Provider Briefing: Adthyza Discontinuation and the NDT Landscape in 2026

If your patients are asking about Adthyza — or showing up with unfilled prescriptions — this briefing will bring you up to speed. Adthyza (thyroid desiccated, USP) was permanently discontinued by Azurity Pharmaceuticals in November 2025, and the broader natural desiccated thyroid (NDT) drug class faces unprecedented regulatory uncertainty.

This article provides the clinical and logistical information you need to manage patient transitions, field questions about NDT availability, and make informed prescribing decisions in 2026.

Timeline of Key Events

• February 2023: Adthyza (thyroid desiccated tablets, USP) first marketed by Azurity Pharmaceuticals (formerly Silvergate Pharmaceuticals/CutisPharma). Available in 5 strengths: 1/4 grain (16.25 mg) through 2 grains (130 mg).
• 2020-2021: NP Thyroid (Acella) recalled multiple lots for superpotent tablets. Nature-Throid and WP Thyroid become unavailable, effectively leaving only Armour Thyroid, NP Thyroid, and Adthyza as commercial NDT options.
• August 6, 2025: FDA announces plans to remove all Desiccated Thyroid Extract (DTE) products from the market, reclassifying them as biologic drugs requiring new approval under the biologics pathway. 12-month transition period announced.
• November 2025: Azurity Pharmaceuticals discontinues Adthyza. NDC listings expired/excluded from official directory.
• Early 2026: Armour Thyroid (AbbVie) and NP Thyroid (Acella) remain available but face uncertain futures. Compounded NDT continues as an alternative.

Prescribing Implications

Current Adthyza Patients

Any patient currently prescribed Adthyza needs to be transitioned to an alternative. Key considerations:

• Dose equivalence is not exact. Adthyza's grain weights differed slightly from Armour Thyroid and NP Thyroid. For example, Adthyza 1 grain = 65 mg (38 mcg T4 + 9 mcg T3), while Armour Thyroid 1 grain = 60 mg (38 mcg T4 + 9 mcg T3). The T4/T3 content is similar, but confirm with the patient and adjust as needed.
• Monitor thyroid function (TSH, Free T4, Free T3) 4-6 weeks after any switch. NDT-to-NDT switches generally require minimal adjustment, but switching to synthetic Levothyroxine requires careful dose calculation.
• Conversion from NDT to Levothyroxine: A commonly used approximation is 1 grain NDT ≈ 100 mcg Levothyroxine, though individual response varies. Consider adding Liothyronine 5-10 mcg for patients who specifically benefited from T3 content.

New NDT Prescriptions

Given the FDA's stated intention to remove DTE products, prescribers should consider:

• Whether starting a new patient on NDT is appropriate given uncertain long-term availability
• Whether synthetic T4/T3 combination therapy could serve as a more sustainable alternative
• The role of compounded NDT as a fallback — particularly for patients with demonstrated preference or clinical need for NDT

Current Availability Picture

As of March 2026, the NDT landscape looks like this:

For real-time pharmacy availability data, direct your staff and patients to Medfinder for Providers.

Cost and Access Considerations

Several factors affect patient access and affordability:

• Insurance coverage: Most formularies prefer synthetic Levothyroxine as first-line therapy. NDT products often require prior authorization. With Adthyza's discontinuation, any existing PAs for Adthyza will need to be rewritten for the replacement product.
• Prior authorization for NDT: Document clinical rationale clearly — e.g., patient tried and failed Levothyroxine monotherapy, persistent symptoms despite optimized TSH, or specific adverse effects with synthetic formulations.
• Patient assistance: Adthyza Cares program is no longer active. AbbVie offers patient assistance for Armour Thyroid through their patient support programs. Generic Levothyroxine is available on most $4 generic lists.
• Compounded NDT and insurance: Most insurance plans do not cover compounded medications. Patients should expect to pay cash, typically $30-$60/month.

Tools and Resources for Your Practice

• Medfinder for Providers: Real-time pharmacy availability checker. Help patients locate NDT and other medications in stock near them.
• ASHP Drug Shortage Resource Center: Updated shortage information for all NDT products.
• American Thyroid Association (ATA): Clinical guidelines and position statements on NDT use.
• FDA DTE Transition Information: Official updates on the biologics reclassification timeline and manufacturer compliance status.

For patient-facing resources you can share, see:

• Adthyza Shortage Update: What Patients Need to Know in 2026
• Alternatives to Adthyza If You Can't Fill Your Prescription
• How to Save Money on Thyroid Medication in 2026

Looking Ahead: What to Expect in 2026-2027

The NDT market is at a crossroads. Here's what providers should be prepared for:

• FDA enforcement timeline: The 12-month transition period from the August 2025 announcement puts the deadline around August 2026. It remains unclear whether the FDA will grant extensions or if manufacturers will have completed biologics applications by then.
• Potential market exits: If the regulatory burden proves too costly, additional NDT manufacturers may exit the market, following Azurity's lead. AbbVie (Armour Thyroid) has not publicly confirmed whether it will pursue biologics approval.
• Patient advocacy pressure: Significant patient and provider advocacy efforts are underway to preserve NDT access. Congressional attention may influence the FDA's timeline or approach.
• Compounding as safety net: Compounded NDT may become the primary avenue for patients who require desiccated thyroid, assuming the FDA does not extend its removal order to compounded preparations.

Key Takeaway for Providers

The practical message for 2026: have transition plans ready for all patients on NDT. Whether it's a switch to Armour Thyroid (while available), conversion to Levothyroxine ± Liothyronine, or referral to a compounding pharmacy, proactive planning now will prevent emergency situations later.

Use Medfinder for Providers to help your patients find thyroid medications in stock, and read our companion guide: How to Help Your Patients Find Adthyza in Stock: A Provider's Guide.