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Hypothyroidism Treatment

The treatment for an underactive thyroid -- hypothyroidism -- is thyroid hormone replacement medication. The medication puts back in the thyroid hormone you’re missing. There are three categories of thyroid hormone replacement medication:



Currently, the most commonly prescribed medication is  levothyroxine, a synthetic form of T4 hormone that was introduced in the early 1950s. Since its introduction, levothyroxine has become the “preferred” treatment of endocrinologists and mainstream physicians. 


There are several brands of levothyroxine tablets available in the U.S., including Levoxyl, Synthroid, and Unithroid. There are also a number of generic levothyroxine tablets available. 

Levothyroxine is also available as Tirosint capsules, and Tirosint-SOL oral solution.

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For more information on levothyroxine, see the Levothyroxine Deep Dive Program, which includes a free three-part on-demand video webinar, online guide, and free downloadable book with everything you need to know about your levothyroxine options.


The Need for T3

Levothyroxine treatment assumes that:

  • You produce enough T4 to convert into T3, and 

  • You can effectively convert T4 into T3. 


But, as noted, some people are “poor converters” and end up with a shortage of T3.


This means that low-producers, non-producers, and poor converters can have continued hypothyroidism symptoms after levothyroxine treatment, with symptoms that include:


  • Fatigue

  • Weight Gain

  • Brain Fog

  • Depression

  • Hair Loss

  • Dry Skin

  • Constipation

  • Muscle Pain


This is why some patients report much better relief of their hypothyroidism symptoms when their thyroid treatment includes T3.


Three Ways to Add T3

There are three ways you can include T3 as part of your thyroid hormone replacement treatment.


1. Add synthetic T3 to levothyroxine


Liothyronine is a synthetic for of the T3 hormone. Generic liothyronine typically costs around $14 to $20 per month on average. The brand name liothyronine, Cytomel, costs around $65 to $83 per month on average. Keep in mind that the cost of the T3 is in addition to the cost of monthly levothyroxine. 


2. Take custom-compounded levothyroxine/ liothyronine

Some patients get a specially compounded combination synthetic T4-T3 combination. The quality and potency of a combination compounded medication varies by compounding pharmacy. Also, keep in mind that compounded medications are less regulated. They are also expensive, and a compounded combination medication can cost as much as $100 per month, and is usually not covered by most health insurance plans.


3. Take natural desiccated thyroid 


More than 50 years before levothyroxine was introduced, the first thyroid hormone replacement, natural desiccated thyroid (NDT), was introduced. NDT is extracted from the dried ("desiccated") thyroid glands of pigs, and has been safely used for more than a century. While levothyroxine provides only the T4 hormone, natural desiccated thyroid provides both T4 AND T3 hormones in a single tablet. It's usually the most affordable way to take combination T4/T3 treatment. 

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