Tablet
Armour Thyroid
Armour Thyroid, a desiccated thyroid extract used to treat hypothyroidism. Commercial formulation prescribed and dosed by a licensed physician.
30 tablets per month
Starting at $129/mo
ThyroidCombinationOptimization
T3 + T4 Combination Capsules
RxPrescription onlyTaken by mouth · Once a day · 4.5–27 mcg / 114 mcg · Thyroid · Combination · Optimization
Starting at $79/mo
Compounded T3 and T4 in one capsule at a ratio your physician sets. Combines the reserve benefit of T4 with the immediate activity of T3. Oral, once or twice daily.
How many capsules per month?
MonthlyEvery 3 months
30 capsulesper month
You'll receive 30 capsules per month. $99 billed monthly. Cancel anytime.
Real prices from our pharmacy. Longer plans cost less per month and are billed up front. Pause or cancel anytime.
- T4 and T3 together at a custom ratio set by your physician
- Faster onset than T4 alone, more stable than T3 alone
- Dosed as few or many capsules as your protocol needs
Every plan includes
- Personalized, physician-guided plan
- 30 capsules per month, monthly and 3-month
- Dispensed by a US-licensed compounding pharmacy
- Unlimited protocol adjustments and messaging
- Ongoing support and check-ins
- Pause or cancel anytime
- Reviewed by our in-house physicians
- Physician-guided care
- Ongoing, expert support
- 100% online
- Free, discreet shipping
What is a T3 + T4 combination?
(compounded thyroid replacement)
Some people thrive on T4 alone; others feel better with some T3 upfront. A T3/T4 combination gives you both: T4 as a stable reserve, and T3 for immediate activity. Your physician sets the ratio based on your symptoms, labs, and response. A common ratio is 4:1 or 5:1 T4 to T3, but yours will be individualized.
- How it is taken
- Taken by mouth
- How often
- Once a day
- Dose range
- 4.5–27 mcg / 114 mcg
- Form
- Thyroid · Combination · Optimization
Customized
T4/T3 ratio compounded by a licensed pharmacy
The combination works for people who need more immediate T3 activity than T4 alone provides, but don't tolerate T3-only dosing. Ratio is adjusted at every check-in.
How it works,
week by week.
Day 1
A US-licensed physician reviews your thyroid symptoms (fatigue, cold intolerance, weight, mood), medical history, and medications. Discusses how thyroid hormones work and the importance of lab-guided dosing.
Week 1
Start with an initial dose (usually conservative) of your prescribed thyroid hormone, taken once daily in the morning with water on an empty stomach.
Weeks 4-6
Thyroid hormones accumulate slowly; effects build over 4-6 weeks. Energy, temperature regulation, and mood may shift gradually. Keep a symptom journal.
Week 6-8
First lab check: TSH and Free T4 (or Free T3 if on T3). Your physician adjusts dose if needed. Repeat this cycle every 6-8 weeks until TSH and symptoms align.
Beyond
Thyroid hormones work best on a stable dose. Annual labs and check-ins ensure your dose stays right as your body and needs change.
What you may notice,
and when.
More energy
fatigue lifts as thyroid levels normalize
Better sleep quality
mood and sleep rhythm often improve together
Mental clarity
brain fog clears; focus and concentration return
Body temperature
cold intolerance eases as metabolism normalizes
Individual results vary. Benefits reflect what Zepym Health members commonly report to their physician at check-ins; they are not the results of a clinical trial.
Safety first:
what to know before you start.
Important safety information and common side effects
Thyroid hormones regulate metabolism and affect every cell. Overdosing causes tachycardia, palpitations, anxiety, insomnia, and heat intolerance; underdosing leaves fatigue and brain fog. Thyroid hormones are not for weight loss in people with normal thyroid function. Do not use if you have uncontrolled high blood pressure, active angina, or untreated adrenal insufficiency. Tell your physician about all medications, especially beta-blockers, stimulants, and any cardiac history. Stop and seek care for rapid heartbeat, chest pain, severe shortness of breath, or signs of thyroid storm (high fever, confusion, agitation).
The research behind
T3 and T4 together.
A combination of liothyronine (T3) and levothyroxine (T4) is an option some patients ask about. Trials have not shown a clear advantage over levothyroxine alone.
- GuidelineNo clear advantage
The 2014 ATA guideline reviewed the combination trials and said they did not reach a clear conclusion about benefit over levothyroxine monotherapy. It recommended long-term outcome trials of combination therapy.
Jonklaas et al., Thyroid 2014 (ATA guideline) - Early trialMood signal, not repeated
Bunevicius and colleagues (NEJM 1999), 33 hypothyroid patients, crossover, reported mood and cognition gains with T3 added; later studies did not consistently reproduce them.
Bunevicius et al., N Engl J Med 1999; review of later evidence (PMC10522160) - Randomized trialNo quality-of-life gain
In a 2003 JAMA randomized trial (46 people, 4 months), adding T3 to T4 did not change quality of life beyond what levothyroxine alone achieved.
Clyde et al., JAMA 2003
What the studies found
- Mood and cognition gains reported in a small 1999 trial, not reproduced later (Bunevicius, NEJM 1999)
- No clear benefit over levothyroxine alone in the guideline review (ATA, Thyroid 2014)
- Patients who prefer the combination may value that choice; this is preference, not a measured clinical gain
Trials of combination therapy used levothyroxine plus liothyronine at doses set by the investigators. Compounded T3 plus T4 capsules have no trial of their own.
What this does not say
- No trial has shown that combination therapy prevents or treats long-term disease.
- The combination carries the same T3 uncertainties as liothyronine alone.
- Dosing needs regular blood tests and medical supervision.
The research
behind it.
T4/T3 combinations bridge the gap between T4-only and T3-only therapy. T4 provides steady-state coverage; T3 covers the peak-demand times.
No clinical trial compares all T4/T3 ratios, so your physician uses experience and your feedback to dial in the best ratio for you. Adjustment takes 4-6 weeks per change.
Getting started
takes a few minutes.
- 1
Connect with a physician
Answer a few questions online and a US-licensed physician reviews your health, history and goals to make sure treatment is right for you. 100% online. No in-person visit required.
- 2
Get your discreet shipment
If approved, your treatment is compounded by a US-licensed, LegitScript-certified pharmacy, inspected for quality, and shipped discreetly to your door.
- 3
Receive continuous support
Start with one goal, then keep building over time. Unlimited physician messaging, easy refills and dose adjustments, all from the Zepym Health app.
Frequently asked questions
Contact supportHow do I take T3 / T4 Capsules?
Taken by mouth, once a day, in the morning. The starting prescription is 1 capsule (4.5 mcg / 19 mcg) each time. Your physician sets your own dose and it is printed on your label.
What strengths does T3 / T4 Capsules come in?
The pharmacy carries 7: 4.5 mcg / 19 mcg, 9 mcg / 38 mcg, 12 mcg / 38 mcg, 12 mcg / 50 mcg, 18 mcg / 76 mcg, 25 mcg / 150 mcg, 27 mcg / 114 mcg. Your physician chooses which one you get.
What exactly is in it?
Liothyronine (T3), Thyroxine (T4).
How much arrives in each shipment?
30 capsules at the starting strength, shipped to your door from a licensed US pharmacy.
How is this different from Armour?
Armour is a fixed ratio of natural T4 and T3 from pork thyroid. A T3/T4 combination is compounded with a ratio your physician chooses and can adjust. The flexibility is the main difference; your physician can increase T3 or T4 independently based on your response.
Why can't I feel my dose immediately?
Thyroid hormones accumulate in your tissues and bloodstream over weeks. The half-life of T4 is about 7 days, so it takes 4-5 half-lives (1 month) to reach steady state. Be patient; your physician will adjust if needed at your 6-8 week check.
Will thyroid hormone help me lose weight if my thyroid is normal?
No. Thyroid hormones are not weight-loss drugs. They work only in people with low thyroid function. Overdosing a person with normal thyroid function causes dangerous side effects (tachycardia, heat intolerance) without weight loss.
Can I adjust my dose myself?
No. Thyroid dosing requires lab values (TSH, Free T4, Free T3) to be safe and effective. Too much causes palpitations and anxiety; too little leaves you fatigued. Your physician adjusts by the numbers and your symptoms, never by guessing.
T3 + T4 combination educational content reviewed by our physician
Scott Nass, MD Doctor of Medicine, board-certified in Family Medicine
Charles R. Drew University and David Geffen School of Medicine at UCLA. Family Medicine residency at Ventura County Medical Center.
More options
in this area.
Capsule
Liothyronine (T3) Capsules
Liothyronine (T3) slow-release capsules, used to support thyroid hormone levels and metabolic function. Prescribed and dosed by a licensed physician.
30 capsules per month
Starting at $89/mo
Capsule
Thyroxine (T4) Capsules
Thyroxine (T4) slow-release capsules for thyroid hormone replacement therapy. Prescribed and dosed by a licensed physician.
30 capsules per month
Starting at $79/mo
Injection
Tirzepatide + B12
A weekly dual-action GLP-1/GIP injection for meaningful weight loss and appetite control, paired with vitamin B12 for energy.
Starting at $198/mo
References
- 1.Hypothyroidism: evidence-based diagnosis and management in adults. N Engl J Med, 2017
- 2.Levothyroxine replacement in primary hypothyroidism: a clinical update. J Clin Endocrinol Metab, 2012
Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Products are compounded by a licensed pharmacy. The FDA has not reviewed or approved compounded products for any use for safety, efficacy, or quality. Compounded medications are not FDA-approved brand-name products.