A Patient Guide to Choosing the Right Thyroid Treatment
Why Thyroid Hormones Matter
Your thyroid gland plays a key role in regulating metabolism, energy levels, mood, and overall health. When the thyroid is underactive (hypothyroidism), treatment with thyroid hormone replacement may be required to restore balance and reduce symptoms such as fatigue, weight gain, brain fog, and hair thinning.
What Are My Treatment Options?
The two main options for thyroid hormone replacement are:
- Levothyroxine (T4-only therapy) – the standard NHS treatment
- Combination Therapy: T4/T3 (synthetic) or Desiccated Thyroid Extract (DTE) – an alternative approach for those who remain symptomatic on levothyroxine alone
Both approaches can be effective, but patients should first trial levothyroxine before considering alternative therapies.
Levothyroxine (T4-only) Treatment
Levothyroxine (also known as T4) is a synthetic version of the inactive thyroid hormone your body must convert into the active form (T3). This is the standard NHS treatment for hypothyroidism.
✅ Pros:
- Well-studied and widely prescribed
- Provides consistent hormone levels with a long half-life
- Bioidentical to human thyroxine (T4)
- Can be prescribed in various doses and adjusted as needed
❌ Cons:
- Some patients struggle to convert T4 to the active T3, leading to persistent symptoms
- May not fully relieve fatigue, brain fog, or weight gain in some individuals
- Typically prescribed based on TSH blood levels rather than symptoms
- Conversion to T3 requires the enzyme deiodinase, which can vary between individuals
Checking Your T4 to T3 Conversion Ability
Some individuals have genetic variations (SNPs) in the deiodinase enzyme that affect their ability to convert T4 to T3 efficiently. Lifecode GX offers a genetic test to assess deiodinase activity, which may help determine whether a patient could benefit from combination T4/T3 therapy or DTE.
If you have difficulty converting T4 to T3, adding synthetic T3 (Liothyronine) or trying DTE may be beneficial.
When to Consider Adding T3 (Synthetic Liothyronine) or DTE
For some patients, levothyroxine alone does not fully resolve symptoms. In these cases, additional treatment may be considered.
Synthetic T3 (Liothyronine) – NICE Guidance
- NICE does not routinely recommend Liothyronine (T3) for primary hypothyroidism, citing insufficient evidence of superiority over levothyroxine monotherapy.
- However, a small subset of patients who remain symptomatic on levothyroxine alone may benefit from adding T3.
- Combination therapy with T3 should be initiated carefully and monitored by an experienced practitioner, particularly in patients with ongoing symptoms despite optimal TSH levels.
- Liothyronine (T3) is typically added in low doses (5-10 mcg/day), with adjustments based on response.
Desiccated Thyroid Extract (DTE) & Compounded T4/T3
DTE is derived from porcine (pig) thyroid glands and contains a natural combination of T4, T3, and small amounts of T1 & T2—hormones also present in the human thyroid.
Alternatively, compounded T4/T3 therapy allows for a tailored dose of both hormones, adjusted to individual needs.
✅ Pros:
- Contains both T4 and the active T3, potentially reducing symptoms more effectively for some patients
- Some patients feel better on DTE compared to levothyroxine alone
- Compounded options allow for precise T4/T3 ratios to suit individual needs
- Prescribed via an MHRA-regulated compounding pharmacy, ensuring quality and safety
❌ Cons:
- Not routinely available on the NHS
- Requires careful dosing to prevent excess T3 levels, which can lead to heart palpitations or anxiety if not well-monitored
- Some patients with Hashimoto’s may be sensitive to porcine-derived proteins in DTE. While many do well, others may experience an immune response or an increase in antibodies. This is an individual response and should be monitored closely.
Which Option Is Right for Me?
Functional medicine takes a personalised approach, looking at more than just TSH levels. If you’re still experiencing symptoms on levothyroxine alone, you may benefit from:
✔ Adding a small dose of T3 to your current treatment
✔ Switching to a tailored compounded T4/T3 therapy
✔ Trying DTE under close supervision if appropriate, after failing other options
We work with an MHRA-regulated compounding pharmacy to ensure you receive high-quality thyroid medication in the right ratio for your needs.
Optimising Thyroid Health Beyond Medication
While thyroid medication is essential, other factors can impact how well you feel:
✅ Nutritional support – Ensure adequate iodine, selenium, zinc, and iron
✅ Managing stress – High or low cortisol can interfere with thyroid hormone conversion
✅ Gut health – The microbiome plays a role in T4-to-T3 conversion
✅ Hormonal balance – Oestrogen dominance or adrenal issues can impact thyroid function
Next Steps: Speak to Us
If you’re considering T3 therapy, DTE, or compounded T4/T3, speak with The Bespoke Clinic to determine whether this option is right for you.