Learn here about different thyroid medications for hypothyroid treatment!

MOST PROBLEMATIC: 1) Synthetic T4-only:  Names include Synthroid, Levothyroxine/Levo, Tirosent, Oroxine, Extroxin and more.

These are hypothyroid meds first brought out in the 1960’s which represent only the thyroid storage hormone T4, one of five known thyroid hormones made by a healthy thyroid. T4 is meant to convert to T3–the latter the most active thyroid hormone.  T4-only meds are taken once a day. They are the most problematic of hypothyroid treatments, based on years of patient reports and experiences. Some feel better at first with these medications; some never do feel better, possibly due to certain genetic mutations. Nearly all on T4-only have issues related to being forced to live for conversion alone. Even those who feel better usually run into problems, sooner or later. Read Chapter 1 in the revised STTM book–it will open your eyes. For more info, go here.

2) Synthetic T3-only:  Names include Cytomel, Cynomel, Tertroxin, Linomel, Cyronine, Unipharma, Ti-Tre, Tironina, Tiromel, Trijodthyronin and more.

This medication represents the active thyroid hormone T3–the hormone which brings back energy, metabolism, good health, etc. A healthy thyroid also gives direct T3 in addition to conversion of T4 to T3. If one is on T3-only, it’s generally taken three times a day, such as morning, then four hours later, then four hours later. Some will take a tiny amount at bedtime, but it’s individual. T3-only has a short half-life, thus multi-dosing. Using T3-only is about finding one’s optimal dose, which tends to put the free T3 at the top of the range, along with good iron and cortisol levels. If one raises T3-only without having optimal levels of iron or cortisol, the free T3 tends to go high without relief of symptoms. Treatment with T3 is never about the TSH, which will drop quite low and is not a problem as doctors wrongly claim. It’s a rougher treatment than having some additional T4 in one’s treatment. Some people will add T3 to lower doses of NDT (#4 below) if they find themselves with high reverse T3, the inactive hormone—which will go up due to chronic inflammation, Lyme disease, low iron, etc. .Others have RT3 so high that they go solely on T3-only for awhile.

HONORABLE MENTION: 3) Combination of the above Synthetic T4 and Synthetic T3

These are generally combined and taken twice a day at a minimum to spread out the direct T3, such as first thing in the morning, then early afternoon. Works well if raised to find one’s optimal dose, the latter which puts the free T3 towards the top part of the range and free T4 mid-range. Optimal will also lower the TSH quite low, which is NOT a problem.  Important to have adequate iron and cortisol to avoid problems with raising. Preferred by those who might have reasons to avoid porcine or bovine meds as in #4 below.

MOST EFFECTIVE: 4) Natural Desiccated Thyroid aka NDT

This treatment has been around the longest–since the late 1800’s. Most NDT comes from porcine (pig) thyroid; many over the counter versions come from bovine (cow). It contains all five thyroid hormones, T4, T3, T2, T1 and calcitonin. NDT powder usually meets the strict guidelines of the US Pharmacopoeia. By years of reported experiences, NDT seems to give the best results, and needs to be used correctly and raised appropriately. Good iron levels and cortisol are important to avoid problems when raising NDT. Optimal puts the free T3 towards the top of the range and the free T4, midrange. The TSH will fall below range on NDT and contrary to the poor training of many doctors, is not a problem.  Study Chapter 2 in the revised STTM book about NDT. More here. Note: one of the brands called Naturethroid is now weaker than it used to be.


    1. If NDT is the most effective, why did I NOT do well on it? Answer is here, i.e. you stayed on too low a dose (common mistake) or it was revealing inadequate iron or a cortisol problem.
    2. I felt great on T4-only, so why are you saying it’s the most problematic?  Yes, some outright do better on T4-only than others. But it eventually backfires, as there are too many issues which can cause problems forcing your body to live for conversion alone, ranging from any kind of illness, stress, genetic mutations, even age. Additionally, many patients who were once on T4-only look back and say “No, I really wasn’t as great as I said I was.” Read more here.
    3. My doctor has me on T4-only. Why should I trust you over my doctor?  Stop the Thyroid Madness (STTM) represents years of reported patient experiences and the wisdom they have gained from those experiences. Unfortunately, too many doctors aren’t listening well to millions of patients.
    4. Why not just the two synthetics i.e. both T3 and T4?  They do work if one is optimal and explained above! Definitely go for it. But over the years, a large body patients who switched from the two synthetics to NDT reported they felt even better! That impressed us, so STTM reports it.
    5. Do I need to add T4 to NDT?  It’s really not necessary. NDT is 80% T4 already. We just raise NDT until optimal–the latter which puts the free T3 towards the top and the free T4 mid-range. But if you want to add T4 to NDT, might want to be careful, as adding too much will increase RT3, the inactive hormone. Some add T4 to a lower dose of NDT because they feel the T3 was too powerful…but that may be more about having a stressed liver, or reacting because of inadequate iron and/or a cortisol problem.