This is Part 1 of a 3-part series on the Ultimate Guide to Thyroid Medication:
- Part 1 – [You Are Here] – The Ultimate Guide to Thyroid Medication (the Good, the Bad, and the Ugly)
- Part 2 – 3 Simple Rules to Supplementing Thyroid Hormone the Right Way
There’s a lot more to your thyroid medication than you might realize.
Sure, as with most medications and drugs today we are led to believe that all we have to do is pop a pill and somehow it just magically works as expected and everything will be OK.
But what happens when it doesn’t?
Well, the reality is that in the case of thyroid medications, it almost never does…
…which is why today we’re NOT going to be talking about useless medical theory that sounds great on paper.
Instead, we ARE going to be covering the practical experience… the good, the bad, and the ugly of thyroid medications and how they actually work in the “real world”.
Finding What Works Best For YOU
When working with clients, we sometimes spend a good amount of time discussing what options might work best for them.
And in most cases, I find they are using the wrong medication… or using the right medication in the wrong way.
I’ve personally had dozens of clients who have seen drastic improvements just by changing to a source of thyroid hormone more appropriate for them.
In case you missed that, let me repeat “a source of thyroid hormone more appropriate for them.”
When it comes to thyroid medications and supplements, there’s no one best option that works for everyone.
I wish there was, but there’s not.
The type of medication or supplement that would work best for you can be quite individualized depending on the underlying problems that are driving your thyroid condition.
(Note: If you haven’t seen it, I discuss many of these underlying problems and how we address them in this article here.)
And oftentimes determining what works best for you requires a little experimentation to see what your body responds to best.
In other areas of medicine we see this all the time.
In cancer treatment, it’s not uncommon for doctors to try multiple anti-cancer drugs or even combinations of drugs until they find what works the best for a specific type of cancer.
But when it comes to hypothyroidism… I guess the medical system doesn’t think your quality of life is quite as important.
While this is not designed to be a comprehensive list of every available thyroid medication option…
…let’s cover the most commonly used thyroid medications you might be using or might want to work with your doctor to take for a test drive.
If you’re unsure of which category your supplement or medication falls under, you should ask your doctor or do a little research and look at the manufacturer’s website.
1. T4-Only Medications
Here’s quick list of some commonly prescribed T4-Only medications:
T4-only medications like Synthroid and Levothyroxine are by far the most commonly prescribed thyroid medications used today.
In fact, Synthroid is the most prescribed drug of all drugs today.
Unfortunately, these are pretty much the worst options too, which means that they are doing millions of people a great disservice.
We’ll have to dig deep here, because by themselves, T4-only medications tend to cause more problems than they solve.
However, there are cases when T4-only medications can provide some benefit.
For example, when your thyroid gland becomes blocked resulting in a significant drop in your T4 level.
However, this rarely if ever is the only thyroid issue at hand. And in almost every case the addition of T3 is warranted.
Or if you have a goiter or enlarged thyroid and we need to slow the production of thyroid hormone produced by your gland in order to allow your gland to unload its stored thyroid hormone slowly.
In this event, the addition of T3 is almost always warranted as well.
Yet, in some cases, T4-only medications can be better than nothing at all.
T4 is the inactive form of thyroid hormone that must first be converted into the active T3 version of thyroid hormone before your body can actually use it.
This T4 to T3 conversion takes place in your liver.
Unfortunately, almost all hypothyroidism sufferers quickly develop liver dysfunction, which impairs your ability to convert your T4 medication into usable T3 thyroid hormone efficiently.
I talk about this in detail along with simple ways to fix this in this post on How to Heal Your Thyroid By Healing Your Liver.
In other words, for most hypothyroidism sufferers, T4-only medications are more often than not useless, and oftentimes dangerous.
I’ll explain what I mean by dangerous in just a second.
Yet, this is the most common reason why you may still be experiencing all of the same thyroid symptoms even after long term use of your T4 thyroid medication… and even when your thyroid labs are within the “normal” range.
There are now plenty of studies showing just how ineffective T4-only medications are.
For example… the following study showed that the test subjects using T4-only medications experienced worse thyroid symptoms than test subjects that received no treatment whatsoever.
Thyroid Insufficiency. Is Thyroxine the Only Valuable Drug?
Journal of Nutritional & Environmental Medicine (2001), 11, 159–166
Yet, the medical system still continues to push T4-only medications as the best available option.
But, what about when T4-only medications become dangerous and cause more harm than good?
When your liver can’t convert T4 into useable T3, then what happens to all that T4 you’re medicating with?
It tends to build up in your system and shuts down your thyroid gland.
Keep in mind that your thyroid gland produces both T4 and T3… so this can result in a further drop in your useable T3.
This is oftentimes the main reason why many feel worse after using T4-only medications or fail to improve no matter how much T4 they use.
2. Desiccated Thyroid
- Natural Desiccated Thyroid (NDT)
Desiccated thyroid has been used for well over 100 years and was the thyroid medication of choice long before synthetic T4-only medications were designed in a lab.
It is derived directly from the thyroid glands of pigs and/or cattle depending on the brand of the medication or supplement.
One of the biggest benefits of desiccated thyroid is that the thyroid hormone it contains is far better matched to what your thyroid gland naturally produces.
Your thyroid gland produces both T3 and T4, making T4-only medications quite unnatural from a physiological perspective.
For many of my clients who come to me using T4-only medications and have not tried desiccated thyroid, I generally recommend that they start there.
That is unless their lab testing, temperature, and pulse measurements suggest otherwise.
And it’s typically easier to get a prescription for desiccated thyroid than some other options.
But unless you are working with someone qualified to understand your lab results and help you in more depth, desiccated thyroid is generally a safer option.
And research studies continue to show that compared to T4-only medications patients prefer desiccated thyroid.
However, there are also problems with desiccated thyroid as well which is why some people don’t respond well.
But it’s important to understand that if you don’t respond well to desiccated thyroid, it’s not “typically” an issue with the medication itself.
It’s typically an underlying issue with you that needs to be fixed, which I’ll explain in a second.
Many doctors are not open to the idea of using desiccated thyroid with their patients. If your doctor is one of them, then it might be time to start looking for a new doctor…
…one that will listen to you and truly has your best interests at heart.
As I mentioned, some people don’t respond well to desiccated thyroid for a couple of reasons.
Many hypothyroidism sufferers respond negatively to desiccated thyroid because they are very sensitive to the active T3 thyroid hormone it contains.
(Note: I talk about how to use thyroid hormone in this post on the “3 Simple Rules to Supplementing Thyroid Hormone the Right Way”)
For many, using a thyroid medication or supplement containing T3 can cause elevated heart rate, heavy breathing, and feelings of stress and anxiety.
If you’ve ever experienced this then you know exactly what I’m talking about.
But the important thing to understand is that just because you can’t tolerate T3 (right now)…
…it doesn’t mean that you don’t need T3 (quite the opposite).
Elevated stress hormones are by far the most common cause when it comes to not being able to tolerate T3.
Because when you become hypothyroid your body compensates by over-activating your stress response.
For many, this means very high levels of adrenaline.
And T3 tends to make you much more sensitive to the effects of adrenaline.
In other words, too much T3 will amplify the effects of adrenaline causing those symptoms of increased heart rate, anxiety, and other high stress symptoms.
This is one reason why you might want to be careful when using thyroid medication containing active T3 when you’re already in a stressed state.
But as I mentioned, this is not a problem with the medication, it’s a problem with you that needs to be corrected by properly de-activating your stress response.
Do that and your tolerance for thyroid hormone will improve dramatically.
Another problem with desiccated thyroid medications is that some people can’t digest and absorb them properly.
And when you can’t digest and absorb the thyroid hormone from your medication, you tend to experience little to no positive benefits.
Oftentimes this is due to various fillers and binders used in the production of the tablets.
For example, with Armour Thyroid, some people cannot break down the cellulose (fiber) component within their digestive tract, so it just passes through and is excreted without being absorbed.
The bottom line is… if you can’t absorb the thyroid hormone, it’s not going to do you much good.
3. Compounded Thyroid
Compounded thyroid is thyroid hormone containing T3 and/or T4 that is specially formulated or customized through what is called a compounding pharmacy.
Oftentimes it is very similar to standard desiccated thyroid medications but with certain tradeoffs.
One of the biggest benefits of using a compounded pharmacy is that they have the ability to customize or adjust the strengths or ratios of T3 and T4 outside of what is commercially available with desiccated thyroid medications.
So, in a perfect world where you knew the perfect ratio of T3 and T4 that works best for you, it could be made to order.
Another benefit of compounded thyroid is that compounding pharmacies can also control the additional inactive ingredients that are added to the formula which you might be sensitive to as well.
This can be a benefit to people with severe allergies to certain ingredients commonly used in many types of thyroid medications.
Like desiccated thyroid, compounded thyroid also oftentimes contains fillers, binders, and time release components that can negatively affect your ability to digest and absorb the hormones.
And even though compounded thyroid can be customized to your needs, it is rarely if ever done properly.
And in reality, the amount of thyroid hormone you may need at any given time can change depending on a number of variables from seasonal climate changes to changes in your stress levels.
For example, I had a client who over the course of three months made a miraculous recovery.
Then after her father passed away unexpectedly, the amount of stress she was under set her back significantly.
While we can’t always control stress, we can learn how to compensate for it through proper diet and supplementation.
And after making some adjustments to her diet and thyroid hormone, this particular client was able to stabilize her thyroid function and prevent further regression.
The inability to adjust the dosage is really a problem with most types of thyroid medications including desiccated thyroid.
Unless your doctor is willing to work with you and take the time to properly monitor how you’re responding to your thyroid medication, it can be difficult to find a single dosage of thyroid that works best year round.
There is a common problem among compounding pharmacies in that they typically do not do a good job producing a standardized product.
In other words, there tends to be variations in the actual amount of thyroid hormone from batch to batch.
In my experience in working with clients using compounded thyroid, it’s not the most reliable option.
In many cases, my clients have had to switch from a compounded thyroid medication to something more reliable and the results in some cases have been remarkable.
4. T3-only Medications
T3 as mentioned above is the active or useable form of thyroid hormone on which you and your cells thrive.
Because T3 is the useable form of thyroid hormone and doesn’t need to be converted by your liver it has a much better chance of being used by your cells.
Or in other words, T3 generally works better, makes you feel better, and is much more effective at improving your thyroid function and health.
(Note: Simply taking T3 does not mean that your body will be able to use it. There are still places along your Thyroid Hormone Pathway that can block your cells from using T3 as covered in this article on How We Overcome Hypothyroidism When All Else Fails.)
T3 is also found in both desiccated thyroid and almost always in compounded thyroid, so this applies to those types of thyroid medications as well.
But I also want to cover some important points specific to T3-only medications.
Similarly to compounded thyroid, using T3 alone provides a much greater degree of flexibility with adjusting your dosage.
But since it’s T3-only, you can also adjust the amount on an as needed basis.
It can also very effectively be paired with T4-only medications, desiccated thyroid, or any other T3/T4 combination medications.
This really allows you to completely fine tune your dosage to meet your specific individual needs… including the timing of when you take it and how often you need to take it during the day.
Many of my clients have favored this approach among all others.
There’s a general fear of T3 in the medical community making it more difficult for patients to get it prescribed.
This goes for desiccated thyroid as well, but even more so for T3-only medications.
Working with my own clients, I’ve found that most doctors are completely opposed to the idea of giving T3 to their patients.
Some of my clients’ doctors are open to the idea but simply don’t know how to because they are entirely uneducated on how to use and prescribe it.
And based on the dozen or so of my clients who have been prescribed a T3-only medication by their doctor, only two were using it properly.
It is this general unawareness and uneducated use of T3 that accounts for the vast majority of negative responses that patients experience when using it.
As mentioned with desiccated thyroid, some people with poor diet and who compensate with a large over-production of adrenaline can’t tolerate much T3.
Too much T3 at one given time can make you very sensitive to adrenaline resulting in almost hyper-thyroid like symptoms… elevated heart rate, sometimes heart palpitation, anxiety, feel extremely stressed, etc.
Yet, this doesn’t mean that you can’t use T3 or even that you shouldn’t.
You may simply need to adjust the dosage properly while you address your over-active stress response through proper diet.
It’s also important to note that with certain heart conditions, T3 should be used with extreme caution and generally in very small amounts while being closely monitored by your doctor.
Keep in mind that your heart does depend largely on T3 to remain healthy and function properly.
But when the heart is in a weakened state, stimulating it too much with too much thyroid hormone can sometimes over-stress the heart.
So, there you have it.
That’s a fairly comprehensive overview of thyroid meds.
Now the question is…
…if your thyroid medication isn’t working for you, are you going to take what you’ve learned and push your doctor to try a medication or supplement that might be more appropriate?
Or is it going to take something as serious as cancer before finding the right medication or supplement for you becomes a priority?
Thank you very much for this article, Mr. Brimeyer!
It was a pleasure to read, highly educational for someone like myself and filled with useful informational.
I work with some personal clients having the exact challenges you cover in the article.
This will surely help us on our way to the optimal individual strategy.
Many thanks for sharing your expertise!
I wish you and your family all the best!
Jon Ch. Henningsen,
JCH Ernæring & Træning,
I was on synthroid for almost 20 years, and complained to my doctor frequently. She sent me to endocrinologists, who did the standard tests and said my thyroid was normal on the drugs, refusing to do reverse t3 or any other than the standard tests.
I got her to switch me to dessicated thyroid, but I am not seeing much difference.
I must have been hypothyroid most of my life (like my undiagnosed mother), with hair loss, ridged nails, irregular periods, inability to lose weight , and many more.
If I ever get out of this house, I am going to see a naturopath and get properly tested. Right now, my thumb nail is split and is painful if it gets caught on something.
Lol mine too, have you ever used white iodine? I don’t stick to it regularly, but when I do, there’s a huge difference. Do you have weird hair like things growing under your nails or other random places?
Sorry. But this article is just another promotion of dessicated thyroid and bashing of t4 meds only. T4 is taken by millions who do well in it. They are not all going to eventually get diseases and die from it. Yes business wellie other meds but some do not. I thought by thebtitlebit might be average unbiased report. It is not.
my t4 is high and im hypothyroid not sure why on earth I would take t4. regular drs don’t even check the full thyroid panel go figure. I don’t think traditional drs know anything at all as they are regulated by insurance protocols . the so called healthcare system is a place of death. you wont even get sent to a specialist until its too late, no one is interested in you until you are DOA
i disagree with Barbara O. I believe that those who are on t4 only meds and they are not having simptoms, they are not going to even read this article cos they are fine and we can be only happy for them. But the rest of us who reached to a point where we suffer irrelevant of increased t4 only, we owe it to ourselves to get educated and try other options out there which might be more helpful.
thank you Tom for sharing this complex meds info and trying to make a difference.
this takes courage to stand agains conventional medicine…
In my clinical experience, porcine glandulars seem to work better than bovine. Some patients fare well on T4 and do not do well on glandulars, inspite of adequate iodine, selenium, zinc, manganese, etc. stores. I’ve discovered that no one size fits all, and that one of the best kept secrets is to get the adrenals functioning optimally in many cases BEFORE fiddling with the thyroid gland. Cortisol depletion is endemic and can have a major impact when it comes to hypothyroidism. Functional endocrine disorders are more common than most doctors know and are largely ignored – until diseases occur.
Thanks for re-iterating what’s mentioned in the article. As for the adrenals, a very misunderstood topic that I plan to write about. Most have it backwards. Hypothyroidism itself over-activates the adrenals which I’ve touched on in past articles.
Absolutely, that’s absolutely correct. Thank you for putting that out there. I’ve had about enough of people not understanding that hypothyroidism causes adrenal dysfunction every bit as much as adrenal dysfunction exacerbates cellular/tissue hypothyroidism. The liver needs to be dealt with, first and foremost, along with the stomach acidity and the gut health, simultaneously taking care of the thyroid and the adrenals. Trying to fix the adrenals first only causes more stress while the hypothyroid state continues to worsen… those of us who have been to doctor after useless doctor, being told “you’re fine” have already been waiting long enough. We can’t afford to wait years more to fix the adrenals before fixing the thyroid. So thank you, Tom, for putting this information out there, and correcting those who are just plain wrong.
I appreciate this article more than you will ever know. My levels are like a roller coaster. I have reached the bottom, and I feel like that commercial I have fallen, and I can’t get up. Finding an endocrinologist that will listen is a challenge. Once upon a time I had a decent Endocrinologist, who finally put me on a combination of meds.; I felt physically alive again and, of course, we had to move. Then back to GP that puts you back on the basic generic meds that cause a great deal of added stress especially when you live for, and Desire physical activity and you have two boys. It makes no sense when you eat healthily and exercise like a freak that your weight and energy level is like a ridiculous roller coaster ride. Every time you go to the DR. your glucose level is high when you are barely consuming any sugar ( 20 grams or less a day, I MONITOR THAT!) somehow your tests results just don’t make any sense what so ever. Your Neruo puts you on some other med that totally depletes your appetite and, of course, you are going to lose weight if you are forcing yourself to run 10 miles a day ( training for marathons) and have no desire to eat. But the side effects of this medication. I hate medication that is not a necessity, but they force you to take it or make threats of taking away your life. There has to be some natural solution for seizures. Yes, it’s called don’t force me to take meds! I love to exercise to reduce anxiety and stress, a natural remedy. Now, I waited months to see the best Endo. in my city and I have never been more disappointed in my life. I didn’t see him they rescheduled my appointment without my knowledge with his daughter. She said you take one med or the other not 2 and at night or in the morning, your other Endo. Your other Endo. didn’t know what she was doing. I could tell she was fresh out of medical school and not open to anything new. One of those individuals that will deny ignorance about anything, so this was obviously going nowhere. I might as well have been talking to the wall. Lower the LEVO ( generic) and since I have been on generic compared to Synthroid, no matter if the dose is the same my energy level, and weight varies month to month or within a 90 day period. So, what does that tell you about generic? I don’t have the energy to run anymore and after my 5-mile walk every day I hobble around. It is ridiculous. I want myself back! If I consume anything more than 800 calories per day the pounds pack on, and I have gained over 14 pounds in the last eight months. I fight it, but it just slowly keeps coming on. This depletion of energy is driving me insane, and it is only getting worse. I hate the woe is me attitude! I like the HEY WORLD IT’S ME attitude. I am thankful that my brain never stops, I have responsibilities, and I am a fighter. I will not stop until I find a solution that is if I can remember what in the heck I read yesterday and the day before. LOL! I just want to wake up and sing the hills are alive with the sound of my music every single morning and just LIVE it! :D I hope someone knows where the heck I am coming from.
Your cells rely on glucose/sugar to survive. If you don’t consume carbohydrates then your body will over-produce the stress hormone cortisol to break down protein in your body to convert it into sugar. And cortisol suppresses thyroid function. That’s why you blood sugar is elevated even when you don’t consume carbohydrates. It’s also why eating a low carb diet doesn’t solve the real problem.
What a great article! Definitely makes things so much clearer! I was on Synthroid for couple years without any trouble. My doctor recommended that I try Nature-Throid. I was on it for a couple months and felt fine and she recently upped my dosage due to my TSH level of 6 and my TPO of 600 (I also have Hashimotos). Ever since then I have had flue like symptoms (severe nausea-especially after eating, heart racing, lost 10lbs, sweating/chills, irregular periods, anxiety). I have never experienced any of these symptoms before. It feels like I am now hyperthyroid even though my bloodwork shows otherwise. The symptoms come on like a wave out of nowhere and now I am wondering if I am reacting to the T3?
I am quite new and really enjoyed reading the messages, I am hypothyroidism and Hashimoto’s, I was really impressed by Tom articles and bought his meal plan hope it will help me
For the moment thanks for all the information you provide me
Can stopping Synthroid give you hyper symptoms like racing heart, insomnia, anxiety?
Hi Tom, yes if your body compensates by producing more adrenaline.
What about when you have no thyroid?? Had mine taken out due to multiple masses on it. Now, I feel like a yoyo bouncing back and forth between hyper and hypothyroidism symptoms. Working with a great practitioner now, she’s reading the articles I give her, help!!
Hi Ms Sam, everything we teach still applies 100% however you will need to supplement thyroid hormone to the degree that you can’t produce it. I’ve written more on the topic here: https://www.forefronthealth.com/rai-and-thyroidectomy/
Hello Dr. Brimeyer,
I only take Levotyroxine (150) and have problems sleeping, I find myself unable to fall asleep although I am tired and any little noise wakes me up. I never checked my liver function but I put on weight easily although I don’t eat much. Having my hypothyroidism treated I would expect not to have these issues at all.
Would you advise to take the T3 as well?
Hi Laura, T3 is always important to use, especially when taking T4. This article on sleep might help: https://www.forefronthealth.com/hypothyroidism-and-insomnia
I’m new to this site and to my hypothyroidism diagnose. I went to my Dr. because I was having severe muscle aches mainly under my arms and in my chest area and I felt exhausted all the time. After a mammogram came back normal, my blood worked showed that I have hypothyroidism. I started taking Armour thyroid and almost immediately got a terrible yeast infection (very rare for me). We decided to increase the dose to see if I needed more but the yeast infection got worse so I have switched to Naturethroid. Most of the yeast infection cleared up except for one small area. Have you ever heard of this happening before and if so can you suggest why it would?
Mr.tom…I have no thyroid…I started on armour and was having terrible sensitivity to it…nausea…shakes..anxiety… insomnia..etc…I was changed to levothyroxine…am only on a low dose due to tolerability issues…please help me…I have too much adrenaline..I get headaches and itchiness…on low does I need more thyroid hormone…
Hi Teresa, that’s one reason it’s best to start very slowly when supplementing thyroid and multi-dosing. It’s also best to lower adrenaline through diet. I would recommend getting started with the 3 Food Thyroid-Boosting Protocol here: https://www.forefronthealth.com/lp/thyroid-boosting-daily-protocol/
I have been taking NP Thyroid by Acella for about two years and have been doing well on it. Because Medicare will not cover NDT and will not allow it to be prescribed, I will be going to a DO in New Hampshire that is a Direct Pay physician. She uses a compounding pharmacy, so I am anxious to see how I will do with that form of NDT. Anxious in a good way!
I was diagnosed with hypothyroidism and a low starting dose of T4 resulted in bolting awake at 3 AM approx 3-4 weeks in. I didnt sleep for 5 days, I was exhausted but could NOT sleep.I lost 48 pounds in ONE MONTH ! Severe depression and anxiety was constant and a visit to the emergency room and later to the same doctor who prescribed it (with the proper appointment 2 months later of course) PROVED to me 2 things. NOBODY KNOWS OR CARES TO LEARN, Both just casually took blood for lab results that would return several days later like I was there for a routine checkup or something .Lab work from the emergency room came back with TSH still almost 4 and Free T4 normal. despite the hyperthyroid or thyroid storm symptoms. It took 3 months to feel anywhere near “normal” which is back to no energy to the point of being bedridden and constant bouts of severe depression and anxiety but I am supposed to pull myself up by the ole bootstraps and do everything myself ? I really admire and respect the ones who do fight it and get better. You are stronger than I am. The system, like nature has a way of thinning the herd also.
Hello again, just to comment on here that my experience has been all that Tom has stated: continued then worsening symptoms of hypothyroidism under synthetic T4-only, then trying NDT with the ups-and-downs of formula changes and manufacturer issues, then hoping that extremely small amounts of T3-only (liquid form) would save the day which led to too many negative reactions. Working on the factors around T3 conversion using Tom Brimeyer diet recommendations / recipes and starting to get the Ray Peat Newsletter plus joining the Ray Peat Forum in the process, has led to amazing bodily improvement (lifelong issues not seemingly related to thyroid itself but definitely histamine-related have come up and started to slowly resolve — in the 5th year now, from February 2016). It’s a journey not a destination and takes awhile but progress is assured once one STOPS the levothyroxine and starts taking these Brimeyer diet and blog advice posts to heart. Essential to take very small steps / amounts in all things: from foods to substances ‘taken’ to activities pursued. Remain calm to combat stress and get sleep (easier said than done, believe me I know). JW (age 65 and still working — never retire!)