Which thyroid medication is best? This is a question we get from patients quite often. Conventionally for hypothyroidism, there is one medication prescribed. Regardless of your gender, family/personal history, symptoms, goals. If you need thyroid replacement, you will get Synthroid.
If you have had your thyroid gland radiated, now it is hypothyroid. If you have had thyroid cancer and your thyroid has been removed. If you have Hashimoto’s disease, or you have a sluggish underactive thyroid. In this day and age, there is only one medication you will be given.
Yes, that is Synthroid. Synthroid is T4 monotherapy. Meaning–it is a form of levothyroxine. As mentioned in other blogs, T4/levothyroxine is a stable molecule, which is supposed to convert to the active thyroid molecule, T3. There are so many other ways and medications to treat an under-functioning thyroid, so here is a synopsis of thyroid medications.
As I said, there is T4 Monotherapy, also known as levothyroxine. Levothyroxine is also known as Synthroid. Also included in T4 monotherapy is Levoxyl and Tirosint.
Remember T4 is supposed to convert to T3 which is the active form of thyroid. Often T4 will not efficiently convert to T3. It is common to hear patients say that even on Synthroid or raising their dose, they still feel hypothyroid. Also, higher doses of T4 monotherapy can convert to Reverse-T3 instead of T3. Reverse-T3 (RT3) is an inert molecule that has no activity.
Conventional T3 therapy is not commonly prescribed. The only option for T3 treatment conventionally is to use the commercially available prescription is Cytomel, which is a very unstable medication because it is instant release upon ingesting.
Taking too high a dose of Cytomel can put pressure on the heart and cause heart palpitations and even a risk to the cardiovascular system. You must be careful with Cytomel dosing because of the risk to the heart. Most docs only prescribe 5 mcg or at the most 10mcg.
Desiccated thyroid medication is made from a porcine source. It is pig thyroid gland desiccated (dried) to make thyroid replacement medication. This type of medicine is considered a natural form of thyroid medication.
The good thing about porcine thyroid is that it has T4 and T3 in the same medication. So a patient can get the T4 and the active form of thyroid, T3 at the same time. There are a few name brands to the porcine thyroid:
Nature Throid and West Throid are identical medications and are made by the same company, RLC Labs. WP Thyroid is also made by RLC Labs but is made with different fillers such as coconut oil and inulin. Patients that are sensitive to fillers can do better on WP Thyroid, and it can also be chewed up as well as swallowed.
There is also compounded porcine thyroid available from a compounding pharmacy. This is useful if a patient is sensitive to fillers in the commercially available brands of desiccated thyroid. Recently with the backorder of Nature Throid and the rising cost of Armour, compounded thyroid is another option.
One drawback of desiccated thyroid medication is the doses all come in a 4:1 ratio of T4 to T3. So 65mg of Nature Throid is equal to 38mcg of T4 and 9mcg of T3. Some patients cannot tolerate the T3 and need lower T3 levels, and some patients need more. So with desiccated thyroid, the T4/T3 ratio cannot be individually tailored to the patients. Also, Desiccated thyroid medication is made from pigs, so it is obviously not a vegetarian option of thyroid medication.
The great thing about compounded T4/T3 it is available in any microgram dosing of levothyroxine/liothyronine. The dosage of each hormone can be adjusted independently of the other.
In most situations, we prefer to prescribe compounded thyroid because of the dosing flexibility for us and the patient. Compounded porcine and Desiccated thyroid are also great options. We typically do not prescribe any of the T4 Monotherapy medications or Cytomel very often if at all.
If you have any questions, please leave a comment below, or feel free to send an email to [email protected]
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Exciting Announcement! We’re launching the Progress Your Hormones Community today—a space designed to empower women with expert guidance and support for navigating perimenopause and menopause. Get access to live office hours, hormone hot seats, lab interpretation, and more! If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
Launching August 11: Join our new Progress Your Hormones Community! Get expert guidance, real support, and answers to your HRT questions—together, not alone. Get expert guidance, real support, and answers to your HRT questions—together, not alone. If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
Welcome to Episode 2 with our upgraded video setup! Dr. Valorie Davidson and Dr. Robert Maki from Progress Your Health answer a thoughtful listener’s question: Why are my progesterone labs always low even on 200mg oral HRT? If you’re taking progesterone and worried about low numbers or uterine protection, this episode is for you. 💡 We cover: ‘ ● ⏱️ Why timing your blood draw makes or breaks your lab results ● 💊 The difference between sustained-release vs. instant-release progesterone ● 🧬 How genetic variants (like CYP enzymes) impact progesterone metabolism ● 🩺 When to get a transvaginal ultrasound to assess uterine lining health ● ✅ What blood level to aim for—and when to test it ● 💡 Bonus: How your detox pathways (and even caffeine tolerance!) can affect hormones If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode of the Progress Your Health Podcast, Dr. Valorie Davidson and Dr. Robert Maki answer a listener’s question about spotting and night sweats after starting hormone replacement therapy (HRT). Lisa, age 55, shares her experience using Bi-Est cream, oral progesterone, and testosterone—and why she’s now experiencing unexpected bleeding and sleep disruption. We break down: ● Why spotting can happen after starting HRT—even with low estradiol levels ● The difference between estradiol and estriol in Bi-Est cream ● How progesterone protects the uterine lining ● When to increase vs. decrease HRT doses ● The role of cortisol and adrenal health in night sweats ● When to order a transvaginal ultrasound ● How body type, menstrual history, and hormone sensitivity influence dosing ● Why cookie-cutter HRT doesn’t work for most women 💡 Plus, we share details about our upcoming Progress Your Hormones Community, launching in August 2025—a safe space for women navigating perimenopause, menopause, longevity, and personalized hormone education. If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode of the Progress Your Health Podcast, Dr. Valorie Davidson and Dr. Robert Maki dive into a question from Sabrina about the accuracy and usefulness of saliva versus blood testing for hormone replacement therapy (HRT). 👉 Is saliva testing more accurate for transdermal Bi-Est creams? 👉 Why does your estradiol look low in bloodwork but high in saliva? 👉 Does skipping your hormones before testing give a better result—or just confuse the picture? 👉 What’s a true 80/20 Bi-Est ratio, and how can you read your prescription dose properly? 👉 Why might oral progesterone make you anxious instead of sleepy? You’ll learn: ● How to interpret blood and saliva test results when you’re on HRT ● The pros and cons of different testing methods (serum vs. saliva vs. urine) ● The real reason your progesterone might backfire and worsen sleep ● Why your estrogen dose may be too low—even if your labs say you’re “in range” ● How to work with your practitioner to adjust your HRT plan safely This episode is perfect for anyone on HRT who’s feeling confused about their labs, frustrated by persistent symptoms, or stuck between conflicting advice. 🧠 Bonus: Dr. Davidson breaks down estrogen ratios and cream dosing using real-world examples. If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode of the Progress Your Health Podcast, Dr. Valorie Davidson and Dr. Robert Maki dive deep into a question from “Amber,” a 49-year-old woman struggling with extreme perimenopausal symptoms — despite being on progesterone, an estradiol patch, and thyroid medication. 🔍 Topics Covered: ● Why HRT (Hormone Replacement Therapy) might not be working ● Common perimenopause symptoms: sleep issues, fatigue, brain fog, weight gain ● The pitfalls of cookie-cutter hormone prescriptions ● How cortisol, stress, and over-exercising sabotage your hormones ● When estrogen dominance, low progesterone, and thyroid dysfunction overlap ● Could progesterone be making things worse? ● Why rhythmic hormone dosing may offer a better solution 💡 Learn why so many women feel dismissed or misdiagnosed during this transition—and how to find a treatment that actually works for your body. If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
