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February 15, 2023 8 min read

If you've been diagnosed with hypothyroidism, you may have heard the term "levothyroxine" thrown around a lot. But is this the only option available? As it turns out, there is an alternative - combination therapy - that may be more effective than levothyroxine alone. In this article, we'll explore what combination therapy entails and discuss the pros and cons of both treatment options.

What is thyroid hormone replacement therapy?

As a hypothyroid patient, your doctor may recommend "thyroid hormone replacement therapy." But what exactly is it, and how does it work?

Thyroid hormone replacement therapy is a treatment for people who have an underactive thyroid, a condition known as hypothyroidism. The thyroid is a small gland in the neck that produces hormones that regulate the body's metabolism. The two main hormones that the gland produce is thyroxine (inactive - T4) and triiodothyronine (active - T3). Collectively, they're called the thyroid hormone. When the thyroid doesn't produce enough hormones, the body's metabolism slows down, which can lead to symptoms such as fatigue, weight gain, and sensitivity to colds.

The goal of this therapy is to compensate for the lack of hormone secreted by your thyroid gland. As a result, it raises your abnormally low levels of natural thyroid hormones in the body and allows you to live a healthy and normal life.

The standard medication used in thyroid hormone replacement therapy is levothyroxine, but other options are also available. These include liothyronine and natural desiccated thyroid (NDT).

What is levothyroxine?

Levothyroxine is the most commonly prescribed medication for treating hypothyroidism. It's the synthetic form of thyroxine (T4). T4 is the storage hormone (inactive). It must be converted by the body into the active form, triiodothyronine (T3) before it can be used by cells. This conversion process requires a complex network of proteins known as deiodinases, as well as co-factors such as selenium, zinc, and iron.

Levothyroxine is available in pill or liquid form. Some of the most popular brand names of this thyroid medication in the United States are Synthroid, Levoxyl, and Unithroid. It's taken once a day on an empty stomach, usually 30 minutes to 1 hour before breakfast. It's important to take levothyroxine exactly as directed by your doctor. Moreover, follow-up appointments are necessary to monitor your hormone levels and adjust your dose as needed.

Pros and cons of levothyroxine

While levothyroxine therapy has been effective for many patients, it is important to know its potential benefits and drawbacks to make an informed decision about treatment.

Pros of Levothyroxine:

  • Effective treatment for your thyroid function

  • Relatively affordable and widely available

  • Easy to adjust dosage based on your needs.

Cons of Levothyroxine

  • Levothyroxine may trigger serious side effects such as heat intolerance, nervousness, and diarrhea. Contact medical emergency if side effects of levothyroxine persist.

  • It may take some time to find the proper dosage, but you need to take frequent blood tests to ensure the dosage is correct.

  • It may not address all thyroid disease symptoms.

  • Levothyroxine may trigger allergic reactions.

What is liothyronine?

Liothyronine is the synthetic form of triiodothyronine (T3). T3 is an active thyroid hormone that works at the cellular level to help facilitate the delivery of oxygen and energy to cells, tissues, and glands throughout the body. Cytomel is the brand name of liothyronine.

Unlike levothyroxine, liothyronine is rarely prescribed by doctors because there's a debate that T3 may have more side effects than T4. In most cases, it's recommended as an addition to levothyroxine therapy for people who have difficulty converting T4 to T3 or who have not seen improvement with levothyroxine alone. However, it can also be used alone by itself.

Is Cytomel liothyronine better than Synthroid for your thyroid gland?

Both Cytomel and Synthroid aim to replace and maintain normal thyroid T4 and T3 hormone levels. While both medications are effective in treating hypothyroidism, some people may find that one medication works better for them than the other. This is because each person's response to treatment can be different, and the effectiveness of a specific medication may vary from person to person. Plus, there are a lot of debates among experts about medications. Therefore, there's no definite answer if one is better than another.

How to take Cytomel for hypothyroidism

The usual starting dose of Cytomel (liothyronine) for treating hypothyroidism is 25 mcg once a day for adults. Your doctor may gradually increase your dose every 1-2 weeks, depending on your response and blood test results, until your hormone levels are within the normal range. Avoid taking Cytomel with food or antacids, as they can decrease the absorption of the medication.

You need to take Cytomel once a day. However, some experts recommend splitting your dosage into two or three smaller doses to take periodically throughout the day. Doing this can help ensure that the patient doesn't experience fluctuations in their thyroid levels. This is because T3, or triiodothyronine, is metabolized more quickly than other thyroid hormones and has a shorter lifespan in the body.

Taking multiple doses of T3 throughout the day will allow for more even distribution and absorption of the hormone into your system. For example, if you are prescribed 100mcg per day, it would be better to take two 50mcg doses rather than one 100mcg dose; this will ensure that your body maintains consistent levels throughout the day instead of having a surge from one large single dose followed by a crash afterward.

Pros and Cons of liothyronine for hypothyroidism

Down below are the benefits and side effects of liothyronine like Cytomel you should be aware of.


  • Clinical trials show liothyronine's effectiveness in treating a specific type of hypothyroidism and treating thyroid cancer.

  • Liothyronine can improve various hypothyroid symptoms.

  • Quick acting, it only takes 4 hours for 95% of a dose of liothyronine to be totally absorbed.


  • Liothyronine has more significant risks of side effects, such as chest pain and muscle aches, compared to levothyroxine.

  • Requires frequent dosage adjustments. Fluctuating levels of hormones may cause severe side effects on your body.

  • Not suitable for all patients, especially if you're suffering from adrenal insufficiency.

Can you combine levothyroxine with liothyronine?

Can you combine levothyroxine and Cytomel for thyroid?

It's possible to combine levothyroxine with liothyronine as a treatment for hypothyroidism. This is known as combination therapy. Although the American Thyroid Association guidelines do not recommend taking levothyroxine and liothyronine together, many people under the supervision of an internist/endocrinologist take this combination treatment and prefer to use it for most patients.

Pros and cons of thyroid hormones combination therapy

So, what are the pros and cons of this type of thyroid medication? Here are some of that you should be aware of.


  • Combining levothyroxine and liothyronine can improve hypothyroid patients' hormone balance

  • Suitable if your body is not responding well to levothyroxine alone

  • Another benefit of thyroid hormones combination therapy, it can minimize specific symptoms and improve mental health.

  • Effective in treating specific types of hypothyroidism


  • Increased risk side effects of hypothyroidism, such as mood swings, irregular heartbeat, and triggering too much thyroid hormone produced by thyroid nodules

  • Higher cost of medication. Instead of one, you need to buy two different medications at once.

  • Increased risk of overdose.

Is there an alternative to combining levothyroxine with Cytomel?

1. Natural desiccated thyroid (NDT)

If you haven't had luck with a synthetic combination of levothyroxine and Cytomel or don't want to buy two different medications, natural desiccated thyroid (NDT) can be a great choice for you.

Natural desiccated thyroid (NDT) is a thyroid replacement medication derived from pigs' thyroid glands. It contains both thyroxine (T4), triiodothyronine (T3), and other hormones, such as calcitonin. These are similar to the hormones your thyroid produces. This combination of hormones can mimic your body's natural hormone levels more closely. Many hypothyroid patients prefer NDT because its complete thyroid hormones can ease symptoms more effectively.

NDT is a medication that has been used continuously since the early 1900s. It was the first (and at some point the only) available treatment for underactive thyroid.

Natural desiccated thyroid pros and cons

If you're interested in using natural desiccated thyroid (NDT) as your thyroid medication, here are some pros and cons you should be aware of.


  • NDT mimics the natural hormone levels of hypothyroid patients. Some patients may not be able to convert T4 to T3 effectively, and providing the body with both hormones directly may be more effective.

  • NDT is derived from animal thyroid glands, which is perfect for patients who prefer natural treatment options.

  • NDT is more convenient since you don't have to take two separate medications.


  • NDT may be more expensive than levothyroxine alone.

  • NDT may not be suitable for patients who are vegetarian or vegan, as it is derived from animal thyroid glands.

  • Doctors rarely prescribe NDT, and it can be hard to find in pharmacies. However, some NDT brands, like VitaliThy, are available to buy online.

Can you combine NDT with synthetic medication?

You might have heard the myth that you shouldn't mix desiccated thyroid (NDT) with synthetic T4 because it will be "too much" T4 for the patient. Well, it's not that straightforward. The right answer depends on your T4 and T3 levels and symptoms.

On the other hand, some doctors fear that adding T3 to therapy could result in "too much T3." But, keep in mind, individuals who are poor T4 converters may need a higher T3:T4 ratio in their dosing.

Trying to fit into a strict mold isn't always the best approach. It's like trying to fit a square peg into a round hole - it just won't work. Instead, flexibility is key, and it's important to understand that different parts of your body can react differently as you adjust T3 and T4 levels.

For some people who can't properly convert T4 to T3, using a combination of NDT and liothyronine may be the answer for people who don't respond well to levothyroxine alone. The idea behind this combination therapy is that by providing both T4 and T3 hormones to mimic your body's natural hormone levels to stay within the appropriate ratio.

2. Liotrix

Liotrix, also known as Thyrolar, is a synthetic thyroid hormone combination composed of levothyroxine and liothyronine. In particular, it contains a 4:1 mixture of T4 and T3. It has been said that this particular combination works faster than taking just one of these hormones separately.

Liotrix was developed as a synthetic alternative to NDT, with the aim of offering a cheaper and more profitable version for companies to manufacture. Sadly, in many countries, Liotrix is no longer available for purchase. In the US, it was discontinued in December 2018.

It's worth noting, though, that the withdrawal of Liotrix doesn't imply that it was unsafe or of low quality. The decision was solely driven by business reasons that were not specified.

Which thyroid hormone replacement medication is best for you?

When treating hypothyroidism, the best medication for you will depend on your individual needs and symptoms. While synthetic medications like levothyroxine and liothyronine are commonly used and combined together, many hypothyroid patients argue that NDT is the better option.

NDT is beneficial for individuals with the following conditions:

1. No Improvement with Levothyroxine - If you've taken levothyroxine drug for 6 to 8 weeks and haven't seen any improvement, NDT may be a better option.

2. Difficulty Tolerating Levothyroxine - Some people may have difficulty tolerating synthetic hormones; in this case, NDT is a better alternative.

3. Thyroidectomy - A thyroidectomy is a surgical procedure in which all or part of the thyroid gland is removed. It's beneficial to use NDT medication because it can mimic the body's natural ratio of 80% T4 and 20% T3.


Yes, you can combine levothyroxine and Cytomel for your thyroid! But if those two medications don't quite do the trick for you, there is another option. Natural desiccated thyroid (NDT) is a great alternative to take in order to get your hypothyroidism symptoms under control. NDT works differently than levothyroxine and Cytomel because it contains both T4 and T3 hormones naturally found in pig or cow thyroids. It also contains other compounds that are believed to help with absorption in the body, which makes it an even better choice for many people.

However, there's just one catch: NDT can be hard to find. Don't let that deter you, though! While natural desiccated thyroid may not be available in all local pharmacies, you can still buy it successfully online. One of the best options is VitaliThy, a natural desiccated thyroid you can buy online. It consists of Thyroid (USP), which means it has all the necessary thyroid hormones to keep your symptoms away. Most importantly, VitaliThy is free of allergens, lactose, and gluten, so it's safe for anyone, especially if you suffer from drug allergies.

Wojciech Majda
Wojciech Majda

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