BY DAVID G ROBERTSON, MD

Every week in my clinic, I sit across from patients living with hypothyroidism who are exhausted, disheartened, and searching for hope.

For the group of patients taking thyroxine (T4) alone and still experiencing symptoms, the difference between feeling alive and feeling numb depends on access to desiccated thyroid extract (DTE).

As recently as August 6th, 2025, the FDA announced plans to limit DTE access within the next year. This action risks throwing countless patients who are currently healthy and thriving back into fatigue, fog, and frustration.

Hypothyroidism is a lifelong condition, and patients deserve uninterrupted access to the therapies that work for them.

DTE: A Longstanding, Proven Treatment for Hypothyroidism

DTEs are not new or experimental. They have been utilized safely and effectively for over a century as mainstream treatments, prescribed to more than 1.5 million Americans today.

While levothyroxine (T4), a commonly prescribed thyroid medicine, works fine for some, many patients remain symptomatic—experiencing fatigue, brain fog, weight gain, depression—even when their labs appear “normal.”

That’s why DTEs are so important. Derived from porcine thyroid, DTEs contain both T4 and triiodothyronine (T3). These are the two main thyroid hormones our bodies naturally produce. For this group, adding T3 is the only treatment that finally makes them feel like themselves again.

This isn’t just about numbers on a chart; it’s about real lives. I’ve watched patients go from drained and despondent to energetic and elated once they switched to DTE treatment. For them, it’s not a preference. It’s their lifeline.

Yet the FDA’s recent advisory threatens to take this treatment away. Teachers, nurses, parents, and others in our own community who found stability using DTE will have no option but to switch back to medicines that have already failed them.

What Forced Medication Changes Really Mean

Taking away this option doesn’t just force a medication switch. It means condemning many hypothyroidism patients to a return of symptoms they’ve already fought so hard to overcome. For someone with hypothyroidism, that can mean losing the ability to work, parent, or even function day-to-day.

Health care is never a one-size-fits-all solution. We would never tell a patient with depression that they can only be prescribed one antidepressant, even if it doesn’t work for them. We would never tell a patient with diabetes that insulin is the only option, regardless of how their body responds. Yet that’s exactly what this FDA decision would mean for thyroid patients.

The role of regulators should be to expand safe, effective choices, not eliminate them. When patients and physicians are stripped of options, the result is not better safety but more suffering.

Patients deserve safe options. Patients deserve choices. And patients deserve to be heard. If you or someone you love depends on DTE, now is the time to speak up. Share your story. Reach out to your representatives. Engage with patient advocacy organizations such as the APC, which are urgently working to preserve access.

Because for those who depend on DTE, this is not about preference. It’s about survival. It’s about the right to feel whole again.

Thank you,
Dr. David G Robertson

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David G Robertson, MD, is a board-certified endocrinologist with Atlanta Diabetes Associates and Piedmont Hospital in Atlanta, where he has practiced since 1998. A former faculty member at Emory University School of Medicine, Dr. Robertson served as a National Institutes of Health (NIH)-funded investigator, receiving a prestigious Physician Scientist Award for his research on insulin’s regulation of gene expression. His clinical practice and research span thyroid disorders, metabolic and cardiovascular risks, endocrine complications in transplant patients, and advanced diabetes management.

Dr. Robertson has led and published numerous clinical trials on endocrine therapies and is recognized for his expertise in hormone health, lipid metabolism, and innovative approaches to chronic disease care.

REFERENCES

Hidalgo J, et al. “Real Practice Assessment of Persistent Symptoms After Initiation of Levothyroxine.” Endocrine Practice. 2024 Feb;30(2):95-100. doi:10.1016/j. eprac.2023.10.132

Brigante G, Santi D, Boselli G, et al. “Randomized double-blind place bio-controlled trial on levothyroxine and liothyronine combination therapy in totally thyroidectomized subjects: the LEVOLIO study,” Eur J Endocrinol. 2024;190(1):12–22. doi:10.1093/ ejendo/lvad172

Hoang TD, et al. “Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism,” J Clin Endocrinol Metab. 2013;98(5):1982–1990. doi:10.1210/ jc.2012-4107

Jonklaas J, et al. “Evidence-based use of levothyroxine/liothyronine combinations in treating hypothyroidism,” Eur Thyroid J. 2021;10(1):1038. doi:10.1159/000512970 2021;10(1):10-38.

American Thyroid Association. “L-T3 Therapy in Hypothyroidism.” Clinical T hyroidology for the Public, April 2021.