Hypothyroid patients who take natural desiccated thyroid (NDT) drugs are a loyal bunch. (I count myself among them!) As NDT fans, we view the drug as a lifeline and the one treatment that doesn't leave us feeling tired, brain-fogged, and struggling with other continuing symptoms of hypothyroidism.
Natural desiccated thyroid (NDT) is a thyroid hormone replacement medication that includes natural forms of both of the thyroid hormones: thyroxine (T4) and triiodothyronine (T3). We usually end up taking NDT when the standard treatment, levothyroxine, doesn't work for us.
After some trial and error, we also frequently discover that among the many different brands of NDT – including Armour, Nature-throid, WP Thyroid, or Acella's NP Thyroid – one brand ends up working best. That brand may differ for each of us because there's no one-size-fits-all for thyroid treatment.
Suppose you're a thyroid patient taking a natural desiccated thyroid (NDT) drug for any length of time. In that case, you're also likely aware that there's a downside of taking NDT: drug shortages!
During my more than two decades as a thyroid patient advocate, NDT is frequently in the FDA's crosshairs, leading to short and longer-term recalls and shortages of NDT. And unfortunately, here we go again. As of May of 2021, we are into more than a year of NDT shortages. FDA recalls of NP Thyroid, Nature-throid, and Acella have made it harder to get prescriptions filled, are inflating prices for the NDT that is still available. Most frustratingly for some of us, it forces some of us to take substitute treatments that don't allow us to truly feel and live well!
Unfortunately, the shortages of NDT aren't likely to resolve anytime soon, meaning that many hypothyroid patients now face a challenge. We need to figure out how to get thyroid hormone replacement treatment that will work. Let's look at some tips.
How to navigate the shortages of natural desiccated thyroid drugs
1. Check with other pharmacies
Suppose your usual pharmacy doesn't have your preferred NDT drug. In that case, it's worth contacting some other pharmacies in your area and investigating mail-order pharmacies. A free service like GoodRx or SingleCare can help you identify other pharmacies in your area. My favorite online pharmacy, Honeybee Health, currently has Armour Thyroid, available at prices typically lower than brick-and-mortar pharmacies. Honeybee also has some dosage sizes of NP Thyroid.
Bonus tip: Get three-month refills whenever possible to help you weather the shortages.
2. Switch to an NDT that is available.
If you can't get your preferred brand of NDT, consider trying whatever NDT is available at the time. Even if that brand didn't work for you in the past, periodic reformulations might make it more effective for you now.
Important note: Armour and NP Thyroid have a slightly different dosage system than Nature-throid and WP Thyroid. For example, one grain of Armour or NP is 60 mg, versus 65 mg of for Nature-throid and WP Thyroid. To switch from one dosing system to the other, your pharmacy will likely ask that you provide a prescription that's been rewritten for the preferred new medication.
The following chart shows the equivalent dosages for various NDT brands.
3. Consider synthetic T4/T3 combination treatment.
NDT contains both the T4 and T3 hormones, so some patients successfully replace NDT treatment with a combination treatment of a synthetic T4 (levothyroxine) drug like Synthroid, Levoxyl, Euthyrox, Unithroid, or Tirosint, plus synthetic T3 (liothyronine), like Cytomel.
When substituting synthetic T4/T3 treatment for NDT, do keep in mind that it usually takes some time for trial-and-error adjustments before you find the specific dosage combination of levothyroxine and liothyronine that fully replaces your NDT treatment and resolves symptoms.
4. Consider custom-compounded NDT
Every brand of NDT has a different "recipe," and each has unique key ingredients – known as the "Active Pharmaceutical Ingredients" or API. I've put together a list of the top compounding pharmacies for NDT prescriptions that incorporate high-quality API for NDT.
Remember: When you switch from a brand name NDT to a custom-compounded NDT, you'll need a new prescription specifying compounded NDT from your doctor.
If you're having difficulty making adjustments to your hypothyroidism treatment, consider a consultation with a Paloma Health thyroid doctors to determine your next best steps for optimal thyroid health.