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 M.A., Ed.M., 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. Vicki Jean Byrd says

    After suffering Hypothyroid all my life I recently ask my doctor for Armour Thyroid (T4/T3) and she agreed to try it but it is expensive and has not generic (I am 72 a widow on Social Security) I struggle to afford the (TIER $) medication. The Humana pharmacist’s suggested a combination drug called LEVOTHYROXINE (t4)/ LIOTHYRONIN t3. Instead of Levothyroxine alone which NEVER worked for me. My doctor said she would not??? Do you have any reason why this switch would NOT WORK?

  2. Alice McGaughey says

    I had my thyroid removed after countless years from having tumors in it. I still have issues with loss of hair, not able to loose weight, tiredness and the other problems. My Dr put me on Armour and the dosage worked until Nov 2018, my TSH went to 8.02 this was T3 Uptake,T4 Thyroxine total and free T4 index, changed dosage and now it is .07. This is very confusing so I’m back to my original Armour dosage of 90MCG. Guess my next blood work will be high again.

  3. My grandmother found a grouted when I was 5, has surgery at 8 with 70 % of thyroid gland removed also. It was a long hard process to get my meds just right. For a young child this was very hard. I thought then I was looking my mind. At 19 all of my thyroid gland has grown back and another groiter. They did radio active iodine and killed and shrunk it all. But, I’ve had every symptom and fought them still fighting them at age 53.

  4. Karen Horan says

    I have been following Hypo Mom on Pinterest for some time now and have read many of the heartfelt testimonials from fellow sufferers. I too was diagnosed with hypothyroidism over 30 years ago. Needless to say I have had just about every imaginable pill cocktail out their for a supposed fix to my disease. Well 30 years later I have changed physicians (due to changes in our location) numerous times and have been on probably every combination of thyroid meds one can imagine. Needless to say I am no better today than I was 30+ years ago, same symptoms insomnia, weight gain regardless if I eat, don’t eat, diet, don’t diet, brain fog, fluctuating BP, high cholesterol levels, and the list goes on and on. My hypothyroidism is compounded with other medical diagnoses that I have two of which are fibromyalgia and lupus. My point in adding my story to this site is not to be negative, just the contrary. It is extremely gratifying to have somewhere to go and feel like you aren’t crazy and that there are other people out there who know exactly how you feel and understand where you are coming from. Readers should be grateful for the Hypothyroid Mom because she has provided not only an educational site for fellow thyroid sufferers but also a site where we can find at least a modicum of peace in knowing that we aren’t crazy or alone. I am a fighter and will not allow this disease or any of the other ones that I am faced with to defeat me but I am taking relevant information that I have ascertained from this site to keep on pursuing a better treatment for my disease. Thanks to everyone who has given their stories and a special thank you to Hypothyroid Mom for starting the ball rolling. I know that I am not alone with my sentiments. Karen in Phoenix, Arizona

  5. All of a sudden a out three years ago I felt like a truck had run over me and I gained 20 pounds in 6 months. I couldn’t sleep and could barely get out of the bed. My doctor has had me on all the T4 meds at one time or another. I saw one of the nurse practioners one day and she looked at my lab results and realized that it was the T3 that needed to be treated! Alas, I had hope. Ha! Cytomel only kept me feeling badly. My hair has never been the same on any of these medications. It has continued to fall out and my head itches uncontrollably. Benadryl does not help nor does Xanax (which I would never take for any other reason). When I complain about not sleeping, the weight gain, the itching, and the tiredness they all just look at me and shake their heads. More steroids for the itching? Antidepressants for the depression? I think not. Can anyone out there help me? Is there an alternative to the meds that are full of additives?

    • I was diagnosed with Hashimoto’s disease this past August. I had many symptoms. However, during this time, I also found out that I had hyperparathyroidism, a year and a half prior. Many of the symptoms that hypothyroidism mimic this disease, as well. I had come to realize that even though the doctors continued to tell me my calcium levels were normal, they were not. The results of my lab results from the blood work agencies I was getting, were not accurate to the newer studies that are out there. Anyone who is over 40 years of age, please check your calcium levels, which should be taken at every physical when you have your blood panel done. If it is over 10, you should have your PTH numbers checked. If this is high, this is never normal. I had a tumor growing for approximately 10 years that I recently had removed, on January 31, 2019. Almost all of my symptoms from the hypothyroidism went away. However, I’m still struggling with weight gain. I just had blood work done, so I’m pretty sure I will be getting an adjustment on my thyroid medication. If anyone does have calcium levels over 10, please go to the following web site: parathyroid.com
      I self diagnosed myself, when several doctors were doing absolutely nothing for me. I lived in terrible discomfort for years. All bone and joint pain went away withing 24-48 hours after having the tumor removed. Brain fog went away, I’m happier, no more fatigue, my hair has stopped falling out, and I feel 10 years younger.
      Now I understand, many of you may not have this problem, however, it is worth looking into. It is very common and is misdiagnosed often. Bottom line, I feel that now that the tumor is out, I can concentrate on my hypothyroidism and feel tremendous hope that I will find the right medication to treat it. Having hyperparathyroidism made it impossible to know which disease was causing most of my problems. I know that this is post is for thyroids, but I think there may be a few of you that could benefit from this information, as well. BTW, I diagnosed a friend right after my surgery with the same disease, before her own doctor from UCLA did. I was able to tell by her labs that she had a tumor on her parathyroid just by her test results. She will be having the tumor removed. FYI, this tumor causes many of the symptoms of Hashimoto’s disease, however, many more…such as high blood pressure, kidney disease, and may lead to stroke , heart attack or some cancers, etc. It eventually is fatal. If anyone wants to continue this discussion, I am more than happy to.
      Wishing everyone health and relief.

  6. Heidi Urfer says

    I was diagnosed with Thyroid cancer three years ago and had it removed!
    I went through many different doses of Levothyroxine and I am at 100 mcg
    taking it every morning on a empty stomach with a lot of water!
    Not feeling to bad, but the weight gain doesn’t stop.
    I did eat Paleo even before I had cancer so it can’t be the food, just wonder if other
    Women have the same experience since taking Levo!
    Going to see a Top Doctor very soon who is specialized in Hormon/Weight loss!
    Will definitely let you know what she is going to change!

    • Hello Heidi: I am in the same situation; I have a non-functional thyroid due to radiation. I am on Synthroid and I am having an extremely difficult time losing weight; and I do work out and eat relatively healthy. Please post what your doctor recommends…I am at my wits end!! Thank you!

  7. cynthia smith says

    I’m roughly eight years post-menopausal , what a joyful experience that was !
    So it’s been three months since I’ve been diagnosed as hypothyroid and started on 25 MCG of Levothyroxine. My practitioner did the standard TSH/T4 test which showed my TSH was high, at 6.16 . Now my last bloodwork done after eight weeks , showed the TSH at 2.96. I requested we also test for T3 so , she did the Free T3 , it was at 2.5 ( which I believe to be on the low end of normal ) . I am so amazed that our medical / health system’s teaching is still in the dark ages when it comes to the body. Why aren’t they teaching their students that the body is a whole , and that when one thing is “off” they don’t just treat the symptoms with drugs( that usually mask the symptom) but look at how the body can be healed ! I have yet to have a traditional medical person EVER address the root cause , the diet etc. , it’s always just … “take this drug” . Our medical community is controlled by the biggest , wealthiest industry on our planet ; just watch TV for a night , it’s commercials are about 85% drug sales. Talk about drug pushers ! Then there’s the insurance industry too ! God help us all !

  8. I was diagnosed with Hoshimotos approximately 6 months ago only after I went to see an endocrinologist after dealing with hypothyroid for over 15 years. I’ve been dealing with with brain fog, fatigue, etc. etc. First he advised me that I was on the wrong dose of synthroid. I was also diagnosed with insulin resistance. He increased my dose a bit and I lost a few pounds but the rest of the symptoms were still there. I did alot of research regarding generic verses name brand and apparently there is a difference so I decided to try name brand Synthroid. First of all, I still have some of the symptoms but I have seen a difference. The differences are: my face doesn’t seem as puffy as it usually looked, my joints don’t ache as much and I don’t feel as tired as I did before. The only drawback is that the name brand of Synthroid cost 3 times what the generic costs but I guess it’s worth it because I do feel better than when I was taking the generic form.

  9. Crissie russell says

    well I gotta say after reading alot of the stories here . It makes me feel a lil better knowing I am not crazy !! I was diagnosed with hashimotos last year and it has literally been a nightmare for me . Dealing with all the symptoms and insomnia as well as brain fog and anxiety (ugh) . I have now been on lethroyxin for a year now with no relief . I feel as if my life isn’t my own anymore . And when I have my levels checked it always shows normal range . It’s so fustrating to say the least . So have finally decided to see a endocrinologist and see if I can finally see some relief !! Thanks for sharing all your stories made me feel a lil better ! 😉

    • Heather C Kedzierski says

      Most endos will tell you the same story. They’ll give you Synthroid or Levo and say you’re fine. Join a FB group and start looking for doctors that will prescribe a natural thyroid medicine. Good luck.

    • Check out “stop the thyroid madness” on facebook. You will receive lots of knowledge and what blood tests to take. Don’t be discouraged- learning is what will help you to identify and pinpoint your issues. Get all the right testing. MTHFR, Eptstein Barr, Iron, Ferritin, D3, B12 and others. Best wishes

  10. Well I just have to say I am angry. I know I should be glad websites like yours exist, but hours of pouring through obscure handfisted testimonials based on anecdotal nonsense and little reward leaves me feeling so discouraged. A multitude of you making these kneejerk reactions to new medicine when it can take a few months to adjust to a new medication or change in dosage; proclaiming this and that after a few weeks. People experimenting with their own disages; what the heck is wrong with our world where the sick are left with no answers? And it’s not that Sarah Ballantyne or Terry Wahls aren’t knowledgeable, it’s that neither of them was educated specifically for the areas of healing that they practice; they too had to figure it out for themselves. And I will tell you this: they don’t have all the answers, and some of what they have to say is wrong. And a large part of the natural healing method is an industry like any other. And after how crappy I still feel, I still choose to trust my medical doctor because he listens to me and is not afraid to try new things. But I have tried ketogenic, paleo AIP, and I still feel just as crappy as the day I started it and it has been months. And all of you talking about how badly you feel breaks my heart, because being human is hard enough without being able to be whole. And my kids need me to be well and I feel like there is no possible way I can raise them to adulthood. And my mood swings and anxiety have alienated me from meaningful relationships. Nobody understands what we are going through and that is the hardest part of all.

    • Are you possibly going through pre-menaoause? I am almost 47 and have had symptoms for a couple of years now and it was a nightmare. I have found little support. I thought I was going crazy. Literally. The doctors wanted to push antidepressants but I refused and use a natural progesterone cream. I realized a lot pfy symptoms are coming from high estrogen levels and I wasnt exercising enough and had high stress situations for about a year. Military related. Anyways, I see and agree with your ppint of view.

    • LINDA CLARDY says

      Have you gotten genetical testing? I think each person has to find what is right for them. I might die before I get it right, but since one of my kids was found to carry MTHFR gene it has given me another clue. I am waiting for my own testing to come back, but in the meantime I am going to get some help with methalation therapy. I know I can’t handle folic acid because it has always made me sick. There may be other conditions that can be diagnosed and treated because of genetic testing and research.

    • Heather C Kedzierski says

      Lady if you can get Synthroid or Levo to work for you…..awesome! But there are a lot of people who have been on those drugs for years (me almost 20 years) and still felt the same. The doctors shame you into making it your fault. Mainstream medicine has NOT gotten autoimmune disease right at all. Now I don’t know all your problems, but the first thing you should do is find a doctor who knows how to treat Hashis. Lots of FB groups who will point you in the right direction. As far as diet if you’re still eating gluten and only went off a short time there is no doubt why you’re still feeling bad. Those diets are hard and most are meant to be a forever thing. And yeah that sucks, but so does feeling poorly.

    • I know exactly what you are feeling. I am so disgusted with the ups and downs of Thyroid medications that I have decided to completely stop taking them altogether. I am in such pain from Synthroid. I’m tired of Brain Fog, sleeping too much; and the list goes on. My husband is no longer patient with me. I can’t take this anymore! Do Doctors even care?!

      • Rebecca Davis says

        Please don’t stop taking your meds. You may feel awful but they are keeping you alive. Please don’t stop trying to find what makes you feel better. If it means trying different combinations of meds then try them. I felt terrible on a T4 alone med and now I add a T3 med to it. It isn’t perfect, but it’s better.

    • I empathize and understand what you are going through. After 17 yrs of being on thyroid meds, I was told by a Dr. (Endo) they shouldn’t have ever put me on thyroid meds after the radioactive iodine treatment. Now, I believe after extensive treatment of meds and adverse reactions to Tirosint my liver and kidneys aren’t functioning properly. It’s not fair! And no medical doctor, endo, etc. has any answers. I trusted them, they experimented with my life all these years, and my health is worse than when they started. What kind of world do we live in where they put their wealth over our health?! GOD will judge them all and my prayers go out to each and everyone of us who are suffering with illnesses beyond our control.

      • Hi VS,

        Please look at my above post dated today a few minutes ago.

        I self diagnosed myself at Parathyroid.com

        I don’t know if this web site is for you, but it’s worth looking into. It has saved my life and relieved all of my symptoms, except weight gain. Please take a look at the symptom list provided. I have Hashimoto’s disease. However, along with that, I had another issue that had not been diagnosed by my doctor for 10 years. Both diseases have most of the same symptoms.

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