What’s the Buzz

Levothyroxine is a prescription medication that is used to treat an underactive thyroid gland (hypothyroidism). It is a synthetic version of T4 thyroid hormone. If you have been prescribed this thyroid medication and feel it is not working for you, there are levothyroxine alternatives you can take. You should always talk to your doctor before trying a levothyroxine alternative.  

These include brand name versions with the same active ingredient (levothyroxine sodium), liothyronine (Cytomel), which contains T3 thyroid hormone, Thyrolar, which is a combination of synthetic thyroid hormones levothyroxine (T4) and liothyronine (T3), and natural desiccated thyroid obtained from animal thyroid glands. Please continue reading to learn more about levothyroxine alternatives.

What thyroid hormone does levothyroxine replace?

Levothyroxine is a synthetic version of the natural thyroid hormone called thyroxine or T4. It works by replacing or supplementing blood levels of thyroid hormones in hypothyroid patients. Peripheral tissues in the body convert thyroxine (T4) to triiodothyronine (T3), which is the active thyroid hormone. Taking levothyroxine, therefore, normalizes thyroxine levels in the body. It helps to relieve some of the health problems caused by low levels of thyroid hormones. Read about 8 signs you may have a thyroid condition.

What is the daily replacement of levothyroxine?

The daily replacement of levothyroxine varies from person to person. Doctors measure thyroid stimulating hormone (TSH) and thyroid hormone levels. They use the results of these blood tests to adjust the dose of levothyroxine. 

Finding the correct dose of thyroid hormone replacement therapy can take some time. You will likely need to have regular blood tests to maintain good thyroid health. 

Most people obtain relief from their hypothyroid symptoms after starting thyroid medication. However, some hypothyroidism patients have persistent symptoms while on levothyroxine and may want to try other thyroid medications. A small number of patients have an allergy to ingredients in levothyroxine formulations and need to take levothyroxine alternatives. Learn: “How Long Does Levothyroxine Stay in Your System?”

Is there an alternative to taking levothyroxine?

Some common levothyroxine alternatives are listed below:

Brand name drugs

Levothyroxine sodium is a generic drug. It is also sold under various brand names such as Synthroid, Levoxyl, Levo-T, Unithroid, and Tirosint. These branded products contain the same active ingredient (levothyroxine sodium) and are equally effective and safe as the generic version. 

However, some people find that specific brands of thyroid medication work better for them. This is not because the brand names are superior to generic levothyroxine but rather because the brand names contain different inactive ingredients that can affect thyroid hormone metabolism (how your body absorbs the medication). This can affect how well the thyroid medication works. Find out: “How Long Does It Take for Levothyroxine to Work?”

If you feel levothyroxine is not working for you, talk to your doctor about taking a brand name drug. Keep in mind that brand names can be significantly more expensive than generic levothyroxine and may not be covered by your health insurance plan. Check out our blog, “What Are Some Signs My Thyroid Medication Is Not Working?”

Liothyronine (Cytomel)

Liothyronine (brand name Cytomel) contains the synthetic form of the thyroid hormone triiodothyronine or T3 as the active ingredient. T3 is the active thyroid hormone and has most of the cellular effects in the body. However, scientific evidence does not support the routine prescription of liothyronine as the first line of treatment for hypothyroidism because the body converts T4 to T3.

However, a small number of patients continue to have symptoms despite treatment with levothyroxine and an adequate serum TSH level within the normal range. Such patients may benefit from liothyronine (triiodothyronine or T3) treatment. 

Before prescribing liothyronine, your doctor will ensure:

• Persistent symptoms are not due to other health conditions.

• You are taking levothyroxine properly (for example, taking it with food or certain other drugs can make it less effective).

• The frequency of skipped or missed levothyroxine doses is not too high.

• If poor control of thyroid problems is also present while using other levothyroxine formulations such as the gel capsules or oral liquid.

Liotrix (Thyrolar)

Liotrix (brand name Thyrolar) is used for combination therapy of hypothyroidism. It contains the synthetic forms of both T4 (thyroxine) and T3 (liothyronine). If a thyroid patient does not get relief from symptoms on levothyroxine alone, their healthcare provider may prescribe combination therapy.

Natural desiccated thyroid extract (DTE)

Desiccated thyroid extracts (DTE) are natural alternatives to synthetic (lab-made) thyroid hormones. They are sold under various brand names, such as NP Thyroid, Nature-Throid, Armour Thyroid, and others. Some people find that taking Armour Thyroid or other natural options is a better levothyroxine alternative, perhaps because these natural alternatives contain both T4 and T3. 

However, the American Thyroid Association warns about some of the risks associated with taking Armour Thyroid and other DTE formulations:

• These natural forms of thyroid hormone are not approved by the Food and Drug Administration (FDA).

• They do not offer precise dosing. Each batch of the medicine can contain different amounts of T4 and T3, making it difficult to maintain stable thyroid levels.

• They can be contaminated by viruses and bacteria. 

• They may contain additional hormones and proteins that are only present in animal sources. 

• The ratio of T4 and T3 is different in animals and humans. 

• They contain chemicals as binders and are, therefore, not a completely natural alternative. 

• They should not be used to control symptoms of hypothyroidism in pregnant women because the T3 in desiccated thyroid extracts does not reach the developing baby. This should be avoided in patients over 65 years of age.

Learn more about “Armour Thyroid vs Levothyroxine: How Do They Compare?”

How do you treat hypothyroidism without levothyroxine?

You may not need to take levothyroxine if you have subclinical hypothyroidism, where thyroid-stimulating hormone (TSH) levels are elevated, but thyroxine (T4) levels are normal. Your doctor may choose to monitor with regular blood tests to watch for the development of overt hypothyroidism.

If you have overt hypothyroidism (high TSH levels outside the normal range and low thyroxine (T4) with hypothyroidism symptoms, levothyroxine is the best treatment for your condition. If you do not get symptom relief after taking levothyroxine regularly as prescribed, your doctor will rule out other health conditions or other thyroid problems as the underlying cause. They may recommend other alternatives to levothyroxine or taking levothyroxine (T4) and liothyronine (T3) together to treat hypothyroidism. Natural desiccated thyroid is not generally considered a good levothyroxine alternative and is less commonly prescribed these days.

What thyroid disease is levothyroxine used to treat?

Levothyroxine sodium is used to treat hypothyroidism or underactive thyroid. This is a condition in which the thyroid gland does not make enough thyroid hormones. A common cause of hypothyroidism is Hashimoto’s thyroiditis or Hashimoto’s disease, which is an autoimmune condition. Levothyroxine is also used for TSH suppression, along with surgery and radioactive iodine therapy, in people with thyroid cancer.