There’s a Nationwide Shortage of Levothyroxine. This is Why

One of the most popular drugs in the country, levothyroxine – also known as the brand name Synthroid – is in short supply, making prices higher and even leaving some patients without the drug. The shortage is a result of hurricanes Irma and Maria, which hit Puerto Rico nearly four months ago, and knocked out manufacturing facilities for many drugs and medical supplies, including levothyroxine.

Walmart, for instance, has more than doubled their cash prices for levothyroxine. Before the shortage, Walmart offered 30 tablets of all dosages of levothyroxine for $4 and 90 tablets for $10. Now, 30 tablets is $9, and 90 tablets is $24.

Walmart issued a statement informing the public of their price increase:

“Effective December 8th, 2017, your price will increase temporarily to $9 per 30-day supply or $24 per 90-day supply. We value your loyalty and business and are committed to offering you affordable pharmacy products and services. We’ll return to regular pricing as soon as this shortage has been resolved.”

In other places, the shortage means that patients are leaving their pharmacy without the medicine altogether. Many consumers are turning to Twitter to share their stories:

At present, the FDA has not added levothyroxine to their official shortage list, even as some patients are being blindsided at the pharmacy over levothyroxine’s cost and availability.

Levothyroxine is among the most prescribed medications in the United States; it is a lifesaving maintenance drug used to treat hypothyroidism. Simply skipping a dose, or waiting till you can afford it it is a dangerous option. Patients who suddenly stop taking levothyroxine may go into withdrawal and may experience symptoms like debilitating weight loss, panic attacks, fatigue, muscle weakness, and nausea.

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If you have found it difficult to fill your levothyroxine prescription, or you’re experiencing sticker shock at the pharmacy, here are a couple of alternatives you can try.

Armour Thyroid

Armour Thyroid is considered the natural alternative to levothyroxine. While it is not the first-choice treatment for those with a thyroid condition, according to our friends at Iodine, many people actually prefer Armour Thyroid over levothyroxine. Why? Let’s get into the differences between levothyroxine and Armour Thyroid to explain that.

The main difference lies in how these drugs are manufactured. Levothyroxine is a synthetic T4 hormone, while Armour Thyroid is a natural thyroid hormone. What does this mean? Levothyroxine’s hormone, T4, is not active in the body and has to be processed into a different hormone, called T3, to work its magic. Levothyroxine is also synthetic, meaning that all of the hormones it contains are man-made in a laboratory. In contrast, Armour Thyroid is a natural thyroid, so it comes from animal sources and includes both the T3 and T4 hormones.

Because levothyroxine only includes the T4 hormone, some argue that it might not work for everyone. While studies haven’t shown that Armour Thyroid’s combination T3-T4 therapy is superior to levothyroxine’s T4 therapy, it might account for the high ratings from patients.

Thinking of switching? Here are some things you need to be aware of.

• Birth controls and estrogens have been shown to decrease the effectiveness of Armour Thyroid. Be sure to speak with your doctor if you are taking a birth control.

• Try to avoid antacids within four hours of taking Armour Thyroid, as they can make it harder to absorb the hormones.

• Armour Thyroid and levothyroxine are not interchangeable, so 1 mg of Armour Thyroid is not the same as 1 mg of levothyroxine. It may take some time to determine what dose of Armour Thyroid will work best for you, so as always, consult with your doctor.

• There are no generic versions of Armour Thyroid, and it isn’t covered by many insurance plans, but you can pay as little as $25 with a GoodRx coupon, depending on your location.

• You cannot substitute Armour Thyroid for levothyroxine and will need to get a new prescription from your doctor.

Cytomel

Just like levothyroxine, Cytomel (liothyronine) is another synthetic thyroid medication. But there is a difference. While levothyroxine is a synthetic version of the T4 hormone, Cytomel is a synthetic version of the T3 hormone. Remember how levothyroxine’s T4 hormone has to be processed into the T3 hormone in the body? Since Cytomel contains the T3 hormone, there is no processing needed.

But there is a downside to this. The T3 hormone is absorbed rapidly in the body, which can lead to thyroid hormone toxicity (hyperthyroidism) in some cases. Don’t let this scare you though, Cytomel is safe if used correctly. Be sure to work with your doctor to keep your thyroid hormone levels healthy.

Another downside? According to our friends at Iodine, 13% of people rated that Cytomel was ineffective for them. This side-effect can be common with many thyroid medications, but this is still important to keep in mind.

Thinking of switching? Here are some things you need to be aware of.

• Cytomel has a generic, liothyronine, that is affordable. The average retail price for liothyronine is $33.24 and can be reduced to as little as $12.77 with a GoodRx coupon.

• You may need to work with your doctor to find the right dosage for you.

• Periodic blood tests are a must.

• Cytomel also has many food and drug interactions you should be aware of. For instance, birth control pills, estrogen, anticoagulants, ketamine, antidepressants, and vasopressor medications may interact negatively with Cytomel. Be sure to speak with your doctor if you are taking any of these medications.

• Common side effects include chest pain, diarrhea, weight change, fatigue, headache, insomnia, dizziness, and depression. Be sure to speak with your doctor if you experience any of these for a prolonged period of time.

• You cannot substitute Cytomel for levothyroxine and will need to get a new prescription from your doctor.

Levoxyl

Levoxyl (levothyroxine) is a brand name only medication used to treat hypothyroidism and has the same active ingredient as Synthroid – levothyroxine. Just like Synthroid, Levoxyl is also a synthetic T4 hormone. Overall, Synthroid and Levoxyl are quite similar, so why isn’t Levoxyl as well known?

Pfizer, the manufacturer of Levoxyl, lost their market share for levothyroxine products a couple of years back. In 2013, Pfizer pulled Levoxyl from the market because of a suspicious odor emitted from the packaging. After this recall, Levoxyl was off the market for about a year, causing many consumers to switch to alternatives, and they never looked back. Pfizer officially lost their market share. Out of sight, out of mind.

Despite this recall, after Levoxyl’s return to the market, there has been little concern over the safety of the medication, making it an adequate alternative to Synthroid.

Thinking of switching? Here are some things you need to be aware of.

• Levoxyl has a patient savings program that can help you save $5 off your monthly prescription. For more information see Pfizer’s website here.

• While there is no generic available, the brand is still quite affordable, with an average retail price of $33.29.

• Even though they contain the same active ingredient, you cannot substitute Levoxyl for levothyroxine and will need to get a new prescription from your doctor.

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Written by:

Tori Marsh, MPH

Tori Marsh is GoodRx’s resident expert on prescription drug pricing, prescribing trends, and drug savings. She oversees the GoodRx drug database, ensuring that all drug information is accurate and up to date.

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