Thyroid Freedom · For Patients

Desiccated thyroid: Armour, NP Thyroid, newer brands, and compounded Thyroid USP.

Desiccated thyroid extract, or DTE, is thyroid hormone made from the dried thyroid glands of pigs. It was the first treatment for hypothyroidism, prescribed since the 1890s, and it was the dominant therapy until synthetic levothyroxine took over in the 1970s. It is still used by an estimated 1.5 million Americans, and it is the option at the center of the current FDA dispute. This article explains what it is, how it differs from the synthetic options, and what the regulatory fight means for patients.

By Brittany Henderson, MD, board-certified endocrinologist · October 2026

What is in it

DTE contains both T4 and T3 in a fixed ratio of roughly 4 to 1, bound to the thyroglobulin protein from the gland. One "grain," the traditional unit, is 60 to 65 mg of extract and delivers about 38 mcg of T4 and 9 mcg of T3. That is a higher share of T3 than a human thyroid makes (about 14 to 1), which is why some patients feel more energetic on it and why clinicians watch free T3 and heart rate closely.

Because the T3 is released as the tablet dissolves, many patients split the dose, morning and early afternoon, to smooth the peak.

Product	Maker	Status (October 2026)	Notes
Armour Thyroid	AbbVie / Allergan	Marketed; unapproved, grandfathered drug	The oldest brand; contains dextrose and other fillers; periodic supply gaps
NP Thyroid	Acella	Marketed; unapproved, grandfathered drug	Fewer excipients than Armour; recalls for potency in 2020 and 2021
Adthyza	Azurity	Marketed since 2023; unapproved, grandfathered drug	Newest brand; reported shortages in 2025 and 2026
Nature-Throid, WP Thyroid	RLC Labs	Not available since 2020 recall	Many patients moved to NP Thyroid or compounding
Compounded Thyroid USP	Licensed 503A compounding pharmacies	Available under FDA risk-based enforcement as of fall 2026; long-term status depends on the petition and the PEAT Act	Custom T3:T4 ratio, custom strength, no dyes or allergenic fillers, slow-release options

How DTE differs from synthetic combination therapy

Both give the patient T4 and T3. The differences are practical. DTE comes in a fixed ratio with a relatively high T3 share, while synthetic combination lets the clinician set any ratio. DTE's T3 is released somewhat more gradually from the glandular tissue, while synthetic liothyronine is absorbed fast. DTE is a single product rather than two prescriptions. And DTE is a natural product, which appeals to some patients and concerns others; the FDA's stated concern is batch-to-batch consistency, and there have been recalls for sub- and super-potent lots.

In the randomized crossover trial that compared all three approaches head-to-head, DTE performed the same as levothyroxine for the average patient, and 35 percent of the most symptomatic patients preferred it, a figure close to the 50 percent who preferred synthetic combination. The point, again, is that there are patients for whom each option is the right one.

Why some patients need the compounded version

Compounded Thyroid USP is made by a licensed pharmacist from the same USP-grade thyroid powder, to a prescription written for one patient. It exists because manufactured DTE does not fit everyone:

Patients who react to the fillers in Armour or NP Thyroid, which is common in people with autoimmune thyroiditis and multiple sensitivities.
Patients who need a T3:T4 ratio different from the fixed 1:4 of the manufactured tablets.
Patients who need a slower-release formulation so that the T3 does not peak and crash.
Patients who need a strength the manufacturers do not make, or who have been stranded by recalls and shortages.

The Foundation's position is not that compounded thyroid is better than other options. It is that removing it leaves this group of patients with nothing that works.

The FDA dispute, in plain language

In a 2022 letter to state pharmacy boards and again in an August 2025 letter to manufacturers, the FDA stated that DTE meets the legal definition of a "biological product" because it contains a protein, thyroglobulin. Under federal law, biologics cannot be compounded by ordinary pharmacies, and manufacturers would need a biologics license to keep selling. The FDA set August 6, 2026 as the date after which it could enforce that view.

The counter-argument, made in the Citizen Petition filed with the FDA on August 28, 2026 and in the PEAT Act introduced in Congress, is that thyroglobulin is a carrier protein, not the active ingredient; the active ingredients are the small-molecule hormones T4 and T3, which makes DTE a drug, not a biologic. As of this writing the FDA has said it is using risk-based enforcement, compounded Thyroid USP remains available, and the petition is awaiting a decision. Our Advocacy page tracks every development and links to the full petition.

What this means for you

If you take Armour, NP Thyroid, or Adthyza, nothing has changed today, though supply has been uneven and it is wise to refill early. If you take compounded Thyroid USP, your pharmacy can still fill it for now. If you are considering DTE for the first time, the questions to ask are the same as for any thyroid medicine: what are my free T4 and free T3, how will we dose and monitor, and what is the plan if supply is interrupted.

Questions to bring to your appointment

Is my T3 share on DTE right for me, or would a lower-T3 option suit me better?
Should I split my dose?
If my brand is recalled or back-ordered, what is our backup plan?
If I react to fillers, is compounded Thyroid USP or a dye-free levothyroxine the better next step?

About the author

Brittany Henderson, MD is a board-certified endocrinologist and Medical Director of The Thyroid Foundation. She is the Medical Doctor at MyThyroidDoctor, a thyroid-only telehealth platform. Follow her on Instagram at @mythyroiddoctor.