Levothyroxine alternatives: Thyroid treatment options explained

In this article:

• What can I take in place of levothyroxine?
• Natural alternatives to levothyroxine
• How to switch to a levothyroxine alternative
• Switching from levothyroxine to Armour Thyroid (desiccated thyroid)
• Switching from levothyroxine to Cytomel (liothyronine)
• Switching from levothyroxine to other brand-name equivalents

In this article

• What can I take in place of levothyroxine?
• Natural alternatives to levothyroxine
• How to switch to a levothyroxine alternative
• Switching from levothyroxine to Armour Thyroid (desiccated thyroid)
• Switching from levothyroxine to Cytomel (liothyronine)
• Switching from levothyroxine to other brand-name equivalents

Levothyroxine is a commonly prescribed drug for an underactive thyroid (hypothyroidism) and is also used to suppress thyroid-stimulating hormone (TSH) in conditions like thyroid cancer. For many people, it works well, but some may experience side effects, trouble absorbing it, or allergies to the ingredients. A healthcare provider may suggest another option, including other prescription thyroid drugs and natural thyroid products.

What can I take in place of levothyroxine?

Levothyroxine is a synthetic version of thyroxine (T4), one of the main hormones made by the thyroid gland. Once in the body, T4 is converted into triiodothyronine (T3), which is the more active thyroid hormone.

If levothyroxine isn’t the right option, there are other choices. Some alternatives provide T4 alone, others provide T3, and some contain a mix of both hormones. These can be either synthetic products or natural thyroid hormone products.

Desiccated thyroid brands

Armour Thyroid is a popular brand name for desiccated thyroid made from dried porcine (pig) thyroid glands. It contains both T4 and T3, the main hormones produced by the thyroid, and can be used to treat the same conditions as levothyroxine, such as hypothyroidism.

Another option is NP Thyroid, which is also made from porcine thyroid glands and contains both T4 and T3. Like Armour Thyroid, NP Thyroid is sometimes used by people whose symptoms don’t improve with just levothyroxine. The main difference between NP thyroid and Armour Thyroid is in their inactive ingredients.

Some people may feel better on natural thyroid extract than levothyroxine, though it may cause more side effects like palpitations or anxiety. Armour and NP Thyroid aren’t approved by the FDA but are available by prescription and sometimes recommended by healthcare providers.

Cytomel (liothyronine)

Cytomel is the brand name of liothyronine, a synthetic form of the T3 thyroid hormone. Unlike levothyroxine, which contains T4 that the body needs to convert to T3, Cytomel skips a step to provide T3 directly.

However, it’s absorbed faster and can increase hormone levels faster than levothyroxine, which could increase the chance of side effects if it’s not taken as prescribed. Regular thyroid tests may be needed to check levels during treatment.

Cytomel can be an effective thyroid hormone replacement drug, especially in people who don’t respond well to T4 alone.

Combination treatment (levothyroxine and liothyronine)

Some healthcare providers prescribe levothyroxine and liothyronine together to better mimic natural thyroid hormone levels. This combination may be helpful for those who continue to have symptoms on levothyroxine alone, even with normal lab results. One study in thyroid cancer patients found that combination therapy was safe and worked about as well as levothyroxine alone, with some evidence it may even benefit heart function.

Synthroid, Levoxyl, Unithroid, Tirosint, or other brand names

Levothyroxine is sold under several brand names, including Synthroid, Levoxyl, Unithroid, and Tirosint. All of these are approved to treat hypothyroidism and may also be used for TSH suppression in conditions like thyroid nodules, goiter, or thyroid cancer. 

These brand-name drugs contain the same active ingredient as generic levothyroxine and work in the same way. The main difference is in the inactive ingredients, which can affect how well a person tolerates one product compared to another. 

Tirosint differs from other brands because it comes as a liquid gel capsule without dyes or fillers, which can make it a good option for people with allergies or sensitivities to inactive ingredients.

Other alternatives to levothyroxine

• Tirosint-SOL (levothyroxine)
• Thyquidity (levothyroxine)
• Ermeza (levothyroxine)
• NP Thyroid (desiccated thyroid)
• Thyrolar (liotrix) (discontinued)

Compare levothyroxine alternatives
Drug name	Price without insurance	SingleCare price	Savings options
Levothyroxine	$70 per 90, 75 mcg tablets	$10 per 90, 75 mcg tablets of generic levothyroxine	See latest prices
Armour Thyroid (desiccated thyroid)	$153 per 90, 60 mg tablets	$83 per 90, 60 mg tablets of brand-name Armour Thyroid	See latest prices
Cytomel (liothyronine)	$190 per 90, 5 mcg tablets	$22 per 90, 5 mcg tablets of generic Cytomel	See latest prices
Synthroid (levothyroxine)	$207 per 90, 75 mcg tablets	$148 per 90, 75 mcg tablets of brand-name Synthroid	See latest prices
Levoxyl (levothyroxine)	$121 per 90, 75 mcg tablets	$13 per 90, 75 mcg tablets of brand-name Levoxyl	See latest prices
Unithroid (levothyroxine)	$484 per 90, 75 mcg tablets	$13 per 90, 75 mcg tablets of brand-name Unithroid	See latest prices
Tirosint (levothyroxine)	$195 per 30, 50 mcg capsules	$148 per 30, 50 mcg capsules of brand-name Tirosint	See latest prices

Drug prices fluctuate and vary by pharmacy and location. These are the most current prices at the time of publication. 

Natural alternatives to levothyroxine

The natural alternative to levothyroxine is natural desiccated thyroid extract from animal sources. However, when people think about “natural alternatives,” they may also be referring to nonprescription options like vitamins, supplements, diet, and lifestyle changes that support overall thyroid health.

Selenium

Selenium is a trace mineral that can play a role in thyroid functions. Studies have found that low levels of selenium may be associated with thyroid diseases, including hypothyroidism. Selenium supplementation may help, but more clinical trials are needed to confirm its benefits.

Vitamin B12

Low vitamin B12 levels may be associated with thyroid problems, including hypothyroidism and autoimmune thyroid diseases, such as Hashimoto’s disease. Vitamin B12 supplements may help correct deficiencies and improve related symptoms like fatigue, but it does not directly replace thyroid hormone.

Vitamin D

Vitamin D is an essential nutrient, often taken with calcium, that supports the development and health of bones. It may also play a role in thyroid conditions, with studies showing that low levels of vitamin D are linked to thyroid diseases. Other studies have found that vitamin D supplementation may help manage certain thyroid problems in people treated with levothyroxine. 

Essential oils

Anecdotal evidence suggests that essential oils can help manage the symptoms of hypothyroidism. No clinical trials have proven these claims. Some essential oils that are used to manage hypothyroidism include:

• Lavender
• Peppermint
• Rosemary
• Sandalwood
• Cedarwood
• Lemongrass

Herbal supplements

Certain herbal remedies are sometimes used to help support healthy thyroid hormone levels. However, these remedies are not approved or proven by clinical trials. More evidence is needed to confirm the use of herbal remedies.

• Bladderwrack (Fucus vesiculosus): Although not technically an herb, bladderwrack is a type of seaweed that is a good source of dietary fiber and minerals. Bladderwrack contains iodine, a nutrient the thyroid uses to make the hormones T3 and T4.
• Ashwagandha: This herb may help manage thyroid hormone levels in people with early-stage hypothyroidism. Studies show that ashwagandha root extract may be beneficial for managing thyroid hormone levels. 

Diet

The right diet may help support overall thyroid health. Fruits, vegetables, whole grains, and lean proteins may help you feel more energized, while too much sugar, processed food, or unhealthy fats might add to fatigue. Diet can also affect gut health, which affects how well the body absorbs nutrients and regulates the immune system, both of which are closely tied to how the thyroid works.

Exercise 

Hypothyroidism often slows down metabolism, which can lead to weight gain. Along with medication, a healthcare provider may recommend physical activity to manage weight. Exercises like walking, jogging, and swimming may help keep the body’s metabolism in check.

Stress reduction 

Stress can affect the thyroid gland and cause an imbalance of thyroid hormone levels. For this reason, managing stress can be an important part of regulating hormone levels. Yoga, meditation, and other relaxation techniques can help reduce stress. 

How to switch to a levothyroxine alternative

Any change from levothyroxine to another thyroid medication should only be made with guidance from a healthcare provider. The right dose depends on factors like your age, weight, and overall health. The process for switching to a levothyroxine alternative will depend on the thyroid medication switched to.

Switching from levothyroxine to Armour Thyroid (desiccated thyroid)

Armour Thyroid contains desiccated thyroid with a strength measured in grains. Levothyroxine is measured in micrograms (mcg). Therefore, the dose of levothyroxine needs to be converted to an appropriate dose of Armour Thyroid. One grain of Armour Thyroid is roughly equal to 88 to 100 mcg of levothyroxine. 

The following conversions might be used when switching from levothyroxine to Armour Thyroid.

Levothyroxine to Armour Thyroid conversion chart
Levothyroxine	Armour Thyroid (desiccated thyroid)
25 mcg	¼ grain (15 mg)
50 mcg	½ grain (30 mg)
100 mcg	1 grain (60 mg)
150 mcg	1.5 grain (90 mg)
200 mcg	2 grain (120 mg)

 

Switching from levothyroxine to Cytomel (liothyronine)

Cytomel contains a synthetic version of T3 called liothyronine. T3 is three to four times more potent than T4, which is found in levothyroxine. Healthcare providers typically recommend a dose of liothyronine that is lower than that of levothyroxine to account for the increased potency. 

The following conversions may be used when switching from levothyroxine to Cytomel.

Levothyroxine to Cytomel conversion chart
Levothyroxine	Cytomel (liothyronine)
25 mcg	5 mcg
50 mcg	12.5 mcg
100 mcg	25 mcg
150 mcg	37.5 mcg
200 mcg	50 mcg

 

Switching from levothyroxine to Synthroid, Levoxyl, Unithroid, Tirosint, or other brand-name equivalents

Both the brand name and generic versions of levothyroxine contain the same active ingredients. When switching from the generic to the brand-name version, the dosage typically remains the same. 

Talk to an endocrinologist or other healthcare provider when switching to or from a levothyroxine alternative. In some cases, dosages need to be adjusted based on medical conditions and responses to therapy.