Which Is The Best Thyroid Drug For Hypothyroidism?

Which is the best thyroid drug for hypothyroidism

The biggest human temptation is to settle for too little.

-Thomas Merton

Many Hypothyroid Mom readers ask which thyroid drug is best. My answer is always the same, “I wish there was one thyroid drug that worked for all of us but the reality is that we each react differently to the different medications. We must work closely with our doctor to investigate which treatment is ideal for us and what dosage is optimal.” The key is that you must know all the treatment options to ensure your doctor is exploring the options to find what’s right for you. If you are being treated with thyroid hormone replacement medication but you still don’t feel well, insist on further exploration. If you are still not feeling well, get a second opinion, a third opinion, even ten medical opinions until you find a doctor that explores the options to find what’s right for YOU.

Don’t settle.

Thyroid Drug Options

T4 Drugs

Author of the book Living Well with Hypothyroidism: What Your Doctor Doesn’t Tell You…That You Need to Know Mary Shomon shared the following information:

Levothyroxine is the generic name for the synthetic form of thyroxine, a thyroid hormone replacement drug. This drug contains the synthetic form of one thyroid hormone, T4. Levothyroxine is the most commonly prescribed thyroid hormone replacement drug.

Brand names in the U.S: Synthroid, Levothroid, Levoxyl, Unithroid

Brand names in Canada: Synthroid, Eltroxin, and PMS-Levothyroxine

Brand names outside U.S.: Euthyrox, Thyroxine, Berlthyrox, Droxine, Eferox, Elthyrone, Eltroxin, Eutirox, Letrox, Levaxin, Levotirox, Levothyrox, Levotiroxina, Oroxine, T4KP, Thevier, Throxinique, Thyradin, Thyradin S, Thyrax, Thyrax Duotab, Thyrex, Thyro-4, Thyrosit, Thyroxin, Thyroxin-Natrium, Tiroidine

When I polled my Hypothyroid Mom followers for their top thyroid medication, many mentioned Tirosint. The levothyroxine in Tirosint is in a liquid form inside a capsule.

T3 Drugs

There are synthetic T3 drugs like Cytomel. Through a compounding pharmacy, there are also prescription compounded T3 drugs including time-released T3.

Natural Desiccated Thyroid

Brands include Armour made by Allergan (formerly Forest Laboratories), Nature-throid and Westhroid by RLC Labs, and NP Thyroid by Acella Pharmaceuticals. Canada’s desiccated thyroid made by the company Erfa is called simply Thyroid. There are also compounding pharmacies worldwide that produce compounded versions using the raw natural desiccated thyroid powder.

Find The Right Thyroid Treatment For YOU

We are each unique with individual sensitivities. Our bodies will NOT all react the same to these different medications. The dosages that are ideal for each of us will also vary. Our uniqueness is what makes finding the right thyroid treatment tricky.

Thyroid hormone replacement drugs are powerful, so powerful they can kill you if not taken properly. This is why it is critical to be under careful medical supervision when on these drugs, especially careful when starting a new brand or increasing dosage level. Call your doctor immediately if you experience adverse reactions.

1. Sensitivities to the fillers used in the medications

Author of the book Your Personal Paleo Code: The 3-Step Plan to Lose Weight, Reverse Disease, and Stay Fit and Healthy for Life Chris Kresser wrote:

Many popular thyroid medications contain common allergens such as cornstarch, lactose and even gluten. As I explained in a previous post, most hypothyroid patients have sensitivities to gluten, and many of them also react to corn and dairy (which contains lactose).

Synthroid, which is one of the most popular medications prescribed for hypothyroidism, has both cornstarch and lactose as a filler.

Even the natural porcine products like Armour suffer from issues with fillers. In 2008, the manufacturers of Armour reformulated the product, reducing the amount of dextrose & increasing the amount of methylcellulose in the filler. This may explain the explosion of reports by patients on internet forums and in doctor’s offices that the new form of Armour was either “miraculous” or “horrible”. Those that had sensitivities to dextrose were reacting less to the new form, and experiencing better results, while those that had sensitivities to methylcellulose were reacting more, and experiencing worse results.

Thyroid Pharmacist Dr. Izabella Wentz, author of the book Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause wrote:

Compounded T4/T3 products offer another alternative. These medications also offer the advantage of being made without fillers such as lactose or gluten, which are present in some thyroid medications and can be problematic for thyroid patients.

However compounded T4/T3 products need to be prepared by a specially trained compounding pharmacist. These compounds are usually much more expensive and may need to be refrigerated to preserve activity.

Thyroid compounds are usually prepared in the same physiological ratio that is found in Armour®, however, physicians can elect to change the amount of T3/T4, as the compounding pharmacists are literally making the medications from scratch. This can be a huge advantage for those patients that did not feel well on conventional treatments or natural desiccated treatments.

2. A gentle start to dosing

My doctor increased my thyroid drug dosage gradually in an incremental fashion until she found the dose that was optimal for me. She adjusted my dosages by regularly monitoring my Free T4, Free T3, Reverse T3 and thyroid antibodies and most importantly by listening to my symptoms. I contrast that with the stories I hear from readers of their adverse reactions to their doctor’s  prescription for sudden large dosage increases and medication brand switches at high doses. T3 drugs such as Cytomel and natural desiccated thyroid have active T3 in them which for some people can be stimulating for the heart and cause heart palpitations. It is critical to have a gentle start.

In the book Thyroid Power: Ten Steps to Total Health, Richard Shames and Karilee Halo Shames wrote:

Some people do not want to take the time to start with a mild dose, adjusting to their medication gradually. However, we have found that the slow, step-by-step method of reaching your optimal dose is more easily tolerated by the body than the “sock it to me” approach so characteristic of our fast-paced culture.

3. The need for T3 treatment

In mainstream medicine, T4 drugs like Synthroid are the gold standard for treatment of hypothyroidism. While these drugs work for some, for many of us these drugs fail to relieve our symptoms. Our bodies need to convert the T4 in these drugs to the active useable thyroid hormone T3. However for many hypothyroidism sufferers, our bodies don’t convert the T4 to T3 and we are left suffering symptoms. If you are on T4 only drugs and you are still not feeling well, speak with your doctor about testing your Free T3 levels to determine if you would benefit from T3 medication.

Many of us report feeling our best on natural desiccated thyroid. However others report not reacting well to NDTs and responding better to synthetic T4 and T3 drugs. Even with natural desiccated thyroid, many of us feel great on one brand but terrible on another. Again we are each unique and it’s about finding what works best for you.

4. Finding your optimal thyroid levels

Many hypothyroidism sufferers are not feeling well despite treatment because their lab results are in the “normal” range but not at the optimal level for them.

If you are being treated with thyroid hormone replacement medication but you still don’t feel well, insist on further exploration. If you are still not feeling well, get a second opinion, a third opinion, even ten medical opinions until you find a doctor that explores the options to find what’s right for YOU.

Don’t settle.


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About Dana Trentini

Dana Trentini founded Hypothyroid Mom October 2012 in memory of the unborn baby she lost to hypothyroidism. This is for informational purposes only and should not be considered a substitute for consulting your physician regarding medical advice pertaining to your health. Hypothyroid Mom includes affiliate links including the Amazon Services LLC Associates Program.


  1. I have been on several thyroid meds. I am currently NOT taking any because to date I have discovered that these meds are increasing my arthritis pain and swelling in my ankles. I was to 4 different drs for aa out 18 months for pain and swelling in my ankle. No one could explain the cause. The pharmacy change the med, because the didn’t read the entire script, the new med created sever anxiety so I stopped taking it. Within days the sever ankle pain subsided, went to endo dr. Who said I needed to be tirosint. 2 weeks sever pain was back, so currently I am not taking any. Tired of ankle pain from meds, arthritis pain will always be but I am refusing drugs that make the pain worse!

  2. I finally found a dr that agreed that maybe compounded would be better so he can increase the T3. Ive been on every brand of NDT and still have symptoms and can only tolerate increasing my dose so far bc I get jittery and anxiety. I did not realize the compounded version was NOT NDT. Now I’m worried bc isn’t synthetic not so great? I assumed compounded was NDT. This is so confusing!

  3. Chet Brough says

    Doctors do not listen?

  4. I stopped going to the endocrinologist becaused she was doing the exact same test my family
    doctor was doing, and I didn’t feel she was helping me. Only difference is she charged more and I was having to pay more out of pocket. Insurance isn’t going to pay for double testing.
    Jesse is right we are our own best advocate. We have to push for answers.

  5. Jimmie Ruth Brock says

    I take 32mg of Armour Thyroid. Test show ok. But can’t sleep. Have terrible insomnia. I feel it’s the medicine. Could it be?

  6. Karin Bolton says

    Dear Jenn,
    I am an RN who was so touched by your story. It really sounds like you did not go to a perceptive MD. I do not want to talk down to you in any way but please know that you check every MD’s reviews online prior to selecting an MD. This is what I always do. To see a caring GYN doctor I eliminated about 8 who were either rude, had a poor bedside manner, kept clients waiting too long, etc.
    Best of luck in your journey toward health and do Not give up or settle for less than you deserve! Hugs

  7. Carol Martin says

    I am lucky my Dr really stay on top of things when it comes to my thyroids have blood work every 6 months if they are off we change my Armour up or down until back on track. She is also up on thyroid storms since I have had 3 the last one thought I was going to die, it come from pharmacy giving me a generic zpack. She got right on it after she found out my husband took me to the hospital cause didn’t know what was happening. So blessed to have great Dr that looks after me & my whole family. Some of these Dr don’t give a crap just want their money####

  8. I was hep c medication interveron free for 12 weeks, last month of treatment noticed hair was thining and balding, 3 months after treatment still hair falling out not as bad , some have said it will grow back on it’s own etc. should I get my thyroid tested at a lab and what to look for, greatly appreciated if I can get help

    • Morena spicer says

      Morena spicer jan 20th 2020
      I was on interveron for hep c ,i wwas on it for 12mths,i my thyroid stopped working ,so ive been on thyroid medication ever since ,ive started to get sores and skin rashes on my hands ,and really bad pains in me legs feet and both hands

  9. Finally yesterday I saw an endocrinologist and thought ” Finally an educated professional who will test my thyroid more than TSH and figure out why my symptoms are back on synthroid” well fast forward and they told me my TSH is normal (and really optimal), they don’t need to test anything else since they did it before and it was normal. So my symptoms must be from something else since “everyone is tired” – try Vit D for my mood (I never mentioned having mood issues) and prioritize losing weight (but whenever I exert even walking the mall I have crazy hip pain and exhaustion for days)… I’ve never been so offended or disappointed in doctors… I don’t remember life before exhaustion.

    • You are not alone Jen! I’ve had a very similar experience. Unfortunately, some doctors have been beaten into insurance submission or are too tired themselves to take the time and effort with each patient. We have to fight for ourselves and be willing to take a setback like that but not give up. So please, Don’t give up, you are your best advocate. You know something is wrong, so keep pushing. See another endo and if that doc doesn’t get it, see another! All you need is one of them to listen and order the tests. Stay positive.

    • Hi, my endocrinologist said the same – after 2 sonograms and 5mm and 8mm found in my thyroid- its normal, nothing is going on , we’ll keep an eye out for it to see if it gets bigger, come back in 6 [email protected] how frustrating! I’m looking for a solution to my fatigue and symptoms and she shrugs it off!
      I made an appointment with another endo in 2 weeks- for a second opinion! Good luck with your case- ⚘

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