Is NDT safer or more "natural" than synthetic thyroid medication?

Not inherently — it's a different formulation with a different hormone ratio, not automatically superior. The right choice depends on your individual response, not on synthetic versus natural framing alone.

Why would my doctor add liothyronine instead of just increasing my levothyroxine dose?

If the issue is inefficient T4-to-T3 conversion, simply raising the T4 dose doesn't necessarily fix that. Adding T3 directly addresses that specific gap rather than assuming a higher dose of the same hormone will solve it.

Do optimal TSH targets change depending on which medication I'm on?

Yes, to some degree. Because these medications affect TSH, free T3, and free T4 differently, what counts as an appropriate result can shift slightly depending on what you're taking, which is why individualized interpretation matters more than a single universal number.

Are your services covered by health insurance?

Yes! Naturopathic medicine is covered by most extended healthcare benefit plans in Ontario. To make things as easy as possible for you, we offer direct billing to the majority of major insurance providers. It's always a good idea to check in with your insurance provider beforehand to see exactly how much coverage you have for naturopathic care so there are no surprises!

Can you see people who live outside of Ontario?

No. Since naturopathic medicine is regulated provincially, we are only licensed to treat individuals who are physically located within Ontario. If you live anywhere in the province of Ontario, we're good to go!

How do specialized lab tests work if we meet online?

You will be emailed a lab requisition form that you can take to any LifeLabs location in Ontario. If we utilize advanced functional medicine testing (like specialized stool, urine, or breath analysis), the test kits are shipped directly to your house with clear instructions for easy, at home collection.

Thyroid health

Levothyroxine, Liothyronine, or NDT? Understanding Your Thyroid Medication Options

There are three main approaches to hypothyroidism medication: levothyroxine alone (T4 only), levothyroxine combined with liothyronine (T4 plus T3), and natural desiccated thyroid, which contains both T4 and T3 in one pill. Levothyroxine works well for most people, but if your labs look "normal" and you still feel unwell, it's worth knowing the other options exist.

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Most people diagnosed with hypothyroidism are started on levothyroxine, and for a lot of people, it genuinely works. But it isn't the only medication option, and if you've been on it for a while and still don't feel like yourself despite "normal" labs, it's worth understanding what else is available.

Getting your lab results into range isn't the goal by itself. The goal is actually feeling well, and sometimes that requires a different approach to medication, not just a different dose.

Option 1: Levothyroxine

Levothyroxine is pure synthetic T4. T4 is a storage form of thyroid hormone that your body needs to convert into T3, the active form your cells actually use.

For most people, this conversion happens efficiently and levothyroxine alone is enough to restore how they feel. But conversion from T4 to T3 doesn't happen equally well for everyone. If your body isn't converting efficiently, it's possible to be on a technically adequate dose of levothyroxine, with labs that look fine, and still feel significantly unwell.

Option 2: Levothyroxine plus liothyronine

Liothyronine is synthetic T3, the active hormone form. Adding it to levothyroxine means you're no longer relying entirely on your body's own T4-to-T3 conversion to get the active hormone you need.

This combination approach tends to come up specifically for people who haven't felt well on levothyroxine alone, despite labs suggesting they should. It's not a first-line default for everyone, but it's a legitimate option worth discussing if levothyroxine alone hasn't resolved your symptoms.

Option 3: Natural desiccated thyroid (NDT)

NDT is made from desiccated pig thyroid and naturally contains both T4 and T3 in a single pill, along with trace amounts of other thyroid hormones. Naturopathic doctors can prescribe NDT when clinically indicated.

Because it contains both hormone forms already combined, it's a different approach from either levothyroxine alone or the levothyroxine-plus-liothyronine combination, and it works well for some people who haven't responded to the more standard options.

Why does this actually matter?

There isn't a single "correct" thyroid medication that works identically for everyone. The right choice depends on your specific labs, your symptoms, and how your body is actually responding to treatment, not just whether your TSH falls somewhere inside a reference range.

It's also worth knowing that optimal lab ranges can shift slightly depending on which medication you're taking, since the different forms affect TSH, free T3, and free T4 differently. A result that looks appropriate on one type of medication might not be the right target on another.

The bottom line

If you're about to start thyroid medication, or you're already on one and still don't feel like yourself, it's worth having a direct conversation about whether all three options have actually been explained to you. Reaching a number in the reference range isn't the finish line — feeling like yourself again is.

Looking for personalized support?

If you are looking for more support, detailed testing, and a clear path forward with your health, feel free to book a free consult with me.

— Dr. Monica Velletri, ND

Common questions

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About the clinic

Once you book an appointment, you'll receive a welcome email with a link to complete your intake forms online. Right before our scheduled time, you'll get a secure video link to join our virtual appointment. That means you can log on from wherever fits best into your day, whether that's your couch, your lunch break at the office, or up at the cottage. No commuting, no traffic, and no sitting in waiting rooms. After our visit, your personalized treatment plan is delivered straight to your secure patient portal within 48 hours, so you can focus less on logistics and more on feeling better.

If we determine that natural health products or prescriptions are needed, everything is handled seamlessly online. Your individualized supplement recommendations will be uploaded directly to your treatment plan plus online dispensary, where you can order professional-grade products right to your doorstep. For pharmaceuticals like Natural Desiccated Thyroid (NDT) and Bioidentical Hormone Replacement Therapy (BHRT), your prescriptions will be securely faxed straight to your local pharmacy for easy pickup or delivery.

Absolutely. In fact, it's exactly how we prefer to practice. Your health journey is a team effort, and we are entirely open to working within whatever dynamic you prefer. Whether that means collaborating directly with your conventional medical team, coordinating with your specialist, or sharing lab results, our goal is simply to ensure your care is safe, integrated, and working beautifully alongside the rest of your medical care.

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Your health journey isn't meant to be figured out alone. Everything you're experiencing is real and valid — you deserve proper investigation, deep listening, and intentional steps toward optimal health.

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