- The best thyroid medication regimens right now combine T4 and T3 in separate medications, giving you full control over each dose. Tirosint + SR T3 or Tirosint + Cytomel are the top-performing combos.
- Tirosint is the cleanest T4 medication available with only 4 ingredients. Its gel cap form means better absorption and fewer issues with fillers, dyes, and lactose that plague other formulations.
- NDT brands have struggled with recalls and reformulations in recent years. If you still do well on NDT, Armour thyroid or NP thyroid remain options, but be aware of ongoing quality concerns.
- Using separate T4 and T3 medications lets you individually adjust each dose to match your body's needs. Two patients with similar histories may require completely different ratios of T4 to T3.
- If you are on levothyroxine alone and still have symptoms, switching to a T4+T3 combination is one of the most impactful changes you can make. About 70 to 80% of thyroid patients do better on combination therapy.
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 but these new combinations are working quite well and can still help most thyroid patients feel better.
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 can work for certain people. Currently, Nature-throid and WP thyroid are not available so your only options are Armour thyroid or NP thyroid. If (and when) WP thyroid comes back into stock, it will likely take the place of Armour thyroid as my primary recommendation.
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.
Someone might be able to get away with 75mcg of T4 and 25mcg of T3 while another person may need 25mcg of T4 and 5mcg 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 which can cause serious problems for thyroid patients.
For instance:
- Lactose monohydrate is found in levothyroxine and Synthroid which cause problems for people with lactose intolerance
- Lactose is now found in WP thyroid and Nature-throid when these medications used to be some of the cleanest forms of NDT available
- Changes in the inactive ingredients in NP thyroid (3) have caused problems for many thyroid patients recently
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 is, 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.
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, 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 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 that are in charge of these medications take the problems very seriously and are willing to revert the changes they have made thus far.
Thyroid Medications to Keep An Eye Out For in 2025
At the time of this writing (in 2025, both Nature-throid and WP Thyroid are still “temporarily unavailable” per the manufacturer’s website.
As a result, many thyroid patients using these medications had to switch to either Armour thyroid or NP thyroid.
This switch has resulted in many issues with the resurgence of many low thyroid symptoms that were previously controlled.
This sort of thing is not uncommon for thyroid patients because they will often find that one thyroid medication (even in the same class of NDT) works better for them compared to others.
If you happen to be someone who does well on Armour thyroid or NP thyroid then you are in luck.
If not, then it may be time to seek out synthetic thyroid medications, at least for the time being.
You can create an NDT-like blend using some unique ingredients including:
- Thyroid glandular supplements – Thyroid glandular supplements
- T2 thyroid hormone – You can get T2 thyroid hormone over the counter in supplements like this. This supplement provides a higher dose of T2 compared to what is found in each NDT grain.
- Synthetic T4 & T3 thyroid medications – You can add any combination of synthetic T4 and synthetic T3 in the doses you require.
This blend gets you pretty close to what is included in NDT formulations like Nature-throid and allows you to more finely adjust the dosing of each.
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!
Scientific References
#1. https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/acella-pharmaceuticals-llc-issues-voluntary-nationwide-recall-certain-lots-np-thyroidr-thyroid
#2. https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/westminster-pharmaceuticals-llc-issues-voluntary-nationwide-recall-levothyroxine-and-liothyronine
#3. https://npthyroid.com/product-updates/
#4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3873683/
2 months ago, I went from taking 2 NP thyroid to 3 NP thyroid pills daily. After 8 weeks, my blood test showed that both my Free T3 and Free T4 had gone down (TSH stayed the same, suppressed). It is my understanding that my thyroid numbers should have gone up. Has anyone seen or heard of this before? I was wondering if it is possible that the NP Thyroid I have is a bad batch, as I started a new prescription from a new pharmacy 6 weeks ago. Any information would be appreciated, as I can not find anything online that describes my situation. I still have all my hypo symptoms as before. Thanks
Hi Kristine,
I’ve seen that lab pattern happen many times with the use of NDT. It has to do with the ratio of T4:T3 and how your body responds to T3.
I have done very well on Armour Thyroid until approximately 18 months ago. My hypothyroid symptoms began to return. Labs reflected this. We increased the Armour, but the slight increase in dosage was too high. Lowered the dose back to what I had been taking and began chewing the pills. This helped tremendously and I stabilized once again. As you know, NDT has a distinct odor and taste. Although not as pungent as when I first started taking Armour, it still had a distinct smell and taste up until last month. With my new refill the pills are smaller, whiter, harder and have no smell or taste, not even a faint odor or taste. My symptoms have returned with a vengeance and the full body water retention is increasing daily and quite rapidly. It feels as if I am not taking any thyroid hormone. I just had labs done and am awaiting results. I participate in several thyroid groups and many others have noted the same issues. This is quite upsetting as it took years to find the right medication for me. Armour is the only medication that worked for me. I’m am planning to add T3 to the Armour and see if it helps. I have been unable to find anything about a recent reformulation. There is definitely a difference between my previous prescription and this bottle in addition to the severity of my rapidly worsening symptoms. Has Armour undergone another reformulation in the last few months?
Hi Nina,
I’ve heard some reports of armour no longer working well for certain people but I’m unaware of any changes to the formula. Nowadays, it’s best to just assume that your thyroid medication of choice will undergo some sort of change or recall given the many that have occurred over the last several years. Some people are opting to swap over to Adthyza which is a relatively newer NDT formulation: https://www.restartmed.com/adthyza-thyroid-medication-review/
Dr. Westin Childs
Hello, hope you can answer me. I’m desperate. I wish I could find a doctor that could spend the time to help me.
I started synthroid 30 years ago – Doc, said to help me loose weight. So now I am on Armour Thyroid. 90 & 30mg. Was 90 & 15 a month ago. I am so tired I can barely get out of bed. My bloodwork shows Low tsh, high T3, Low T4. I’m also having lot of body aches and diahrea.
Do you have any idea what type of doctor might help me. Bj in Texas
Hi Bj,
You can use this resource to help you find a competent thyroid doctor: https://www.restartmed.com/how-to-find-a-doctor-to-treat-your-thyroid/
Dr. Westin Childs,
I just posted but forgot to say something. In my last bottle of Armour Thyroid I think I got a counterfeit pill. It looked smaller than the others so I looked at it closely. The imprint is fuzzy and the pill is smaller.
I was taking Armour thyroid. The numbers weren’t great, but I felt ok even though I was steadily gaining weight. Then I had to switch endocrinologists due to a cross-country move. My new endo switched me to Levoxyl and Liothyronine. My numbers are now somewhat lower, I feel awful, and I have a lot of hypothyroid symptoms. But every time she increases my dosage, my TSH falls to well below 0.5 mlU/L. T3 uptake is only 23%. So something is not working. What do you do in this circumstance when supplementation backfires? Nothing seems to work.
Hi Dr. Childs,
I am curious why you don’t list Adthyza in your list of medications available to thyroid patients?
Hi Ann,
Adthyza is fine, but I don’t think it’s anything special. You can read my review about it here if you’d like: https://www.restartmed.com/adthyza-thyroid-medication-review/
Hello,
I have been on Tyrosint 50 mcg per day for 6 weeks. My T4 was low and had been low over the course of a year or so. I have Hashimoto’s. My antibodies go up and down (200 to 400). I already eat a gluten-free dairy-free diet. I take 4.5 mg of LDN per day.
Tyrosint seems to be helping my joint pain. For 1 year, I have had very bad foot pain and knee pain. My podiatrist tried to help, but the only thing that helped was Tyrosint T4 medication. I did not know that low thyroid function could cause foot and knee pain. I am writing to let others know about the musculoskeletal effects of hypothyroidism.
Tyrosint is available for a lower price through Tyrosint direct. You can choose one of three pharmacies to send you the medication. I must pay out of pocket, but it is worth it. I am wondering how we can advocate or lobby insurance companies to cover Tyrosint.
Hi Deborah,
It’s unlikely that you’ll get insurance companies to change their coverage of Tirosint because they view it as equivalent to levothyroxine (which is much cheaper). There are generic versions of tirosint available, though, that you may want to look into.
I have been on Levothyroxine for hypothyroidism for decades. My endocrinologist diagnosed Hashimoto’s two years ago and raised my dosage to 62.5. Unfortunately she dismissed your list of suggested additional testing as non-applicable. About a month ago I added your T3 supplement to my daily Levothyroxine. My next thyroid labs will be in early December. What improvements can I expect in my results? Thank you for any suggestions!
Hi Emily,
I’m glad you took the step to add some T3 support, especially after being on Levothyroxine alone for so long. This combination should be very helpful for you.
It usually takes a solid 8 weeks of daily use before you’ll see any measurable changes in your lab results, and about 3 to 4 months for the supplement to reach its full benefits. Most people notice improvements in their symptoms (energy, metabolism, and mental clarity) before they see big shifts in their numbers, but that isn’t always the case.
When your next labs are checked, pay close attention to your Free T3, Reverse T3, and TSH levels, as those are the ones most likely to change. You may see a rise in your free T3, a lowering of your reverse T3, and either no change or a slight downward trend in your TSH.
Note, however, that supplements do not always impact labs test results, so the best way to determine if they are working is by evaluating your symptoms and how you are feeling.