What are my thyroid medication options?

You have many options, and you should know about them.

The most common treatments for hypothyroidism include T4 monotherapy with levothyroxine, natural desiccated thyroid (NDT) aka “glandular thyroid,” and a regimen of T4 and T3 medications taken together. Figuring out the best option for you may take some time. See the accompanying chart for pros/cons of commonly used hypothyroidism therapies.

T4 Monotherapy (Levothyroxine, Synthroid, Tirosint etc.):

• Pros:

  • Current standard of care for hypothyroidism

  • Proven safe and effective

  • Available at all pharmacies

  • Usually low cost

• Cons:

  • GI conditions, medications, sensitivities to excipients/ inactive ingredients in tablet formulations can interfere with absorption and tolerability

Natural Desiccated Thyroid (NDT; NP Thyroid, Armour Thyroid etc.):

• Pros:

  • Contains both key thyroid hormones: T4 and T3

  • An option for people who need supplemental T3

• Cons:

  • Derived from thyroid glands of pigs – an issue for vegans

  • NDT therapies are tablets that contain excipients or “fillers”

  • The T4:T3 ratio contained in NDT tablets is 5:1 – different

    than the normal human ratio of these hormones

  • Can lead to cardiac problems like rapid heartbeat, insomnia,

    and feelings of anxiety

  • It comes from pigs and may contain porcine antigens,

    which may be problematic for some people

  • Not all pharmacies carry NDT products. Not all insurance

    carriers pay for them

Combined T4 and T3 Medication Therapy (Levothyroxine + Liothyronine/Cytomel etc.):

• Pros:

  • Consistent potency

  • Can be an option for those in need of supplemental T3

  • Available at most pharmacies

• Cons:

  • Two separate medicines that need to be taken daily. T4 is taken once a day; T3 may be recommended in multiple daily doses

  • Some insurance plans may require two medication copays

  • T3 can be risky for some patients with cardiovascular

    conditions. Some patients can experience heart palpitations and other side effects

I know, it can be a lot to take in and it can be difficult to know which option is right for you. I’d be happy to discuss your specific case and thyroid needs - you can schedule a consultation with me to see if I am the right doctor for you! Let’s get you not just feeling better, but optimized so that you can do everything you want to.