Different formulations of thyroid hormone may work better for different individuals with hypothyroidism, necessitating a trial-and-error approach.

“there are some patients in whom one way works and another way doesn't I've had patients who came to me on desiccated formulations and I thought you know I don't really like these desiccated formulations I'm going to switch switch them over to T4 plus control release T3 and I could never get them right and I ultimately end up putting them on desiccated and getting them right similarly I get patients that show up undesicated and they sort of feel okay but they're not quite right and we get them feeling right in other ways”

“there are really competing schools of thought and there are some people that believe that the only thing that should ever be given to any patient with hypothyroidism is a desiccated formulation similarly there are other people who think all of that desiccated stuff is total crap and it should never be given and we should only be giving T4 or we should only be giving T4 with a little bit of T3 or you should only be given control release T3”

“if you're giving desiccated thyroid and this is kind of the reason why I don't generally like to use it except when it works you're giving a fixed amount of T4 and T3 you don't get to control it the ratio is set and it's something like 1 to 4.2 or something like that meaning for every unit of T3 you're giving you're giving 4.2 units or micrograms of T4”