Tirosint vs Levothyroxine: The Case for Switching Thyroid Medication

You've probably heard from other patients that switching from Levothyroxine to Tirosint made all the difference. 

Considering that they are both T4 only thyroid medication, what is the difference between these medications?

Why do some patients have decreased symptoms, lose more weight and feel better on Tirosint but not on Levothyroxine?

Is there a difference between this thyroid medication compared to the others?

It turns out that many patients actually do much better on Tirosint (but not everyone). ​

In this article, I am going to discuss who might do better on Tirosint, why most thyroid patients will probably do better on this medication and make a case for switching thyroid medications...

*Special note: I have no affiliation with the makers of Tirosint or receive payment from them in any way. I am simply sharing my experience using this medication in hopes to help others. 

More...

Tirosint the T4 Only Thyroid Medication

​As mentioned previously Tirosint is a T4 only thyroid medication

That means that it contains only the T4 thyroid hormone known as thyroxine

T4 thyroid medications are the most commonly prescribed medications used to treat hypothyroidism and other medications in this class include Synthroid, levothyroxine, and Levoxyl.

So, what makes Tirosint different? 

The primary difference between Tirosint and other T4 medications is not in the active ingredients but in the inactive ingredients. 

This medication contains the fewest inactive ingredients compared to all other formulations. 

We'll talk about why this is important in a minute but first, let's spend some time talking about T4 medications in general. 

​If you've read my blog before you probably know that I've spent a lot of time and energy writing about how T4 only thyroid medications generally don't work well for many patients.

And this general unhappy feeling is not just seen on my blog (1).  

Why is that?

Tirosint ingredient list

Well T4 thyroid hormone is not an active thyroid hormone.

The only active thyroid hormone is T3 otherwise known as triiodothyronine

And in order to create T3, your body must use T4 as a substrate and precursor hormone.

So, many health providers give patients T4 thyroid hormone with the hope that the body will be able to naturally take care of this conversion process.

The problem with this logic is that under special circumstances the body will actually produce reverse T3 (the antithyroid metabolite) instead of T3 hormone. 

This is the primary reason that many thyroid patients simply don't do well on T4 only thyroid medications.

But this isn't the whole story.

It turns out that many patients would probably do well on T4 thyroid medication IF (and this is a big if), it was being absorbed properly AND if they don't have any negative reactions to the fillers/inactive ingredients in the thyroid medication.

And that's where Tirosint comes into play. 

You see:

​All T4 thyroid hormone medications contain the active ingredient T4, what they differ in is the inactive ingredients. 

And many people are sensitive to these inactive ingredients

It's these inactive ingredients that change the absorption of the hormone or simply cause reactions themselves. 

This reaction can trick patients into wrongly believing that their medication doesn't work or that that hypothyroidism isn't the cause of their symptoms. 

But what if you could take a thyroid hormone medication with very few inactive ingredients that would almost ensure proper absorption and assimilation? (2)

This would remove the conversion variable and give you clear insight as to whether or not T4 only thyroid medication works for you. ​

Well, that's exactly how Tirosint works. 

Tirosint contains the fewest inactive ingredients (3) out of all of the T4 only thyroid medications and many patients have reported an improvement in overall symptoms when switching (4). 

Why do you think these patients notice an improvement when switching?

Is this medication magically better than Levothyroxine or Synthroid?

No, it's a matter of absorption and in the GI tract of the thyroid hormone and a reduced risk of negative reactions to the fillers.

And much of this change has to do with the ingredient list (including both active and inactive). 

Download my Free Resources:

Foods to Avoid if you have Thyroid Problems: 

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. 

How to Calculate "Optimal" Free T4, Free T3, & Reverse T3 Ratio: 

Calculating these ratios is important because it can help you determine if your efforts are on the right track and whether or not your medications are working. 

Download more free resources on this page

Tirosint vs Levothyroxine vs Synthroid

To illustrate this point let's go over the ingredient list of these medications quickly.

Ingredients in Tirosint include (both inactive and active ingredients): 

  • Levothyroxine (this is the T4 thyroid hormone) <--- Active ingredient
  • Gelatin <--- Inactive ingredient
  • Glycerin <--- Inactive ingredients
  • Water <--- Inactive ingredient

​As you can see Tirosint has 1 active ingredient and 3 inactive ingredients for a total of 4 ingredients total

Compare this to levothyroxine:

  • Levothyroxine (this is the T4 thyroid hormone)
  • Butylated hydroxyanisole
  • Silicon dioxide
  • Crospovidone
  • Magnesium stearate
  • Mannitol
  • Cellulose
  • Povidones
  • Sodium lauryl sulfate
  • Sucrose
  • And color additives include dyes (more below and depending on the strength)

As you can see levothyroxine has a huge list of inactive ingredients. 

It is these inactive ingredients that alter absorption and therefore influence the amount of thyroid hormone that makes it into your body.

These inactive ingredients can also cause a list of reactions including dizziness, headaches, reflux, flushing, hives/rashes, etc. (5) 

These variables make it difficult to determine if any negative symptoms you may experience with a thyroid medication are due to the hormone or due to the inactive ingredients. 

Special note:

Below is the list of fillers, dyes, and additives to each dose of Levothyroxine. 

You can see that the 50mcg dosage does not have any extra dyes, so if you can't switch medications from levothyroxine to Tirosint (due to price or some other reason), it would be worth a trial of switching to a 50mcg dose.

In fact, when I dose levothyroxine I almost exclusively use the 50mcg dose because of this.

If you are on 125mcg of Levothyroxine then using 2.5 tablets of 50mcg may improve your symptoms versus using the 125mcg tablet. 

This may require that you take more than 1 tablet, but it's worth the price if you start to feel better. 

levothyroxine added dyes and fillers

Who Should Consider Using Tirosint?

​Does this mean that every patient on Levothyroxine who is still feeling symptomatic should switch to Tirosint?

No (nothing is ever that easy!), but there are a few patients who should strongly consider making the switch to Tirosint if they are on Levothyroxine or Synthroid.

​If you fall into any of the following categories then Tirosint may be a better option for you than Levothyroxine/Synthroid and/or Levoxyl: 

​This list should serve as general and broad guidelines for who should consider switching to Tirosint. 

One important point I want to expand on is the implication that gastrointestinal problems have on thyroid hormone (and other nutrients).

Hypothyroid patients (yes even those already on thyroid medications but still with symptoms) are in a tricky situation.

Thyroid hormone is required for proper stomach acid (HCL) production (10) and HCL is required for proper thyroid (and other nutrients (11)) hormone absorption.

This means that if you are being undertreated then there is a chance that you are also not fully absorbing thyroid hormone and/or other nutrients - making your problem worse.

This general lack of stomach acid can also worsen or create other intestinal problems which make absorption even worse.

This may explain why some studies show that up to 50% of hypothyroid patients have SIBO (12), or why up to 40% of hypothyroid patients have vitamin B12 deficiency (13). 

​The point is that these GI problems are very important and contribute to a reduction in absorption of not only oral thyroid hormone medications but also nutrients which can worsen symptoms. 

It's worth taking some time to point out that replacing thyroid hormone doesn't necessarily reverse these conditions and taking extra steps to treat these GI problems if present will be necessary for many patients. 

Does Tirosint Cause More Weight Loss Than Levothyroxine or Synthroid?

​I get this question from many patients in some form and the answer is that yes, it might cause weight loss in some individuals. 

This is only true if your body has no issues with the conversion process of T4 to T3 and if your problem with levothyroxine was a lack of absorption.

If the change from Levothyroxine to Tirosint results in an overall increase in thyroid hormone in the body, and the conversion of T4 to T3, then yes, Tirosint may result in weight loss.

This makes the huge assumption that your body has no issues with converting T4 to T3 and this is a very big assumption to make. 

We've spent time focusing on the absorption issue, but in reality, this general lack of absorption and reaction to inactive ingredients probably represents 20-30% of patients. 

Another 30-40% of patients simply need T3 added to their T4 dose for optimal results, and altering T4 dosing won't necessarily change this. ​

You can read more about why levothyroxine can actually contribute to weight gain here, and you can read more about how to use Synthroid and levothyroxine for weight loss properly here.

Combining Thyroid Medications (T4 + T3)

This is probably the best way to use Tirosint and this is how I use it effectively in my practice. 

Switching from Tirosint to Levothyroxine ​

Tirosint by itself usually results in a reduction of overall hypothyroid symptoms due to superior absorption, but this effect is multiplied by the addition of T3 containing thyroid medications like Cytomel or liothyronine.

Other thyroid hormones and medications can safely be added to Tirosint, but remember that general rules for taking thyroid hormone still apply. 

That means don't take Tirosint with food, avoid taking supplements or vitamins at the same time as Tirosint and so on

natural thyroid supplements version 2

​One of the best parts about switching to Tirosint is that most providers won't argue with you about the change. 

Tirosint is still a T4 only thyroid medication and using this medication fits into the current paradigm of thyroid treatment (however flawed this paradigm might be).

Compare that to trying to get your provider to switch you to NDT, which is infinitely more difficult. ​

Nowadays it's also becoming more commonplace for providers to add lower dosages of T3 to T4 thyroid doses.

So switching from say 125mcg of Levothyroxine to 100mcg of Tirosint + 5-10mcg of Cytomel is becoming more commonplace than say switching from 125mcg of T4 to 2-3 grains of NDT. 

​Tirosint Dosage vs Levothyroxine Dosage

Is there a difference in dosages between these two medications?

While both contain equivalent dosages and concentrations of thyroid hormone, some patients do find that switching over may result in almost hyperthyroid like symptoms.

In my opinion, this results from increased absorption and a flush of thyroid hormone into the body.

If this does occur in you, simply slightly reducing the dose is usually enough to control these symptoms.

But in general, the dosage between these thyroid hormone medications is equivalent. 

FAQ + Recap

The bottom line is that many patients stand to benefit from switching to Tirosint from Levothyroxine or Synthroid (and even other forms of thyroid medications). 

This improvement is felt to be due to increased and superior absorption in addition to a reduction in symptoms related to inactive ingredients.

Remember that Tirosint has 1 active ingredient and 3 inactive ingredients making it the "cleanest" thyroid hormone medication.

Special interest should be taken in certain patients with gastrointestinal symptoms as these patients tend to have low stomach acid and other nutrient deficiencies.

Another huge benefit of Tirosint is that this medication fits the current thyroid treatment paradigm and because of this many providers are more willing to prescribe this medication over other formulations.

At the end of the day, you are a unique patient and it may take a combination of time and trial and error to find your optimal dose, but don't give up! With persistence, you will get there. 

Below I've also included some frequently asked questions that I receive from patients regarding Tirosint. 

You can use this list if you don't feel that your questions or concerns were answered in the information above. 

If you have any other questions or comments please don't hesitate to leave them in the comment section below as I check these frequently and I want to keep the conversation going. 

Is Tirosint a T4 Only Thyroid Medication?

​Yes, Tirosint is a T4 only thyroid medication. 

It does NOT contain T3.

Medications that are T4 only thyroid medication include Levothyroxine, Synthroid, Tirosint, and Levoxyl.

Medications that contain T3 only include Cytomel, Liothyronine, and SR T3.

Medications that contain both T4 and T3 include Armour thyroid, WP thyroid, and Nature-throid.

Will it Work for Me?

There is no way to know for sure if Tirosint will work for you.

In my experience, I've found that most people do subjectively experience a reduction in hypothyroid symptoms when switching to Tirosint even when switching from levothyroxine to Tirosint or Synthroid to Tirosint at the same dose.

That doesn't mean it will work for you, but it's certainly worth a 1-2 month trial in most cases, especially if you don't feel well on your current regimen. 

When trying to optimize and reduce your symptoms it's important to take into account other factors like T4 to T3 conversion, inflammation, and other hormone imbalances. 

These other factors may be playing a role in why you are or aren't doing well on your current regimen. 

Can Tirosint Cause Weight Gain?

Like other T4 only thyroid medications, Tirosint can potentially and indirectly lead to weight gain.

This usually occurs from improper thyroid conversion and the production of too much reverse T3.

Recall that reverse T3 is the antithyroid metabolite and directly competes for binding and cellular activation with T3.

The more reverse T3 you have in your body the more likely you are to experience hypothyroid like symptoms (even with a normal or low TSH).

Many patients on T4 only thyroid medications also may experience a condition known as low T3 syndrome which is felt to be due to a variety of reasons including lack of thyroid conversion (though this condition doesn't always have high levels of reverse T3). 

How Do You Take it?

Like other thyroid hormone medications, Tirosint should be taken on an empty stomach in the early morning. You should also avoid supplements and the intake of food for at least 60 minutes after taking it.

Some patients opt to split the dose and/or take this medication at night, but these are advanced techniques and depend on symptoms. 

It is worth mentioning, however, that some studies have shown that Tirosint can be taken with foods (14) which makes it unique among other thyroid formulations. 

These studies show that taking Tirosint in the morning with food does not impact its absorption. 

Tirosint can and should be considered, in cases where you may be experiencing nausea when taking your thyroid medication on an empty stomach. 

Even though it can be taken with food doesn't necessarily mean that you should take it with food, but it's certainly worth considering in certain situations. 

Can it be Used with Other Thyroid Medications?

Yes, Tirosint can safely be combined with other thyroid hormone medications.

It is often best used in combination with Cytomel, liothyronine or SR T3. 

Can Tirosint be Taken with Supplements or Vitamins?

If you are taking vitamins or minerals then it's best to consume these supplements 30-60 minutes after you take your medication. 

Doing this will help enhance absorption in the gastrointestinal tract. 

It's also best to avoid taking Tirosint directly with supplements which contain iron or calcium as these may directly bind up the active thyroid hormone. 

You can see a list of other substances which interfere with thyroid hormone absorption here

Does Tirosint Have Any Side Effects?

Like other thyroid hormone medications Tirosint (if used in high doses) can result in hyperthyroid like symptoms:

  • Heart palpitations
  • Feeling of anxiety or jittery sensation
  • Rapid weight loss
  • Sensation of overheating or feeling too warm
  • Anxiety, depression or other mood changes
  • Insomnia or change in sleeping patterns

These would be considered adverse or serious side effects and if you experience any of these you should seek medical care as soon as possible. 

​Because of the small list of inactive ingredients many patients tolerate Tirosint quite well and generally don't complain of minor side effects like headaches, rashes, flushing, etc. 

This doesn't mean that you can't or won't experience any negative side effects from this medication, but it does mean that the chance of this happening is low. 

Any minor symptoms associated with using Tirosint are usually self-limiting which means they tend to resolve on their own within a few weeks. 

If you are ever worried about a side effect you feel is related to your medication then it's best to contact the doctor who prescribed the medication for you. 

Can Tirosint be Taken with Food or Coffee?

Believe it or not, Tirosint is one of the only thyroid medications that CAN be taken with food (and even with coffee). 

As you probably know, thyroid patients are told that they should take thyroid medication on an empty stomach and avoid eating or taking supplements for at least 1 hour afterward. 

While this rule technically still applies for Tirosint, some studies have shown that eating food right after taking it, and even drinking coffee while you take it, do not alter how much is absorbed into your body. 

This is potentially great news if you are someone who has to have coffee in the morning. 

While I typically don't recommend drinking coffee before you take your thyroid medication, this might be an alternative for those people with schedules that don't really allow for a 1-hour rest after eating or right after waking up. 

But remember:

If you take levothyroxine or Synthroid, you should absolutely avoid coffee when taking your medication. Drinking coffee can speed up your intestinal tract (from the caffeine) and reduce thyroid hormone absorption. 

If this sounds like you then you may want to consider switching to Tirosint. 

How Much Does Tirosint Cost?

Because Tirosint is a newer formulation of T4 thyroid medication the price tends to be more expensive than other generic brands. 

You can see a list of cash prices below using goodrx.com:

Without insurance, and for the 100mcg dose, Tirosint will cost around $122 (depending on your location). ​

Tirosint cash price

You can use goodrx.com to get a discount on medications (even other formulations of thyroid hormone and other medications). 

If your insurance won't cover the cost and if the cash price is too high you still have one last option:

A manufacturer coupon. 

Tirosint does have coupon codes as well which can help reduce the cost down to around $35 per month. 

Tirosint savings card

You can find more information about the coupons here

At the end of the day, paying up to $100 per month may be expensive but if it improves your quality life the price may be more than worth it. 

Now I want to hear from you:

Are you doing well on your current thyroid medication?

Have you considered switching to Tirosint?

Is your doctor willing to work with you to switch medications?

What other strategies have you tried?

Leave your comments or questions below! 

References (Click to Expand)

This post was most recently updated on October 14th, 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.

122 thoughts on “Tirosint vs Levothyroxine: The Case for Switching Thyroid Medication”

    • Hey Paula,

      If you poke around my blog you will find thorough articles explaining how to use all forms of thyroid medications including combinations of T4 + T3 and so on. There is no “perfect” medication for any one person and finding the best medication for you will take a combination of trial and error and symptom management. The most important thing you should focus on is trying to find someone local to help guide you through this process.

      Reply
  1. Does armour thyroid have enough T3 and T4 to help me lose weight easier/ faster and feel better altogether? Cause my Dr just told me to stop taking levothyroxine, which I’m glad, cause no matter how well I eat and how much I work out I can’t lose any weight while being on levothyroxine, please be blunt, thank you

    Reply
  2. thinking about switching from Naturthyroid to tirosint/cytomel. I have taken synthroid and cytomel and switched about 3 years ago to naturethyroid. My labs have always been pretty lackluster – low in the range, or below. I have recently felt more symptomatic (hashimotos’) – fatigue, weight gain,etc. any specific things to be concerned about making the switch?

    Reply
  3. Hi Dr Westin, I am on 90 mg armour, and want to switch to WP thyroid as I have some gluten issues (hashis) but just read up on tirosint! MY BIGGEST ISSUE right now is my weight (30 lbs) that I need to lose. Perhaps i should try the tirosint? Thoughts?

    Reply
  4. I’m switching back from Tirosint to Levothyroxine purely because of the cost benefits. Three months of Tirosint is $366 compared to $12.96 for three months of Levothyroxine. When I started taking Tirosint a few years ago it was approximately $30 a box. The price has steadily increased since then. Same product and same packaging. I can’t say if I’ve done better or worse on it but for now I prefer to keep that money in my pocket. We’ll see if I notice a big difference on the Levothyroxine.

    Reply
    • Did you notice a difference when switching from Tirosint back to Levothyroxine & if so can you please describe in detail what they were?
      I would really appreciate if you could share your experience which could help me & a lot of others out there trying to get there life back from thyroid issues. Thank you.

      Reply
      • Hi Isabelle,

        While it is important to see that Tirosint can help other people, it’s important to remember that even if it did work for her it may not work for you or vice versa. Thyroid medications are very personal and what you need will be different than what other people need.

        Reply
  5. My biggest complaint has been my hair loss. Over the past year I am experiencing extreme fatigue, moodiness, depression and overall feeling horrible. My “levels” have low but still within “optimal level”. My last results my T4 has decreased. I was originally started on Levothyroxine and my hair loss was worse with chest pain. I was switched to Armour and had extreme swelling in face, hands, abdomen and feet. I was given Tirosint to try however I’ve been worried to start it due to all of the reviews are stating more hair loss and heart palpitations. I Have had gastrointestinal problems for years and I’m concerned of more problems related with that. I don’t understand why I’m being given a T4 only medication when my biggest concern has been hair loss. My doctor does not seem to be listening to the issues I’m having because she feels my levels are not low enough to be causing these problems, even telling me to try Rogaine. My family is worried about me because of the drastic change in my personality, depression and overall state. I just don’t want to start another medication that is going to cause anymore hair loss. Any recommendations on other tests I can have done, information that I can give to my Dr., if compounds are an option or should I just try Tirosint and see if helps.

    Reply
  6. Hi. I’ve been taking levothyroxine for years and it’s been fine. However I’ve stated getting an angry red itchy rash across my chest, up to my ears, down my arms, etc. Could I have become allergic to it after years? I really can’t think of anything else it could be.

    Reply
    • Sarah-

      I recently was having hives, rashes, itching, skin breakouts from Levothyroxine. Went totally off it and all symptoms disappeared. Won’t go back to it.

      I had been on Levothyroxine/Synthroid for more than 12 years with no results.

      I think my body said, “I’ve had it with these medications” when the breakouts, itching started.

      Reply
    • Did the generic your pharmacy carries change? I had mine change and my throat broke out in a rash, so I just switched to brand-name Synthroid. More expensive, but I know I’m getting the same thing. My best guess it was one of the inactive ingredients.

      Reply
  7. I’m wondering if switching will help my IBS. It’s seems like it hasn’t gotten worse this last year right about the time my levothyroxine pills started looking a little different. Is their gluten in levothyroxine ?

    Reply
  8. Hello,
    In desperate need of help (& a good doctor who could listen). I’m a patient 42 yr old woman but feel stuck. Had my thyroid removed 9 years ago after a tumor close to it contained embryoic thyroid tissue & cancer, leading to complete removal. 9 years of on again off again of feeling mostly hypo. Never did well on synthroid or generic. Brain fog always remained. Last June started generic levothyroxine come January felt awful. I was on 150mcg and new endo switched me to Tirosint 150 mcg, 2 weeks into it never felt better. No brain fog for first time in 9 years! Week 3, awesome. Week 4, energy off the wall, up at 5:30, go all day till 11:00, hard time sleeping. Week 5 & 6 heart palpitations, feeling like I’m going to faint, dizzy spells throughout the day. Bloodwork done and TSH at .07, shaking hands. Doctor lowered dose to 137, 3 days later I called and said I feel anxiety and heart racing. I’m far from a paranoid person, practice yoga and exercise regularly and eliminated gluten like he requested. Next day needed up in ER with BP 157/100, thought I was fainting. Called endo and he said sounds like inner ear problem or anxiety, definently not meds which surprised me. I was scared to take Tirosint again, he gave me Synthroid 137mcg. 2 weeks later my fog is back, stomach hurts and TSH at 5.
    I feel he started me too high. I feel Like Tirosint could have been for me but I don’t know what dose would be good. Sorry for long story, but feel so lost. I eat healthy and balanced, 5”5 137 pounds. Bottom line, would a dose of 100 be better for me to start? Endo pretty much asks me what I want. Thank you for any advice at all.

    Reply
  9. I am recently diagnosed with hashimotos after suspecting for several years. My dr started me on naturethroid, 1 grain- after 8 weeks had slight weight loss and feeling better , but antibodies increased and my t4 became low/ started tirosint a week ago and feel I am gaining weight and water retention! Water retention is one of my biggest problems with hashis so I am very discouraged. Do I wait it out? Or does this mean my body is reacting negatively to the T4? Thank you for any feedback!

    Reply
  10. I have been on thyroid meds for about 12 years. I was on Levothyroxine for many years, switched to Armor for a year (which gave me palpitations), and have been on Synthroid for the last 3 years. Approximately 3 years ago, I started having severe heat intolerance issues. I’ve had extensive testing done, been to the Mayo Clinic, many doctors and no one can find a cause. Yesterday, my ends switched me to Tirosint to see if that might help alleviate my heat intolerance issues. I understand that Tirosint is the cleanest of the T4 meds, but lists heat sensitivity as a possible side effect. Is it worth me even trying Tirosint vs. Synthroid since they both lost heat issues as possible side effects?

    Reply
  11. I have had HT for 12 years (from dx ). I gained 10 pounds before I was diagnosed and I was never able to go back to my 122 pounds, in spite of “great” TSH, T4, free T3, etc. values all along and even training for a marathon (and completed it). Many symptoms definitely improved and I just accepted by new weight. However, my doctor recently switched me from synthroid to tirosint only to see a horrendous 12 pounds of weight gain and water retention in about 2 months! I don’t even know where it is going as I fit well in my clothes. I am also on BHRT, and started LDN 2 weeks ago, tons of magnesium, selenium, Myer’s cocktaiils, vit D drops . I really dislike this very much. I have a very clean GF diet, exercise regularly … The only culprit seems to be the tirosint (she also added Naturethroid first and then switched me to cytomel ). I am really shocked and sad. What else could be at stake? I am a 48 female.

    Reply
    • Hi Mara,

      Weight gain can be from numerous different issues so you would need to sit down and figure out a timeline of what was given and when and then try to figure out what caused it.

      Reply
  12. I have been on Tirosint (112) for about 6 months and now I am having issues again. Just went back to my Endocronologist 3 weeks ago, had my levels checked and they said I was in the low normal range but was having side effects like palpatations, jitterness, heat tolerance, so I was just lowered to 88 mcg last week. Started yesterday 6/4/17 with freezing, and still having issues of jitterness, (not so much the palpatations) but kind of like tightness and my diabetes (sugar levels) have gone higher and the endo has upped my diabetes medicine. I have had thyroid issues over 30 years. I’m 61 years old and keep having issues of my thyroid meds having to be changed over and over again. The reason I tried Tirosint was cause I was allergic to the fillers in the other meds like Levoxyl, Synthroid, Nature Thyroid. The only other alternative is that the endo said maybe I would have to have a compound pharmacy make the right dosage for me…..I’m at the point where I don’t think any of these meds are working at all……What is the next step if I’m allergic to everything I take. Would like your opinion. Can Tirosint be interacting with my diabetes meds (Glipized and Tradgenta) Thanks.

    Reply
    • The formula was changed. I was using 88 mcg of levo in a tiny round blue pill – it was all of $10 a month and worked fantastic.. hair was getting thick and healthy, facial complexion improved, nice weight.. then they changed to an oblong pill and I developed horrible hives.. found out the new one contains shellfish.
      I think since the Tirosint was changed to the blister pack, it also contains shellfish fillers as the hives are back bigtime, my hair is falling out, I am gaining weight and I dont feel well, very fatigued.
      Why do the mess with someone that was working ?

      Reply
  13. Hi! I started Tirosant a few months ago after trying all the natural meds ( w/ the T3)and synthetic brands. Nothing really made any significant changes over the course of almost 10 years. I decided to try the Tirosant as a last hope. I liked that it only has four ingredients in it, so it was a similar make up as the natural med’s. I also like that its absorption differed from the pill version and hoped that would make a difference. So far it seems to be somewhat effective, my skin isn’t terribly dry like it became with taking Synthroid, and my scalp feels somewhat normal compared to the way other meds made it feel. I had to stop taking the natural meds because my T3 was becoming really high and if my does had to increase my T3 would have gone over the norm. So my doctor and I have started all over again, staring wit the lowest does of Tirosant and working up. I was just tested while on the 25mcg for a few months now, my labs look ok, my TSH is 1.82, it was over 4 before I started Tirosant, and we are increasing the does by 13mcg to see is we can get the TSH closer to 1.30 where I think would be a good range for my body. My T3 hover is now within the normal level but in the low end. I still suffer from hair loss, and fatigue and weight gain and I’m wondering is that has anything to do with the T3? Even when I was getting the T3 though I still felt the same. My question is if I add Cytomel ( I think that’s what it’s called) is that as pure as the Tirosant? I imagine it will add additional ingredients I’m trying to avoid.
    Thank you for this information, and any insight you can offer.

    Reply
    • Hi Maryellen,

      Cytomel is not as “clean” as tirosint. The only way to reduce inactive ingredients is to get your T3 compounded.

      Reply
      • Dr. Childs can you tell me where to get a “clean” T3 as most pharmacies I talk to are still diluting with microcrystalline cellulose which I do terrible with. Also, what ratio should the tirosint/cytomel be for good dosing?

        Reply
    • Hi, would you mind talking with me about how you work out your dose with Tirosint? I’m currently having this issue. I switched from Armour thyroid at 60 mg over to tirosint at 112mcg which I felt that was too high because I was having headaches and loopy feeling and they reduce my dose to 88 but it still feels like it’s too high cuz I’m having headache still and upon waking up this morning at my headache was pretty bad. I noticed that in your comment above your doctor started you over with the lowest dose? How often did you get your Labs pulled? I’m lucky that I have a naturopath path that I’m working with.

      No one’s ever told me that because this was a liquid form it probably absorbs a lot quicker than the pills of the other t4 medications not a lot of doctors know about this it seems like I’m curious to see what your battle has been.

      Reply
  14. I just read your article on Tirosint. I do not have a thyroid, it was removed partially due to Grave’s and then radioactive iodine took out the rest. (80’s).
    I loved Tirosint when it first came out, I felt better on it than any other med. Recently, I tried natural since I felt the different T hormones included in this branch of thyroid meds would be beneficial. I really liked WP the best. However, my doctor kept having to ratchet up the dose. Eventually my weight kept going up and up. This is after trying a 1250 calorie diet and exercise and then thinking that was not enough calories, switching to 1500-1600. When I say exercise I mean jogging 8 miles a week and I can cycle 18 miles in one spin class. I still gained weight to the point I became insulin resistant. After a brief time on glucophage and back to Tirosint, I’m losing weight.

    Reply
    • Hi Amy,

      If you read some articles on my site you will discover how that kind of diet damages your metabolism long term. You definitely want to avoid further calorie restriction because it may cause some short term weight loss temporarily, but it will always result in weight gain long term and then it makes future weight loss more difficult. This process continues until eventually calorie restriction isn’t enough to cause any weight loss at all.

      Reply
  15. So Dr. Childs, for complete disclosure, please offer an in-depth explanation of your relationship, interests, holdings, etc. in Akrimak. Thank you.

    Reply
  16. I do okay on NDT but still have some hypothyroid symptoms and don’t feel quite stable. My Free T3 hovers around 73% of the range; I can’t seem to tolerate more than so it was recently suggested I add some Synthroid to bring up my Free T4 which is around 20-30% of the range. Would adding Synthroid to NDT be completely crazy or might there be some benefit? I’m open to the idea but I’m not sure how to proceed i.e start taking Synthroid and decrease NDT at the same time or is there a better way? You seem to be one of the only doctor who considers everything and doesn’t preach NDT only or vice versa and I really appreciate that so any input you have would be fantastic.

    Reply
  17. I’ve been on this medication for 1 week an already feel the difference, I have hyperthyroid an they had to take it out, an was on leve. An was sluggish an no energy an I work building cars an need the energy, when I made the switch, I felt it within 2 days energy came back an mood changed an not as nervous anymore. But did have swelling ankles the first week but soon stopped. I prayer this medication does better for me as the other gave me headaches an irritable.

    Reply
  18. Help! I was on Levothyroxine for 7 years for hypothyroidism. I never really felt any improvement in my fatigue or cold intolerance. Suddenly, I developed severe premature ventricle contractions. I went to the cardiologist, wore an event monitor and was have over 25000 pvcs a day. I also started gaining weight and gained 35 lbs. I stopped the levothyroxine and the pvcs went away. I have been to doctor after doctor and they continue to tell me that the levo had nothing to do with pvcs. I tried Armour and Westhroid and the same problem…pvcs. All the while my thyroid hormones all showed normal levels. I stopped all thyroid medications and again the pvcs went away. I finally went to an endocrinologist, told him the problems I was having with pvcs while on levothyroxine. He as did every other doctor said levo was not the cause of my cardiac symptoms. Then he prescribed me .75 mcg of you guessed it…levothyroxine. The pvcs returned. He refused to try any other thyroid meds. I went to another doctor who prescribed 19 mcg of a t3 compounded med. My heart rate went up from 69 bpm resting to around 100 bpm and the pvcs started again. My thyroid hormones are still in the normal range. Why am I having hyperthyroid symptoms when on medication when my tests reveals normal thyroid ranges. I am losing hope. I’ve gained 30 lbs, my hair is falling out in handfuls, I have no energy, joints and muscles ache. Someone please help. I’m desperate and was wondering if maybe tirosint may be the answer.

    Reply
    • Hi Jackie,

      Sometimes the side effects that patients experience when taking thyroid medications may be due to inactive fillers/dyes and not the actual thyroid hormone in the medication itself.

      Reply
    • I read your post about your difficulties taking Levothyroxine and pvcs. I am not having that issue but after taking Synthroid for 20 years, it’s like I’ve become intolerant to it. I get horrific palpitations on just a 1/4 of a 50mcg tablet. I use to take a 50 mcg tablet but stopped and started it at a lower dose and now, down to just a 1/4. I ended up having to take it a beta blocker just to reduce the cardiac issues. I’ve had lots of blood work that all seems normal except the hypothyroidism. My heart checks out Ok but I know thyroid medicines can overstimulate the heart. I am going to have my cortisol and adrenal levels all checked as well. I am looking for an answer to the palpitations, too. I’ve been to the ER twice, a cardiologist, endocrinologist and GP. It all seems to center around the thyroid medicine. If you find a solution for yourself, I would like to know what you ended up doing. Thanks, Elaine

      Reply
  19. Hello, I am a thyroid cancer patient-thyroid removed. I was on levothyroxine(generic) with no complications until I was treated with radioactive iodine therapy. Since I react to every medication including synthroid dye free, tirosint. My symptoms did improve slightly on tirosint until they stopped my thyroid meds altogether prior to annual cancer scan. Allergic to thyrogen. Upon restarting Tirosint, I had facial/tongue/throat swelling, major joint pain swelling, irritability, insomnia etc(none of these occurred while tking before)Dr then switched back to Synthroid dye free 50mcg- same reactions. Now Dr wants to try Compounded Pure Levothyroxine. my question is- Does this make sense when all the meds tried and failed are “levothyroxine”? Am I recting to the levo? Dr’s ( i’m now on #3) all refuse NDT. I am a severly Dysfunctional individual. My TSH is where they want it but I am unable to function as a human being. please help to guide me towards asking the right questions to make them believe it’s their idea!
    P.S. My cancer was papillary, follicular and medullary with invasion of lymphovascular system.

    Reply
  20. After a thyroidectomy 22 years ago, and levothyroxine for all these years, I just switched to levoxyl. Is levoxyl about the same as levothyroxine as for as excipients go? I have all sorts of problems that fit right into the low T3 list. Thinking maybe I should jump to the combo therapy. Tirosint/T3

    Reply
  21. Bonjour! I have hashimoto, my thyroid is not functioning anymore, or close to, I also have Raynaud’s syndrom, a heart failure with mitral leak, and lots of family (aging parents) stress. I am more or less on AIP diet since June 2014. Besides that, I love champagne and fun! 😉 After trying everything on earth but Tirosint, I am now on WP + Cynomel, split in 4 times/day. It is not totally ok as I still have hypo flares, but it is the less worse combo so far. However I am now in France taking care of the mentioned parents, and WP is out of stock at the US lab, plus it is forbidden in France (All animal hormones are)! I am running out of WP, therefore I am wondering if I could not switch to Tirosint. The question is: What are the rules to match dosage between the 2 meds? I take 3 WP 65 and 2.5 Cynomel 0.025 per day. Merci beaucoup. I sent your article to my endo in Oakland!

    Reply
    • Hi Cat,

      There really isn’t a way to convert the dose when you are using NDT and/or T3. You’d be switching from a medication that contains a fair amount of T3 to a T4 only medication. You also have to consider that switching to Tirosint may alter absorption which further clouds the picture.

      Reply
      • Merci Westin!
        Your blog ate my first long answer. :p In a nutshell:
        Merci for your help!
        As I have no other choice being stuck in France until January, and with WP out of stock in the US anyway, I will try to figure out how much t4 I take now with the WP, add some more t3, and see. I still have hypo flares anyway, and no other synthetic or natural meds have worked for me. Tirosint is the only one I never tried…
        Could you please tell me what you mean with “further absorption issues”?
        Wish me luck! I shall report. 😉
        Cat

        Reply
  22. I just switched from Synthroid brand to Tirosint. For the past two years I have either been testing hypothyroid or hyperthyroid. I’m hoping this medication keeps me more stable.

    Reply
  23. Hi!
    I had a total thyroidectomy, non cancerous this past July.
    My Endo has lowered my dosage of Synthyroid from 175mcg to 125mcg.
    She says I don’t need anything for my T3?
    I’ve had panic attacks every morning since the surgery along with other side effects.
    She’s now saying that Torosint maybe better for me?
    Your thoughts?

    I also take generic celexa 40mg and generic klonopin .05mg daily and 1.0mg at night.

    Reply
  24. I have been on levoxyl for 2 yrs’ thyroidectomy was performed 2 yrs ago with para transplant. my tsh levels are at a 30 and i am totally symptomatic. just switched to tyrosint. how long before you see results.

    Reply
  25. Thanks for another great article Dr. Childs. I’ve been following your blog and your guides for the last year and a half and your information has been invaluable.
    Upon your advice when I queried about having to push my endo to consider combination t4/t3, I sought out a new doc and recently came under the care of a fantastic doctor who just switched my t4 to tirosint (was not optimal nor stable with levothyroxine or Synthroid). I’ve noticed a positive difference in symptoms that I’d bet is due to the clean profile of Tirosint. I’m also taking her advice and switching several of my suppliments to the pure encapsulations, which I believe you also recommend for their clean profiles.
    Thanks again – your blog has been an excellent resource and guide, helping me make drastic gains in my health!
    Cheers,
    ~Z

    Reply
  26. I want to start taking Levothyroxine 50 mg because of what you wrote about the ‘no fillers.’ How do I know its the correct Levothyroxine med? My Rx says Levothyroxine, generic for Levoxyl. Is Levothyroxine the generic for all T4 meds? Hopefully this makes sense?!?

    Reply
  27. I had a total thyroidectotemy 5 years ago and have tried every available replacement therapy avaliable in Canada (Synthyroid, Cytomel, Armour, Compounded T4/T3…) and still just don’t feel well (have addressed everything under the sun from metals to gut). Feel stongly issues are still correlated to thyroid replacement. I would like to try Tirsonsit any suggestions on how to obtain from a US pharmacy (I know this is not yet been approved in Canada and company wishes to do a trial in the US in advance of expanding into Canada)? Any direction would be greatly appreciated.

    Reply
  28. I have had hyper thyroid disease for years. When I was finally diagnosed in 2002, I was put on synthroid. I haven’t been Right since my face breaks out ( I’m 60) and lasts for months. My skin is dry and I love the cold but can’t take the heat. I’ve even been to Cleveland clinic, to a doctor who dyes the my levels are fine and just turned me away. I have had treatment like this from many doctors. But I know my body. My skin was always healthy and so was my hair. Never in my life do I have breakouts. Please give me some advice on what may be causing all this and how to fix it. I just don’t know where to go when they tell me that my levels are within normal range.

    Reply
  29. Hi Dr. Childs,
    Thanks for the great article! I recently switched from 130mg (2 grains) of WP Thyroid to Tirosint as an experiment because my Hashimoto antibodies that I had gotten down to 20 began to rise as I increased the WP. My doctor and I weren’t sure of the proper conversion so I tried 75mcg of Tirosint. It was way too much, as I experienced all of the horribly hyper symptoms… I then tried 39mcg for two days and had horrible diarrhea and stomach pains. I didn’t take any for two days and now am starting to take the lowest dose of 13mcg. Is it possibly that the 75mcg made me hyperthyroid and I should’ve just not taken anything for a week or so before restarting? I’m nervous about restarting but I know I need to.
    Thank you so much!!

    Reply
  30. Dr. Childs, this was very helpful insight on the comparison of medications. My daughter had success on Tirosint, clinical trial at her Endocrine office, but due to cost, I had to remove her and put her back on generic levrothyroxine. I am once again going to lobby for her to be back on this medication, Tirosint, because of the lack of fillers. She is gluten sensitive, not celiac, and has GI issues. If I cannot gain success with doctor or insurance company, the most valuable information you have shared is that 50mcg does not have any additives. I would rather give her 2.5 pills vs 1 (she takes 125mcg) in hopes of change. Thank you so much for taking the time to write this article. And I am so happy to have found it. Not one doctor has ever told me what you have today. I don’t think they are concerned with “quality of life”, they are only concerned with a life long patient, they can keep charging the insurance company. Three to four times a year, plus labs, can be quite the paycheck, times the number of people who suffer from thyroid issues.

    Reply
  31. My new endocrinologist is trying to switch me to Tirosint from Levothyroxine after 5 years. I’m having no issues other than my hair is getting thin. I have been a vegetarian for over 28 years. The Tirosint is made with gelatin?

    Reply
  32. Hi Dr. Childs,
    I requested that my Dr. switch me from Levthyroxine to Tirosindt- due to the ‘fewer ingredients factor.’ I am starting my 3rd month and for the most part, I’m feeling better. The past 2-3 yrs my levels have fluctuated taking me from hypo to hyper… e.g. within 3 months, I went from tsh-39 to tsh- 0.01. My concern/question is that, my tsh is still low 0.04, bbt has also been consistantly low- 96-97 F. So although both of these values are low, I am experiencing the typical HYPOthyroid symptoms…? My original diagnosis (26 yrs ago) was Hashimoto’s related Hypothyroidism. Hope to hear from you soon. Thank you for sharing your wisdom!

    Reply
  33. Hi Dr. Childs,
    My problem is I have Graves disease, IBS, mild Crohns, lots of medication allergies. I had Graves a long time before it got severe enough for someone to do a TSH test. By that time I was so hyper that I had no time to try the meds and had to have RAI (double dose) to destroy the gland. Then I went severely hypo (TSH 73) on 25 mcg Levoxyl and it gave me a rectal prolapse from terrible constipation. 88 mcg brought me into range but I have hyper symptoms again including loose BMs which is no good for my prolapse. I believe it is not the range for me. I am also having a hard time gaining back the weight I lost as I am mostly on the BRAT diet. I know most folks complain about not being able to lose weight but I was only 112 lbs, to begin with, and need to gain it back. Any suggestions would be helpful. I begged to go back on 75 mcg as even tho my TSH was 13 then I felt pretty good and BMs were normal. Any suggestions would be helpful.

    Thank you and I appreciate your site as it is very helpful.

    Reply
  34. I changed from longtime Synthroid use to Tirosint at the same dose in hopes of improved absorption. My carpal tunnel, slight headaches & depression vanished. However, I developed fatigue, dark circles all around both eyes, difficulty maintaining weight & anxiety over these new symptoms.
    I changed back to Synthroid & need to work religiously on gut health. I am completely overwhelmed with all the information out there. I just need a few key points to anchor myself on. Thank you for any assistance.

    Reply
  35. Hi doctor Childs,
    Thank you so much for the blog about the Tirosint medication. I will be switching to Tirosint from Levothyroxine which doesn’t work for me for 8 yrs.
    Again, thank you!
    I will let you know the result after few weeks taking it.

    Reply
  36. Dr. Westin Child’s

    I’m on (2) 50mcg (synthyroid) and I take them every morning at the same time and I sweat like crazy 30 mins after I ingest them and then I’m cold this sweating and cold go on throughout the day and night, each episode last for 2-4 minutes “except” in the morning when I take the synthyroid that last for about 30 mins. Does this mean I’m having allergic reaction to synthyroid even though it’s the pure synthyroid and I’m also on 15mcg Cytomel that I take 2 pills 3 hours after synthyroid and 1 pill later in afternoon.

    Can you explain the sweating and cold, my Endo says I’m fine?

    Thanks, Grace

    Reply
  37. I had a total thyroidectomy due to cancer and also a history of gastric bypass. I take 300 mcg of tirosint every day and it is the only thing that has worked to get my numbers to the low end of the scale. It has been a lifesaver!

    Reply
  38. Hi Dr. Childs,
    Have you had patients who get headaches when trying to add T3 to Tirosint? I was up to 75mcg of Tirosint and got headaches when trying to add 2.5 or 5mcg of Liothyronine. My doctor then had me try T3 only for a few weeks but I had headaches the entire time, so I’m going back to Tirosint. My T3 went down to 2.5 but TSH and T4 were good. I’ve revently bought your T3 conversion supplement to try!
    Thanks so much!
    Christine

    Reply
  39. On Synthroid for 3 yrs due to Hashimoto’s, diagnosed after months of idiopathic urticaria/hives. It kept the hives away but took me 3 months of experimenting to determine that my acid reflux/GERD was caused by Synthroid. It was so bad I was moaning and groaning, leaning over in pain and breathing like a fire-breathing dragon. Then I was living on GERD medication on top of my Synthroid. I hate to take pills unless I have to. I wanted to determine what was the cause of the GERD, not just keep taking pills. I asked my doctor about other Synthroid options and was given Tirosint gelcaps. I am CURED of GERD ever since! I have been on the same level of Tirosint for 4 years now with no GERD problems.
    Now the bad news – I may now be experiencing brand new insomnia due to the Tirosint, but am still investigating/ experimenting. PLEASE listen to your bodies and do what is right for you. Doctors don’t always know everything and you know your bodies best, but if I listened to them all the time, I’d probably be a walking, itchy zombie now.

    Reply
  40. Hi, Dr child’s I got diagnosed about 5 years ago with a hypothyroid they have also said hashimotos. I tried brand and generic of Synthroid and levothyroxine and can not take them I have taken the lowest dose and have every side effect possible it was horrible! I have a super hard time taking any medication and usually have a reaction to anything I take.they prescribed me they said the lowest dose of Tirosint 13.9 mcg but I I’m terrified to try it after the way the other medication made me feel. I am very symptomatic from my hypothyroidism it really effects me a lot except with weight I’m actually very thin but I need to take a medication to try and help with the other symptoms. I was wondering if you could give me your thoughts and if the 13.9 mcg of Tirosint would be equal to 25 mg of levothyroxine? If I will have fewer side effects from The Tirosint or if there is a lower dose then 13.9 that I should try?

    Reply
    • Hi Lori,

      Synthroid, Levothyroxine, and Tirosint all have the same amount of T4 in them so the conversion would be the same. 25mcg of Levothyroxine = 25mcg of Tirosint. You may not tolerate the same dose due to absorption or other variables, but the conversion is the same.

      Reply
  41. Hello! Thanks for the info. My Levothyroxine dose was lowered from 100mcg to 75mcg 6 mos ago because of a low (1.2) TSH. Since then I have had hair loss that will not quit! (My TSH is now 3.3)
    I have a history of hair loss since being on T4 medication, but this is depressing. So – with that being my main concern, would I benefit from Tirosint?
    Also, combining T3 & T4 seems like a good idea. Do people usually take two meds or a combination like Armour?
    As additional information , I have gluten and dairy allergies, eat very well, take supplements, and exercise daily.
    I know I’m asking a lot but ANY input will be helpful.
    Thank you!! Penny

    Ps- I’m 64 yrs old and have been on HRT and T4 since 2003… and losing hair since then, too!

    Reply
  42. I love Tirosint. I took 150mcg Levothroid for several years before it was discontinued. My dose of Tirsoint is 125mcg bc I absorb it so much better. I also take Compounded T3 SR at 23mcg. I had papillary thyroid cancer 10 years ago this month. I am doing great! I am thankful for this medication. I had rashes with Synthroid and Levoxyl and I will not use generic thyroid meds bc they aren’t consistent in their doses.

    Reply
  43. Dear Dr Childs, your site is incredible. I need your advice & would like to have a phone consult. Would you be willing? I have a child who I believe has t3/t4 conversión issue. He’s begun treatment on Tirosint and added liothyronine with amazing positive impact but is now having twitches & facial spasms & dr doesn’t know if it’s from the t3 med or the Tirosint. His last levels came back mid-normal range “perfect” svc to his functional endo, but no one knows why he’s having this scary reaction. Are you familiar with this as a side effect of tiro or liothyronine? He’s on 1/4 pill of liothyronine & 13&13&25 Tirosint now…we’ve gone up and down and he’s also on a small dose of Cortef for mild adrenal insufficiency. I’d be so grateful for your input. I’d also happily pay for a consult. Thank you.

    Reply
    • Hi Pamela,

      Thanks for reaching out! Unfortunately, Dr. Childs is no longer accepting patients! We are sorry about that. I’ve never seen spacial spasms or twitches from either thyroid medication, but you can look into magnesium supplementation (if you aren’t already!).

      Reply
  44. Started getting swift hair loss from generic levothyroxine. My doctor told me 60% of her patients, including women, got hair loss from levothyroxine. Not a symptom I’m ok with (and hair loss is an external sign of something else wrong).
    Going to try Tirosint, levothyroxine had my TSH and thyroid values right but joint pain and other symptoms not worth my time.

    Reply
    • Hi Kaden,

      I’m not sure that I agree that 60% of patients have hair loss from levothyroxine. Many women do suffer from hair loss due to hypothyroidism, but the primary cause of this hair loss is from being underdosed, not from the medication itself. It is, however, true that levothyroxine can cause hair loss independently but this seems to be less common in my experience.

      Reply
  45. HI – I wont go into my long, complicated issues except to say I got very ill a few years back and stopping my (very high) dose of NDT cleared up a few of my acute symptoms within a week. I have been on Levo since and have suffered with histamine intolerance. I have only just found research suggesting that the Levo might be the cause. I know I had a change in symptoms after I went on it. I fixed terrible my reflux with aloe vera and probiotics, but then the multiple food intolerances started. 3 years later there are only a handful of foods I can tolerate, mostly meat and veg, and I still get mild symptoms with those (blocked ear, PND, tickly throat, mild wheezing (with wheat, rice, corn, oats, etc). I have tried and stopped every recommended thing like quercetin, milk thistle, etc, but can’t tolerate them. The one consistent thing through this whole time is the Levo I have been taking. So, I have just restarted NDT at a very low dose. The thing is, I am worried that the T4/T3 ratio in NDT is too high (1:4 rather than the 1:10 our bodies produce) and the only way for me to improve it is to add Levo. Tirosint is not available in the UK. Is there anything you can tell me to reassure me about using NDT only? Thank you.

    Reply
    • Hi Rose,

      Many people do well on NDT but I don’t subscribe to the idea that one type of thyroid medication is the “best”. I use whatever works best for the patient.

      Reply
  46. You alluded to seizure meds having negative effects on thyroid meds absorption. I looked around your pages and could not find a further explanation of this. Many patients take gabapentin for peripheral neuropathy. Is this a med that must be taken away from thyroid meds?

    Reply
    • Hi Susan,

      Anti-seizure medications interfere primarily with thyroid metabolism (such as T4 to T3 conversion or thyroid hormone synthesis) as opposed to thyroid hormone absorption. Gabapentin doesn’t have this same effect but it should still be taken away from thyroid medication by at least 1 hour.

      Reply
  47. Hi Dr. Westin,

    Just found your website, while conducting research on Tirosint. I am a Cushing’s Disease survivor (grateful!), who has been on thyroid meds since the brain surgery.

    Due to extreme side effects (presumably caused by the fillers) from the brand name T-4 meds (Synthroid and Levoxyl), I have been on levothyroxin for some time.

    Recently, the manufacturer changed the formula for my levo, so I had to switch to the Mylan brand. My health has rapidly declined, to include a 20-lb. weight gain (I am active – kick-boxing, daily walk/hikes, etc. and lead a gluten-free lifestyle.)

    Looking to switch to Tirosint, in the hopes that the purity of the formula will restore my metabolism and health.

    The addition of liothyronine (2 X daily) to my levo a few years ago improved my health greatly. (Honestly don’t believe the T-4 on its own accomplished anything.)

    Just wanted to post for others who are suffering – will include update, upon start of Tirosint.

    Thank you so much for the time and effort you put into helping all of us with these horrific thyroid disorders. Few people understand how our quality of life is impacted by these debilitating diseases.

    God bless you!

    Reply
  48. Dr. Childs,
    My mother took Levothroid and did well for 35 years. Since it has been discontinued, her life is not worth living. She has severe reactions to all commercial thyroid medications, including Levoxyl and Tirosint. We have tried about 5 different compounding pharmacies to no avail. I am wondering if the quality of the levothyroxine sodium might be the problem with the compounding pharmacy, which has been tested to be highly accurate in dosing.

    Reply
  49. I’ve been on several doses of generic levothyroxine since being diagnosed with hypothyroid in 2013, and then Hashimotos in 2017. My doses are always going up and down and at my lowest my TSH was 0.6, highest was 5.6. Despite these non-extreme numbers I still have so many symptoms. I also have what has been diagnosed as IBS as no other GI tests have found anything. I went to my first endocrinoligst appointment last week and although he wouldn’t put me on T3, because he says it’s a last resort for him because it causes cardiac problems?? But he recommended trying Tirosent because he said many of his patients have benefitted. My insurance covered the whole cost and I’ve been on it about 2-3 days now. I’m hopeful that this will at least help some!

    Reply
    • Hi Caitlyn,

      T3 does not cause cardiac problems unless it is dosed incorrectly. That’s like saying water is bad for you because you can drown in it. Of course, you can but you also need some of it to survive 🙂 You just need to find the right amount.

      Reply
  50. Hi,, please help me with the conversion,, I am currently on Synthroid 50mg, Cytomel 5mg, I am switching to Tirosint, what would be the dose?
    Thanks

    Reply
    • Hi Margerite,

      Synthroid and Tirosint are both T4 medications so the conversion from 50mcg of Synthroid would be 50 mcg of Tirosint. The cytomel is a different story entirely.

      Reply
  51. Dr. Westin I tried for years natural med 3 kinds but ended up on levothyroxine which I feel the best. Tried to add syntetic t3 that was terrible to me.so I had to stop taking it. I feel great on levothyroxine taking 75mcg but one symptoms still persist. Hair thinning, balding up to the point that I need a wig. I could not solve this issue yet. Trying to switch to Tirosint to see if it helps on that. What is your opinion. Could it help?

    Reply
  52. I’m a 49 year old female. I had a partial thyroidectomy in 2010 due to benign cysts on the left side of my thyroid. After the surgery, I was prescribed Synthroid, which was a horrible experience. I started having severe panic attacks immediately following my surgery. So many people do not make the connection with mental health and thyroid problems. I was close to being suicidal while on synthroid. After 6 weeks of pure hell I was switched to Armour thyroid med and did fine with that until it became almost impossible to get. I was then put on Torosint, 125 mcg and have done very well on it. Now, my insurance company has just decided they want me to be on synthroid or Levothyroxine because of price of Tirosint. I love the way insurance companies become doctors when they don’t want to pay for the meds that are actually needed and prescribed. My doctor will contact my insurance company to get it cleared to continue giving me Tirosint but it just makes me so mad that insurance companies think they know more than doctors do.

    Reply
    • Hi Jodie,

      They can, and certainly do try but it is always up to you whether or not you want to pay the out of pocket price for the medication. They can’t force you to use Synthroid or levothyroxine but they can increase the price of your existing medication to try and push you towards that route. But you always have the option of paying out of pocket for Tirosint if you want. The price (with a coupon) is around $30 per month and without a coupon is probably closer to $100. But if it means keeping your life intact and maintaining your mental health then it may be worth it.

      Reply
  53. Dr. Childs, I had a total thyroidectomy 15 yrs ago, I don’t even recognize myself anymore. I have gained 80 lbs and the rollercoaster ride has been horrible. Can your information help me? You talk a lot about malfunctioning thyroids, but what about NO thyroid. Please help. Beverly

    Reply
  54. What would be a good dosage to take if i am taking 1.5 grains of WP and 20mcg of cytomel? I can’t get the WP or Nature anymore! tired of hunting it down. I know the tirosint is a bit stronger?

    Reply
  55. I am presently taking 200mcg of Tirosint daily. My new Endocrinologist is unhappy with my blood results:
    FreeThyroxine
    Normal Range: 0.6 – 1.6 ng/dL
    Your Level: 2.2 ng/dL.

    I had a pituitary tumor in my teens/twenties and no longer produce TSH.

    I recently had a parathyroidectomy and am in recovery.

    I am very sensitive to medication changes.

    My Endocrinologist
    told me to take 100 mcg on Saturdays and Sundays, to which I immediately became depressed and anxious when I did so.

    My MD tried lowering my Tirosint daily dose to 188mcg, in the past, which seemed fine, but I became symptomatic ( hairloss, extremely cold, brain fog etc.) again in 6 months, so he put my dose back to 200 mcgs. I have been taking Tirosint for over 2 years, with great results. I feel good, vital, no brain fog, no muscular cramps, not cold, hair growth much better, energy level high. The biggest problem arose when the parathyroid disease reared its ugly head and in came hypertension, osteoporosis, calcaemia, kidney stones and more.

    BTW, no thyroid hormone has ever produced weight loss for me.

    I have no history of heart problems or hypertension (except with the parathyroid situation).

    I am 61, 5’2″ and 196#

    So, my questions:
    1) What dose do you recommend?
    2) What test(s) am I missing, that might prove my case, to my Dr.’s?
    3) Are there big risks with this dose, if I have none of the symptoms?
    4) Would you recommend not changing my dose, until a few months have passed, since my parathyroidectomy was today, and can only predict the physical changes, as there hasn’t been time to see any. My PTH is 19 now, down from 121.

    Reply
    • Hi Karen,

      Unfortunately, I can’t provide specific medical advice to your case unless you are a patient of mine. I am only able to answer general questions on this blog.

      Reply
  56. Hi! I have congenital hypothyroidism (since birth), and been through my share of medication changes (and attempts at self-medicating in my teens…ie deciding I didn’t need meds for this…I was wrong). In any case, the worst part for me has always been switching of meds due to discontinuation or some other reason. I have been dosed as high as 150mcg with Levoxyl (before it was taken off the market), and now at 125 with Tirosint for a few years. Overall I feel pretty good, but am 48 and a bit worried about the connection to osteoporosis that I’ve read about. Thankfully I’ve been blessed with good genes and never had to worry about weight much (helps that I’ve always been active in athletics). Tirosint, however, is not cheap, $65 per month with my insurance, and I was interested to see your comparison of 50mcg of levothyroxine which has no additive coloring. Is that the generic version or is there a brand name that you recommend. Not looking to switch right now, just curious in case the cost of Tirosint becomes prohibitive at some point, as it’s been steadily going up. One more thing, they just changed the packaging to omit days of the week on the blisters. I am bummed because that really helped me keep track since I tend to forget sometimes when I’m in a hurry and I do have the occasional memory fog (due to getting older or being hypo I don’t know, but used to it).

    Reply
  57. I had a TT about 4.5 weeks ago for papillary carcinoma. Thyroid levels were all in normal range prior.

    I’ve been on levothyroxine and have recently experienced abdominal pains, bloating and the worst reflux of my life. I’ve always had reflux and a hiatal hernia but they were manageable with ranitidine. I’ve been suffering so much lately, I went to see a gastro who prescribed a PPI (protonix). I hope I didn’t have to throw a PPI in the mix as a result of levothyroxine. And the worst part is that I have to space them out 4 hours, so by the time I eat breakfast I have a hunger headache.

    Not sure if I should switch thyroid meds or try taking one of the meds at night.

    Also, I am sensitive to side effects and have several (minor) food allergies.

    And lately, I’ve had joint pain. Though I was told my calcium levels were normal after surgery and my parathyroids were not damaged.

    I know another variable to consider in the big picture is that my own natural thyroid hormone will still be in my system until the 6 week mark. I’m told it is then I will truly know how it feels to not have a thyroid and if I need more or less supplementation.

    Any advice would be greatly appreciated!! I just want to feel normal again!!

    Reply
  58. The only concern I have with switching from Synthroid to Tirosint is that of tweaking the dosage. The website for Tirosint says you can’t cut pills in half. However, I experimented with a pill cutter and made a perfect half, with no spillage whatsoever. I didn’t take it, of course. I would need to be assured that it was safe to take Tirosint once the capsule has been opened. Do you know why we aren’t supposed to cut them in half? Do you have any patients who cut the capsules in half? Thanks!!

    Reply
    • Hi Nicole,

      Medication capsules tend to delay absorption until specific parts of the intestinal tract to optimize medication absorption. Some may also cause irritation in the esophagus or stomach if they aren’t protected. This may be part of the reason why they don’t recommend breaking the capsule.

      Reply
  59. Hello I really could use some answers. I’m working with my naturopath to switch me from Armour thyroid which I was at 75mg over to tirosint at 112 milligrams and I felt like I was having a lot of headaches and loopy headed feeling

    I had my dose reduced to 88 mcg, however I’m still having headaches but I don’t feel quite as loopy..

    I have several questions but the main one that I would like to ask is Armour measures t4 differently than the other t4 medications alone do armor only has something like 38 milligrams of t4 so when you switch someone over to something that is t4 only and that is tirosint which is liquid what would the proper dose be? I still feel that my dose is too high because of this constant headache. My labs have shown me in the hypo status and my t3 is mid to upper level. I could really use some answers I’m starting to get very upset and have some depression was not finding the right dose I can always go back to Armour if I can’t figure this out with tirosint but I really feel like because tirosint is liquid it should be dosed at a smaller rate?

    Reply
    • Hi Tara,

      The fact that Tirosint is a liquid does not necessarily change how you dose it. It’s more readily absorbed compared to capsules which may mean that some people absorb more than others, but in general, the way to transition from Synthroid to Tirosint is to keep your dose the same at first and then adjust as necessary.

      Reply
  60. I have been taking Levothyroxine for many years. The last dose prescribed was 125MCG. I am seeing a new physician. He changed me over to Tirosint 50mcg. I was also put on the Paleo diet. Have been on both for a week. I am not losing weight even though the strips show I am in ketosis and I am sweating terribly. Actually, I feel bad all over. Is this normal with the switch being so recent? I had radio active iodine over 30 yrs ago for Graves’ disease. Thank you for any info.

    Reply
    • Hi Char,

      It doesn’t really make sense for you to transition from 125mcg to 50mcg considering these are the same medications from an active ingredient standpoint. All you did was dramatically reduce your dose which may explain your current symptoms.

      Reply
      • I want to try Tirosint but I can not afford 122.00 a month. I don’t have insurance so I have to pay cash. Is there any other discount programs that would bring it to at least 40.00 a month?

        Reply
        • Hi Julie,

          Yes, there are discount programs which are available and I have links to those programs in the article itself if you want to take a look at them. My experience is that these coupons and discounts don’t always work, however, so keep that in mind.

          Reply
  61. Hello
    I had my thyroid removed in Jan 2019 due to cancer. The surgeon prescribed 100mg Levothyroxine. I seemed to do well on this only it was generic. My endocrinologist wants me on brand only. She switched me Unithyroid. After 3 weeks I had terrible joint pains. She then switched me to Tirosint. About three weeks into both the unithyroid and tirosint I broke out in hives and extreme itching. She sent me to the dermatologist. She put me on Predisone. I have taken 2 rounds of it. Plus topical creams/ointments to relieve the itchy. It is not working. My skin has always been extremely sensitive. I get blood work done again in a few days. Could this be a reaction to the tirosint (too much.) I currently have headaches and trouble with eye sight as well. The itchy and redness along with extremely dry skin is driving me nuts.

    thanks

    Reply
  62. My daughter is 23 and has Graves. Her thyroid was made inactivated by radio iodine right before 9th Grade. She has dealt with extreme depression and self-harm since her first year in college. I can’t help but think it has to do with her taking Synthroid and her inability to absorb T3. It’s very tricky to be involved with her care now because of her age, but I want her to straighten out her hormone difficulties instead of being on prescription meds for her depression and anxiety. Does this sound like a T3 absorption problem?

    Reply
  63. Tirosint question:
    I just went into REMISSION of Hashimoto’s disease. I am happy but still have alot of unexplained fatigue even after a consistent use of bioidentical hormones. I have only been on 15mg of Armour. It is a tiny improvement in energy and the only option for me. I was given a trial of oral Tirosent to try. I felt extremely sad and emotional on the first dose. I didn’t take any of my Armour with it. Is this a bad idea to try another few days? My doctor was so confident that it would finally work for me! She just wants SOME improvement in my symptoms now.
    Please, please help.
    Thank-you,
    Courtney

    Reply
    • Hi Courtney,

      Every medication change requires some amount of adjustment and this adjustment phase can vary in length. It’s probably too soon to tell if you are responding well or not to your medication just based on your reaction over the course of a few days.

      Reply
  64. I became allergic to my generic Levothyroxine after taking antibiotics! Tried Synthroid reacted and just got Tirosint sol! It’s making my ears so clogged I feel like they are going to bust even with small amounts and severely dizzy. Could it be I’m allergic to even the actual Levo ingredients or is it symptoms of starting this?

    Reply
    • Hi Paula,

      I would never say never, but I find it highly unlikely that you would be reacting to the thyroxine component of the medication because this thyroxine component is identical to what your body produces naturally. It would not really be compatible with life you were allergic to hormones that your body produces. It’s theoretically possible, however, but highly unlikely.

      Reply
  65. Hi. Is it, or an equivalent of it, available in Canada? I’m having a terrible time on Synthroid and no one seems to have any answers for me.

    Reply
  66. I have been taking bio-identical T4/T3 for 10 years. I never see it mentioned. My TSH is 8 so my doctor added 25 mg of Tirosint. I’m having heart issues now and not feeling well. I’m more tired than ever. Don’t know what to do? What is your opinion of bio identical and why is it never included in a discussion about thyroid replacement? Thanks!

    Reply
    • Hi Elaine,

      All of the thyroid medications are bio-identical but I imagine that most physicians are probably not aware of that. This is actually uncommon for prescription hormones as most hormones (including birth control and medications for menopause) are NOT bio-identical.

      Reply
  67. Hi Doc,

    My mother is 98 and is on Synthroid now. She was on Levoxyl for many years before her cardiologist switched her to Tirosint in 2012. She tolerated it very well and so many of her symptoms like hair loss, lethargy, lack of energy, dizziness, and anxieties, etc. went away.
    She was put back on Synthroid by her new PCP for reasons we don’t know. Her old symptoms all came back.
    Questions:
    1) How do we convince the new PCP to switch her back without angering her?
    2)We noticed that her caregivers are not giving her the 8 oz of water required after taking her Synthroid in the morning. What happens to absorption and the impact on her gastric condition without this water?
    3) We also noticed that the PCP raised her dose to about 2 times what she was taking while on Tirosint. PCP does not test her T3, only TSH a while ago. Nor did she test her T4 level. What further tests should be taken to ensure the right dose?

    Other medications my mother is taking is Valproic 9 ml (liquid version equivalent to 750mg – 250mg=3ml) at 3ml 3 times per day for seizure. And an extremely small dose of bp medication – Bystolic 1.25mg per day. She takes no other medication. She is lethargic most of the time now and seems not able to connect with you. She also has age-related dementia.

    Any help you can give us to convince her PCP to switch back to Tirosint will be greatly appreciated as this happened on January 9, 2019, and we just now discovered it. Lin

    Thank you, Lin

    Reply
  68. Great read. I just switched from Levothyroxine, today, since taking it for 7 years. The problem I have while on it is extreme tiredness and fatigue. I can sleep for 10 hours, be up for 2 and want to take a nap again. It has impacted my lifestyle so, I am hoping that Tirosint is a better option to regain my energy.

    Reply
  69. I was considering trying Tirosint but thought I would read some reviews before talking to my Dr. about it.

    I just got on Drugs.com and something appears to be amiss with recent batches of Tirosint. Person after person recently reported that they WERE doing very well on Tirosint but are now having major problems with it. This wasn’t just a few people, it was almost every review lately. Many reported that there was a new manufacturer? I don’t see how that could be, but that’s what they said.

    Don’t know what to do now. Recent reviews for Tirosint are awful and the cost is sinful. Of course, people on Medicare aren’t eligible for the cheapest way to buy it. The cheapest I could find was $120.00 for a 90 day prescription. $40 a month….I could probably do, but they seem to go up every year lately. The last thing I would want to do is start using it, only for the price to double or triple. That happened to many.

    Reply

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