compared to typical formulations like levothyroxine. 

We even have studies showing that Tirosint can be fully absorbed even if taken with food (4) or with coffee.  

This isn't true of SR T3 or liothyronine/Cytomel, but if you end up using Tirosint you don't have to worry as much about when you eat/drink after you take your medication. 

This also applies to supplements too, by the way (with the exception of iron and calcium)!

#4. NDT formulations may contain lactose and other fillers which can limit their effectiveness

You may be wondering why I am bearish on NDT compared to other formulations and the reason is simple:

NDT formulations have seen a continual decline in terms of effectiveness over the last 5-6 years. 

As I mentioned above, it doesn't mean that they don't work or that they are completely useless but it does mean that their quality has been dramatically reduced. 

I used to regularly recommend NDT as a first-line therapy for most thyroid patients but I have since stepped away from that type of recommendation. 

There are well documented problems with NP thyroid, WP thyroid, Nature-throid, and even Armour thyroid. 

It also doesn't seem like the pharmaceutical companies which are in charge of these medications take the problems very seriously and are willing to revert the changes they have made thus far. 

Some Additional Thoughts

You should know that just because I am recommending these thyroid medications doesn't mean that you HAVE to use them. 

It also doesn't mean that other formulations aren't working, because they definitely still are. 

I know from experience that thyroid patients are feeling great on all types of formulations of thyroid medications including NDT. 

When I recommend medications to thyroid patients I am always thinking about what will work BEST for the thyroid gland. 

On a general blog post like this, I can't really take into account important factors such as cost or availability. 

These factors may be incredibly important in your case and may limit your ability to use these recommendations. 

Tirosint, for instance, is not covered by most insurance plans and is quite expensive if you are paying out of pocket

But just because it's expensive doesn't mean it should be avoided, because I feel that the expense is worth it for most thyroid patients. 

It also might not be possible to get certain NDT formulations or T3 formulations depending on which country you live in. 

I know, for instance, that getting T3 thyroid medication is hard in the UK but relatively easy in the US. 

So remember these considerations as you read this!

But now I want to hear from you:

What type of thyroid medication(s) are you using right now?

Are they working well for you? Would you recommend them to others?

Have you had any recent issues with medications that USED to work but which are now not working? 

If so, share your story and experience below! 

References (Click to Expand)

I am recommending these thyroid medications in 2020
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.

9 thoughts on “Thyroid Medications That Still Work – What I am recommending in 2020”

  1. I take Tirosint 50 mcg and 10 mcg Cytomel daily and have been for 6 months. Over last 3 years I have tried all the different thyroid meds with miserable outcomes and side effects. My current regimen seems to be working well though! My one complaint is since starting cytomel and tirosint, I have begun to have (within 1 month of starting) a constant ringing/swishing sound in right ear. Have you ever heard of this or know how I might correct it?

    • You need to have your free t4, free t3, and reverse t3 tested. If your free t3 is low and/or your reverse t3 is high adding t3 would be beneficial.
      I would try regular t3 first since it’s not compounded and would be covered by insurance.

  2. I take thyroid S, however had to switch to armour during the lockdown as Thyroid S was on back order. Didn’t really feel great on armour.

  3. My doctor recently, at my request, switched me from compounded levo to Tirosint 100 mcg and SR T3 20 mcg. I am starting to feel so much better and I am even beginning to lose some inflamnation. These last 11 years since I was diagnosed with Hashimoto’s have been long and very difficult. It looks like I’m finally starting to see the light at the end of the tunnel and a lot of it has to do with your wonderful blog and awesome supplements, Dr. Childs. Thank you for all you do.

  4. Dr Childs – is it possible that the raw thyroid powder could be the challenge with NDT’s as they all have that ingredient in common?

    • Hi Lynn,

      Yes, I haven’t had confirmation of that yet but my concern is that they are all compromised because one of their websites states that the lactose comes from the Thyroid USP diluent which would be used for all brands of NDT.

      In addition, I just found out that many lots of WP thyroid and Nature-throid are being recalled due to subpotency so that might cause some significant issues for many hypothyroid patients.

  5. I got some Tirosint samples from my Dr today in two different doses. I’ll start with my usual dose and if it’s too much I’ll go to the lower dose. I’m trying to refrain from using cytomel with it so I can get a baseline over the next 6 weeks but it’s a nightmare going from NDT back to T4. Every horrible hypo symptom you can think of is what I have right now. Also, recall trying Tirosint Sol a few years ago in my usual dose as a sample but I went back to my Sandoz generic after a week. I have to try really hard this time to find a reliable name brand.

  6. My question is in regards to T3 medications that work. I have a prescription for cytomel that I filled and was given a generic, manufactured by King Pharmaceuticals. It contains the same fillers as Cytomel. I took up to 10mcg daily and it felt like I was taking nothing. To experiment, the next day I took one grain of NP Thyroid and within the hour I was out of bed, thinking clearly, and able to move.
    I’m aware that both pills by KPI and cytomel contain Talc. Have you know this to cause absorption issues in people? Is there a culprit in one of these that you suspect people are more sensitive to? Is there a pharmaceutical company that manufactures a T3 that has a higher efficacy among patients? I transferred my script over to a pharmacy that supplies T3 by Sigma Pharm, which does not have talc or sucrose however it has manitol. Thanks


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