What can I take instead of levothyroxine? A guide to hypothyroidism treatment alternatives

October 11, 2025 •

3 min read

For over 50 years, levothyroxine has been the standard treatment for hypothyroidism, but a significant minority of patients report persistent symptoms despite having normalized TSH levels. If you're wondering, 'What can I take instead of levothyroxine?', a range of alternative therapies exist, including different synthetic hormones, combination treatments, and natural desiccated thyroid extracts. However, switching medication should always be a decision made in close consultation with your healthcare provider to ensure safety and effectiveness.

Quick Summary

This guide covers prescription alternatives to levothyroxine for hypothyroidism, such as liothyronine (T3) and natural desiccated thyroid (NDT) containing both T4 and T3. It also reviews combination therapies and lifestyle considerations, highlighting the importance of doctor supervision for safe and personalized thyroid hormone management.

Key Points

Liothyronine (T3) is an alternative: A synthetic form of the active thyroid hormone ($T_3$), available under brand names like Cytomel, is an option for patients not responding to $T_4$ alone.
Desiccated Thyroid Extract (NDT): Derived from animal thyroid glands (like Armour Thyroid), NDT contains both $T_4$ and $T_3$ and is preferred by some patients for symptom relief, though it lacks FDA approval and has variable potency.
Combination T4/T3 Therapy: Using a mix of synthetic levothyroxine and liothyronine can benefit individuals who poorly convert $T_4$ to $T_3$ or have residual symptoms on $T_4$ monotherapy.
Consult a healthcare professional before switching: Any change from levothyroxine to an alternative requires careful medical supervision, dose adjustments, and regular lab monitoring.
Supporting factors complement medication: Diet, stress management, exercise, and certain supplements (like selenium and vitamin B12) can support overall thyroid health but are not replacements for hormone therapy.
Patient preference influences therapy choice: Some patients report feeling better on NDT or combination therapy compared to levothyroxine, influencing discussions with their doctors.

Understanding Thyroid Hormone Replacement

Your thyroid produces two key hormones: thyroxine ($T_4$) and triiodothyronine ($T_3$). Levothyroxine is a synthetic version of $T_4$ and works by having your body convert it into the active $T_3$ hormone. For most patients, this conversion is efficient and effectively manages hypothyroidism. However, some individuals experience residual symptoms like fatigue, weight gain, or brain fog, even when blood tests show normal Thyroid Stimulating Hormone (TSH) levels. These cases prompt exploration into alternative treatment strategies.

Desiccated Thyroid Extracts (DTE)

Desiccated Thyroid Extract (DTE), with brand names like Armour Thyroid and NP Thyroid, is derived from animal thyroid glands and contains a mix of $T_4$ and $T_3$. Some patients prefer DTE and report feeling better than on levothyroxine alone. However, DTE can have variable hormone levels between batches, making consistent dosing difficult, and it is not subject to the same FDA approval process as synthetic hormones. Switching to DTE requires close medical supervision.

T3-Only Medications: Liothyronine (Cytomel)

Liothyronine (Cytomel) is a synthetic form of the active $T_3$ hormone with a rapid effect. It's typically used when patients don't respond well to $T_4$ alone or in specific medical situations like myxedema coma. Due to its potency and rapid absorption, careful monitoring is needed to avoid side effects such as heart palpitations.

Combination Therapy (T4 and T3)

Some doctors may prescribe a combination of synthetic $T_4$ (levothyroxine) and synthetic $T_3$ (liothyronine) for patients with persistent symptoms on $T_4$ monotherapy. This approach can benefit individuals who have difficulty converting $T_4$ to $T_3$. While research results are mixed, some studies show patients prefer combination therapy. Major thyroid associations suggest this approach for patients with residual symptoms who are otherwise healthy.

Comparison of Thyroid Replacement Options


Feature	Levothyroxine (Synthetic T4)	Liothyronine (Synthetic T3)	Natural Desiccated Thyroid (DTE)
Hormone Content	T4 only	T3 only	Natural mix of T4 and T3
Source	Laboratory-made	Laboratory-made	Animal-derived (porcine)
FDA Approval	Yes, gold standard	Yes	No, grandfathered
Dosing Consistency	Highly consistent	Highly consistent	Can have batch-to-batch variation
Absorption/Action	Slower, body converts T4 to T3	Faster, direct T3 activity	Mix of slow (T4) and fast (T3)
First-line Treatment?	Yes, for most patients	No, generally supplemental	No, often for dissatisfied patients

Other Supportive and Lifestyle Factors

Lifestyle and dietary factors can complement thyroid medication but are not replacements. A balanced diet with adequate iodine, selenium, and zinc is important. Stress management, sufficient sleep, and regular exercise can also support thyroid function and overall well-being. Some supplements may help manage symptoms, but they should be discussed with a doctor.

Conclusion

While levothyroxine is the standard treatment for hypothyroidism, alternatives like liothyronine (T3), combination therapy ($T_4$ and $T_3$), or natural desiccated thyroid (DTE) may be suitable for patients with persistent symptoms. Each option has its own considerations, such as DTE's variable potency and lack of FDA approval, or the need for careful monitoring with liothyronine. Discussing your symptoms and treatment goals with your healthcare provider is essential to determine the best and safest approach for your individual needs.

Disclaimer: This information is for informational purposes only and is not medical advice. Consult with a qualified healthcare professional before making any decisions related to your thyroid medication or treatment plan.

Endocrine Society position on combination therapy

Frequently Asked Questions

Some people continue to experience hypothyroidism symptoms like fatigue, weight gain, and brain fog even when their TSH levels are normalized with levothyroxine. This can be due to poor conversion of T4 to the active T3 hormone or other factors, prompting the need for alternative treatment approaches that include T3.

Not necessarily. While some patients report subjective improvements with NDT, it is not FDA-approved and can have batch-to-batch variability in hormone content, making dosing less consistent than with synthetic alternatives. The American Thyroid Association warns about these risks.

Levothyroxine provides synthetic T4, a storage hormone that the body must convert to the active T3 hormone. Liothyronine provides synthetic T3 directly, leading to a faster and more potent effect on the body.

Combination therapy involves taking both synthetic T4 (levothyroxine) and synthetic T3 (liothyronine). It may benefit patients who feel unwell on T4 alone, especially those with inefficient T4-to-T3 conversion or specific genetic factors.

No. While some lifestyle factors and nutritional supplements like selenium, vitamin D, and Ashwagandha can support thyroid health and manage symptoms, they are not proven to effectively replace thyroid hormone or treat hypothyroidism. Always consult a doctor before starting any new supplements.

Because liothyronine acts more quickly and is more potent, an incorrect dose can lead to symptoms of hyperthyroidism (too much thyroid hormone), such as anxiety, rapid heartbeat, restlessness, or trouble sleeping. Regular monitoring is crucial.

If you suspect your levothyroxine is not working, the first step is to discuss your symptoms and concerns with your doctor. They can run blood tests, review your dosing schedule, and help you evaluate if an alternative medication or dosage adjustment is necessary.