More Attacks on Use of Armour Thyroid


Earlier, (http://www.metabolism.com/2009/01/21/dear-dr-repas/) I wrote a letter to Dr. Thomas Repas, explaining why I disagreed with his publication which opposes combination treatment for hypothyroidism (using t3 in addition to the traditional t4 therapy). I never received a reply to my letter. Somehow I wasn’t surprised.

His latest article appearing in the February 10, 2009 edition of endocrinetoday.com, goes even further in attacking the use of combination treatment, specifically as it applies to desiccated thyroid (Armour). He poses the question, “So why do I and most other endocrinologists refuse to use dessicated thyroid?”. He also states, “I believe that desiccated thyroid is antiquated therapy and should no longer be used.” His position then is that using Armour thyroid and similar preparations is an unacceptable medical practice. In fact, the last sentence of his editorial, states that desiccated thyroid preparations are unacceptable for treatment.

Dr. Repas bases his argument on the idea that the amounts of thyroid hormone in desiccated thyroid preparations are more variable than synthetic thyroid preparations. This is true but irrelevant. For the average person, variations in the time medication is taken, the rate the medication is absorbed from the stomach, and the general health of the person taking the medication which alters the metabolism of the thyroid hormone in the tissues, makes the variations in hormone levels in these preparations meaningless for clinical purposes. What Dr. Repas misses is the big picture, which is that for good health the human body requires a more complex form of thyroid hormone replacement then an unchanging daily amount of pure t4. A therapy like Armour which combines t4 with t3 is closer to what a normal thyroid secretes. Not everyone responds but in my experience the vast majority of unsuccessfully treated hypothyroid patients who continue to experience symptoms compatible with thyroid hormone deficiency, these symptoms respond very favorably to Armour thyroid.

In my letter to Dr. Repas from January 2009, I pose various key questions about thyroid hormone metabolism in the body. I challenge any endocrinologist to answer these questions in a meaningful way. Until we have a clear understanding of what comprises the perfect form of thyroid hormone replacement, I find it unacceptable to have physicians with opinions which differ from mine, telling me what is appropriate therapy for my patients.

Thyroid hormone replacement therapy is often complex and takes time and collaboration between physician and patient, to come upon the best treatment solution. Those endocrinologists and other physicians who prefer to over-simplify their approach to treatment with a rigid adherence to a single dose of pure t4, in my opinion, are only fooling themselves.

For recommendations for treatment of medical conditions you should consult your own health professional. My statements are solely for educational purposes, and are not intended to imply treatment advice.

The disclaimer for metabolism.com applies to this publication.

Gary Pepper, M.D., Editor-in-Chief, Metabolism.com

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  • Dr. Pepper is right. A good physician listens to his patient and knows how to ask the right questions. I have Hashimoto’s disease and suffered from Hypothyroidism. Dr.Pepper originally treated me with t4. It did not help much. Since I have been on Armour thyroid, my thyroid nodules have shrunk so that I don’t feel like there is a lump in my throat anymore and my blood levels are in the normal range.

    Thank you Dr. Pepper for making me well.

  • Dr. G. Pepper

    Karen

    thanks for the words of support.

    gp

  • Carole

    I was treated with T4 only medicines since I was first diagnosed with hypothyroidism in 1971. Approximately 25 years ago, the left lobe of my thyroid was removed because of a goiter. Four years ago the right side of my thyroid was removed because of an 8cm growth (I’m assuming goiter). This last surgery damanged my parathyroid glands. I continued to take T4 only meds until I started to do research to try to understand why I felt so much in a fog and why I wasn’t feel well. I then asked my doctor to switch me to Armour Thyroid. I have been on Armour for approximately 2 to 2 1/2 years. I feel MUCH better, although still not as well as I wish I did. The first thing I noticed when switching to Armour was that the brain fog lifted almost immediately.
    Thank God for doctors like Gary Pepper who believe in their patients and allow them to participate in their health plan!

  • Ronald K. Cobbs, MD

    Several points should be noted. The American Assciation of Clinical Endocrinologists (AACE) recommends against the use of dessicated thyroid preparations. They specifically recommend levothyroxine and preferably branded versions as small changes in concentration have marked differences in clinical effects and blood test results such as TSH and free T4. Further, the endocrine literature reports that although most patients are successfully treated with branded levothyroxine alone, there is a small minority who never feel back to normal. However the literature supports the addition of T3 in the form of Cytomel rather than to retreat to the non-precise dessicated thyroid preparations of the past.

    An experienced endocrinologist familiar with the literature can by precribing branded levothyroxine be able to treat most of their hypothyroid patients to the satisfaction of both phyician and patient. However the endocrinologist must listen to their patients and follow thyroid function blood tests. Even when the blood tests are normal, if the patient still does not feel normal again, the careful addition of amounts of T3 (cytomel) to the thyroxine will usually help the rest to feel better again.

    Also remember to avoid taking iron replacement and medications such as cholestyramine or colesevelam too close to the levothyroxine as they prevent the adequate absortion of levothyroxine in the body.

  • Tony Kingkade

    C’mon Dr. Cobbs…just stop it!

    Dr. Cobbs perpetuates the myth that “branded” levothyroxine products (I assume he means Synthroid or Levothroid) are preferable to other manufacturer’s products because the AACE says so. First of all, the AACE statement was published many years ago before ANY levothyroxine product had undergone the FDA approval process. Since then, ALL levothyroxine products on the market today have undergone the same, exact FDA approval process. Some have also demonstrated AB bioequivalency to other “branded” products…ie Mylan levothyroxine is bioequivalent to Synthroid. The generic companies have manufacturing technology, consistency in product and batch-to-batch bioequivalency that rivals or exceeds any branded manufacturer. They know that there can be no variation in their product and they make that a priority.

    That this”brand is better” myth continues today is appalling. It was originally promoted by Boots (former Flint and manufacture of Synthroid) and only exposed as false when Boots commissioned a study at UCSF to compare their product to various generic levothyroxine products. When the results of the study showed no difference in blood levels, Boots withheld publishing of the study. A Wall Street Journal article exposed this and the lawsuits from health plans (that paid more for Synthroid than equivalent generics) extracted millions from Boots.

    In fact, at one CE presentation, I asked the Boots paid speaker why I should change my generic stabilized patient over to Synthroid since, according to him, there might be huge negative effect if one changes between Synthroid and a generic. He was unable to answer the question (because, to be consistant, it would mean that one should never convert back to Synthroid if already stabilized on another product.)

    I know about low therapeutic indexes and the FDA allowable variation in potency for products. I get it! But all these manufacturers get it too. They make sure their drugs are right on, every batch, assay to assay.

    So I ask you, Dr. Cobbs, to show us unequivicable proof that this isn’t true. In fact, just show us that the branded products have less variation in their batch-to batch assays than the generics. Give us the proof!

    I’m not associated with any generic drug manufacturer. In fact, my wife is employed in a high science position by a major US/worldwide brand name manufacturer. So, if anything, I’m definately pro brand-name. But Dr. Cobb’s support of the AACE recommendations to use only branded versions of levothyroxine is just plain wrong.

  • Lynn Mathias

    I’m not a doctor, however I have been on Armour Thyroid for a number of years and refuse to take just a “T4” medication. Fortunately I have a doctor who partners with me in regards to my treatment options. He would tease me about being the only one in the world still taking Armour, but at least he listened to me. We will be adding Cytomel to my regime, which i’m excited about. I’m in 54 years old and I’m not ready for daily naps, I have too much I want to do and I refuse to let a non functioning thyroid gland get in my way. Yeah for pigs!

  • Dr. G. Pepper

    Lynn

    Fear not. You are not “the only one in the world” taking Armour thyroid. In my endocrine practice I have hundreds of people who take this form of thyroid medication, most of whom were unhappy with standard “t4” only therapy.

    You will find many articles on metabolism.com supporting your choice of Armour for thyroid replacement. What is scarry is that the major medical organization that represents Endocrinologists officially came out against using Armour thyroid to treat hypothyroidism. My crusade is to prevent this type of close mindedness from depriving individuals the choice to use Armour.

  • Cindy Caluori

    Curious if anyone has seen this reaction: I started on 25mg of Levoteyoxim May 15th 2008. Within two weeks I had developed a “severe” rash across my neck and onto the lower part of my face. Skin was incredibly itchy, dry & flakey, and it hurt to even smile. June 28, 2008 prescription was change to Synthroid 25mg, and towards the end of June the rash was much improved. By September 2008, from supervision of my endocrinologist, dosage was 75mg Synthroid to maintain 2.190 TSH level. I had taken pictures of the rash…but my endocrinologist said it was not related to the thyroid or thyroid medication. I am not convinced of her assessment as I have never had any type of skin problem/allergies, etc., and it all seems too coincidental.

    Occasionally to date, May 15, 2009, neck “rash” appears but is minor in comparison to the May 2008 rash; and skin is moderately dry. To see if I could get back to my once “normal skin” I increased Synthroid dosage to 100mg on April 25, 2009. Within a few days I started to experience similar conditions that occurred in May 2008, so I decreased dosage to Synthroid 50mg.
    ]
    Tomorrow, May 16, 2009, I will start taking Armour (30mg), prescription courtesy of my G.P. I cannot get an appt with my endocronoligist till end of July. I’m not so sure she will approve and therefore I may be forced to start over with a new doctor?? There is only one other endocrinologist in this town of Missoula MT…. What is a person to do? Any imput is greatly appreciated.

  • Sharon F.

    I tried a couple of endocrinologists and was constantly heckled about my point blank refusal to not come off of the Armour. In the end I simply went back to my GP who now run the relevant blood work and prescribes my meds. I cannot compare Armour with Synthroid because I refused to take it from the beginning but I did a lot of research and I have other complications that I did not need compounded.

    I am not sure I am on the correct dosage however, it seems to get lowered everytime I have bloodwork and I am now just taking one grain (60mg) but still have some symptoms. Increasing my dose makes my hair fall out more and so does decreasing it so I am caught between a rock and a hard place!

    I was diagnosed back in 2001 and the one main thing I wish I could fix would be my libido… That seems to have left the building.

  • Cherie A.

    Cindy – I had a similar experience with a rash/hives. I have Hashimoto’s and started Armour Thyroid in November 2008 (15 mg). After 8 weeks on that, the endocrinologist increased my dosage to 45 mg. Within 2 weeks, I had a severe rash on my feet, legs, torso, arms and neck. Very itchy and irritating. I called the endocrinologist and pharmacist and neither thought it was an allergic reaction, but endocrinologist suggested taking 30 mg. I reduced the dosage and the rash got better, but did not totally resolve. At the advice of my primary care doctor, I went to an allergist and was told that now that I have had the rash/hives for more than 6 weeks off and on that I have chronic hives and that many women with hypothyroidism/Hashimoto’s will experience chronic hives that last anywhere from a year to life. I have been put on xyzal at night and claritan in the morning. The rash/hives were gone after about a week of this routine. I really don’t like being on all this medicine though and have gained some weight I am having a hard time getting rid of. Not sure if it’s Armour related. I also have other medicine allergies that exhibited by way of a rash/hives – any medicine with sulfites in it and NSAIDs.

  • Vicki

    I wonder how many of our Endocrinologists are on Synthroid or Armour Thyroid? I find it rather interesting that these doctors are making “absolute” statements when they aren’t the ones living with the diagnosis. I encountered thyroid cancer in 2001 and had my thyroid completely removed. Forget about hyperthyroidism or hypothyroidism, without a thyroid hormone replacement in my body every day, I am dead. We tried Synthroid, but it didn’t seem to be enough. I also felt like my body needed something more. We switched over to Armour thyroid, and even though the T3 levels are not consistent from month-to-month, I am feeling great and normal! I have found, however, that living without a thyroid, it is a “MUST” to also be on a good multi-vitamin and to take supplements (At a different time of day than my Armour thyroid, of course.) I am never at a loss for energy and I don’t have the “foggy” mind that I did before. You would never know that I don’t have a thyroid. I am very grateful for Armour Thyroid. I guess I can actually say “I can’t live without it!”

  • Kay

    Hiya, I am having big problems and thyroxine is not working even though my blood results come back normal. Can you tell me how to get Synthroid and Armour, I live in the UK.

  • Amy

    Hi, I have belatedly been diagnosed with hypothyroidism after approximately 15 years of symptoms, entirely due to the backwards way of using the TSH as the sole screening method by so many doctors. It wasn’t until I found Mary Shomon’s articles in About.com that I figured out for myself that my 3.05 TSH was actually above normal and that all my steadily increasing and debilitating symptoms were from hypothyroidism..

    I have researched extensively and made the decision to go with desiccated thyroid for my treatment plan. I am following Stop the Thyroid Madness by Janet Bowthorpe as my guide for managing my disease. I highly recommend her book and website to all who wish to get away from the poor effects of synthetic T4 and T3 treatments. What Dr Cobbs above fails to note is that not only does desiccated thyroid have both T4 and T3 but also T1, T2, and calcitonin, all of which are produced naturally by our own thyroids and necessary for proper hormone replacement. Synthetics do not provide all of these trace hormones and just because Big Pharma has indoctrinated most in the medical field as to the absolute necessity of their products, many of us are simply not buying into it. Big Pharma has a lot of bad history behind its tactics and that, fortunately, has finally become obvious to many of us.

    Those who posted above who are still not getting well on Armour need to know that it is possible that your adrenal function may be fatigued, which is very common with people who have been long undiagnosed and/or on T4 treatment. I recommend you test your adrenals with a saliva cortisol test and treat any low cortisol issues before instigating your desiccated thyroid treatment. Cortisol is necessary to get the T3 into the cells and if cortisol is low this process will be impaired.

    Also, it is common to use the brand name “Armour” to cover all brands of desiccated thyroid but many are unaware that there are other brands as well. In fact, Forest Labs, the makers of Armour recently reformulated Armour in spring of 2009 and there are MANY reports that the reformulated product is not performing as well as the original. The natural thyroid forums are full of posts from people who report a return of hypothyroid symptoms on the new Armour. Armour claims that they only changed the filler ingredients but there appears to be something up with this, there are even posts of labs before and after the formulation change and free T3 and free T4 levels have dropped significantly. Most are switching over to other brands like Nature-throid or Westhroid from Western Research Labs.

    I have mixed feelings right now about my health and treatment. I am very, very angry that I was shuffled aside for so many years and instead of receiving treatment for my core problem of an underactive thyroid, I was treated for depression, weight gain, fibromyalgia, orthostatic tachycardia syndrome, constipation, high cholesterol, joint pains, tendonitis, and a myriad of other symptoms that are mostly, if not all, a direct result of the underactive thyroid issue.

    It’s time for doctors to start screening symptomatic patients properly with free T3, free T4, and antibody tests and for doctors to know how to read the results of these tests correctly. Being “in range” does not mean we are getting the optimum amounts of hormones in our systems. We need to be at the top of range or the ranges need to be adjusted accordingly. And doctors need to discard the TSH both as a screening and a treatment guide for hypothyroidism. Patients need to be listened to and treated by symptom relief first, with labs as an adjunct guide instead of the “holy grail”.

    I am also tired of being dismissed as an alternate medicine loony by mainstream doctors and practitioners for my choice to use a thyroid treatment that has been used with great success for about 100 years and which has only in the past few decades been discredited by the makers of Synthroid and other Big Pharma types, while they attempt to hijack the entire hypothyroid treatment arena for their sole profit and gain.

    I am however very grateful to Doctors like Dr Pepper who actually “get it” and will provide the treatment we so desperately need. Thank you Dr Pepper for having the courage to buck the system and give us hope that the tide will finally turn in the sea of poorly treated hypothyroidism.

  • Cale Garret, Pharm. D.

    Let’s get real here for a moment. There are hundreds if not thousands of websites out there specifically created by Forest Pharm, the makers of Armour and other Thyroid drugs, that are part of their promotional campaign. This is the same scam they were sued for and lost on with the Celexa/Lexapro case where they would go on sites like this, and make posts as housewives saying that X drug changed their life and that X drug’s competitors pay doctors to not support it. Everywhere you go on a google search of “Armour Thyroid” paints the exact same picture. This is fraudulent and irresponsible.

    Every legitmate news article about Armour Thyroid paints a different picture, that the makers are under constant fire from the FDA, that they host clinical trials that are more than biased towards their goods, and that they participate in illegal geurilla tactics to sell their drugs.

    All Pharm companies have one goal in mind, help people and make money. There are lots of companies that do both well, and there are lots of companies that does one of the two well. Don’t trust some housewife with a fake sounding name on the internet over your highly educated doctor. If the post says something like “Don’t listen to your doctor, YOU should make your health decisions” You should run. Imagine a plumber coming to your house when a drain is backing up and having him tell you it needs to be rodded, but you read on the internet that plumbers are paid to suggest rodding drains and that you should tell him instead to replace all your pipes. You are NOT a plumber, you are NOT a doctor, you are a patient. If all the doctors in the world are telling you not to take a drug and there’s a minority of internet users, websites with names like “TheThyroidlie”, and doctors with blogs that tell you to take that drug, use common sense.

    We didn’t spend six years extra years in school and spend $200,000 dollars on education to lie to you about some internet scam drug. Read the REAL articles.

    Use your head.

  • gina

    Haha, “Cale Garrett”, you’re too funny! Having been scammed by plumbers, I now google my plumbing problems – and fix most of them myself! Hooray for the internet, freeing us from the arrogant “trust us; we’re professionals” line Cale has just treated us to. Plumbing problems, medical problems, computer problems, you name it – I google them all, and IF I still need to hire help, I am then much better informed about what I need and want from that hired help. Information is power, and it’s not locked up anymore. Welcome to the 21st century, Cale; get over yourself and get used to it; empowered patients are here to stay. Oh BTW, how do we know that you’re not just a pharma shill with a “fake sounding name on the internet”?

  • Amy

    Oh Please Cale, and this is why Armour is now not even covered by Medicare, because Forest did such a bang-up job of promoting its product Armour over all others, and defending it from the winner-take-all Abbott labs? And please cite all the “clinical trials” of Armour that Forest has hosted… can you say Zero? I am certainly not defending Forest here, and their typical Big Pharma antics with Celexa are reason enough to abandon them, even if they hadn’t bungled Armour so badly.
    Sadly, Forest has done a supremely crappy job of promoting Armour (the one decent product they make) and they have put yet another nail into their coffin by first making it scarce and unavailable and then by reformulating it to the point where it’s lost its effectiveness.
    No, it’s not Forest Pharm that makes desiccated thyroid so popular, despite their best efforts to do the wrong thing, it’s the fact that the product works for many who end up burned out on the T4 only meds that Abbott and others have convinced (and heavily funded) the AACE and other endo societies to back 100%. Try Googling Synthroid and see what comes up.
    By the way, that plumbing analogy stinks. I suggest you not compare those of us who chose to inform ourselves and are capable of disseminating information to a thinly veiled comparison of dumb housewives. Very bad tactic, that.

  • Amy

    Per my post above, Dr Pepper, I think it’s important to stress that Armour is no longer the desiccated porcine thyroid preparation of choice for many who were once its champions. Forest Pharm had fallen out of favor with many, many natural thyroid users (including patient advocate Mary Shomon, and thyroid activist Janie Bowthorpe) and most are making the switch to RLC Lab’s Nature-throid and Westhroid.
    Janie Bowthorp’s latest blog describes how Forest won’t even return her calls anymore about why their new formulation is such a dismal failure.
    It’s sad that Forest’s bungling is making it even harder for us who rely on desiccated thyroid hormone replacement as our treatment choice but fortunately there are alternatives that we and our providers and pharmacists need to be aware of.

  • Darla

    Hey Cale,

    I help run one of those site you speak of. Not one of the natural dessicated thyroid companies have given me or the folks that help a dime. Even so I still claim that dessicated thyroid meds changed my life. Not taking up for what Armour did. I take another brand.

  • This is a response to Cale’s comment that Forrest has created websites with fake housewives touting armour when they are really Armour employees. Cale–why do you think these “undercover” employees were so critical of Armour when there were shortages? Why do you think these websites are now advocating leaving Armour and switching to another brand? Are you a conspiracy theorist?

    I was on synthroid for years–all of them terrible–found a doctor who is hypothyroid and takes only armour–I switched and it has been butterflies and unicorns until the formulation switch in May. Now I am switching brands.
    Until you have experienced hypothyroid symptoms please hold your tongue. You really don’t know anything, M.D., pharm d., whatever–

  • misty

    I WENT TO BED AND WOKE UP.SWELLING BY OVER 20LBS RED LOOK LIKE I HAVE BEEN BURNED COULD NOT BREATH WIERD PAIN ALL OVER MY BODY . I THOUGHT I WAS LOSING MY MIND OR GOING CRAZY. Im a 34 year old lady dont smoke dont drink and had never did any kind of drugs in my life worked out 6 days a week . I a mother of four my life stop over night . I went in a thyriod storm . I almost died . i had go to the clealand clinic in ohio to help and to stay al live .

    i was on life support at cleaved clinic .
    misty

  • misty

    THE CHANGES IN THE MEDICATION OF ARMORE IS DEXROSES AND CELLULOSE . THESE ARE FILLERS
    LOOK IT UP SIDE EFFECTS ARE NOT GOOD.

  • patty

    i had my thyroid removed in 2007 and am allergic to levoxyl. and also had brain fog and hives. my doctor put me on armour thyroid i felt better. he has me on 60mg mon-tue-thurs-fri-sun. and 90mg on wed-sat….. up until this april i was feeling good. but now im really tired and have hives again and brain fog. my levels are good. well my question is what else is there for me to take. since my pharmacy can no longer get my doses of armour. if this is a sight that does not take questions. sorry i just started using the internet.

  • Darla

    Patty,

    There is a Yahoo group just for people that have had thryoidectomy. If you would like to find out more here is the link to the group.

    http://health.groups.yahoo.com/group/thyroidless

    I bet they can help you sort this out so you can feel better soon.

    Darla

  • Leslie

    Armour thyoid is a scam? Give us a break. Synthroid mad me sicker than I was….Armour has saved my life! Arroant doctors who don’t have to live with the debilitating symptoms have no business makeing absolute pronouncements! If Armour didn’t work, people wouldn’t take it! Cale Garret is ininformed. One has to wonder why all energy to discredit a medication that is helping millions. Hmmm – maybe he gets a kick-back from the makers of Synthroid?

  • Sarah

    It was very interesting to read these posts. I have never posted to a site such as this but I wanted to contribute my perspectives on this topic. I am a researcher by trade (in a very different line of research). I have been reading general “google” information for years on the controversy between synthroid and Armour. I have had trouble with mild symptoms at 88 mcg (synthroid) but 100 mcg brought my TSH to .4. My doctor was not comfortable with a TSH that low. For a number of years I have requested to try Armour and been denied. My main argument for trying Armour has been that if there are not risks with Armour (beyond the typical risks seen with any thyroid meds) why should I not try it. He has responded that the literature does not support Armour or the use of T3. I sat down for a few hours yesterday and looked at primary research articles and was very surprised. First of all there is a serious lack of research with autoimmune related thyroid disease. Second the few clinical trials that looked at Armour vs synthroid products were very poorly designed. Very small sample sizes with high variability in sample populations. The samples involve wide age ranges, multiple ethnicities represented and both genders. These variables would be important to consider but statistically inappropriate with small sample sizes. Of a greater concern was that in many of the studies most of the patients were being treated for hypothyroidism post surgical removal of the thyroid and then had only two patients with autoimmune related hypothyroidism mixed into the sample. They even noted that with the two patients with autoimmune hypothyroidism there were trends toward more positive outcomes related to the Armour. You will not find statistical significant with these kinds of research design (if being responsive is specific for the autoimmune variety) even if differences exist. If anyone could please provide the references for well designed research studies (either pro or con for Armour) I would really appreciate it.

  • Amy

    Thank you Sarah for finding some studies and pointing out how poorly done they were. I wasn’t able to find any so you have better search facilities than I do. Regarding your doctor’s refusal to prescribe natural thyroid hormones (NTH) I suggest that you seek a more open-minded physician who will actually listen to his/her patient and not rely on the TSH test as the sole measure of how well thyroid hormone replacement is working. The goal here is to have Free T3 at the top of range, Free T4 in the top third of range and (most importantly) an alleviation of symptoms. The combined T3/T4 of NTH is the safest, easiest most cost effective way to accomplish this.

    I highly doubt there are any well-designed research studies out there comparing NTH and synthetics. All we have to go on right now is anecdotal evidence from many patients who started out on synthetics and found they did better when they switched to natural thyroid hormones. It’s unfortunate that there aren’t any studies so that the current biased clinical guidelines that were heavily influenced by Big Pharma can be changed back to allow the use of NTH again. There are some scary rumours circulating now about how the manufacturers of synthetics are making moves to try to get the FDA to prohibit the use of NTH. Forest Labs, who manufactures Armour, has changed its formula so it’s very much less effective and many pharmacies are not able to get supplies in. Most patients have made the switch over to RLC Lab’s Nature-throid as a result. Forest Labs also manufactures synthetic T4 and T3 hormones.

  • Samantha, MSN, NP

    I’m a nurse practitioner in NY, and find that our patients generally do better or Armour Thyroid than on the usual T4 products. As for Cale, it sounds as if he’s in love with BigPharma, but many conservative practitioners and dispensors abound, so take what he says with a grain of salt. I, several MDs and NPs and a DO of my acquaintance all use Armour Thy. ourselves, but have noticed a slight decrease in effectiveness since the reformulation. The real frustration is having to convert our patients back to Levothyroxine and Cytomel which many do not find nearly as helpful. Other brands such as wes-throid and nature-throid are now out of stock, (in our area) and so there is no real alternative. Some of our patients have even tried getting stocks from Canada, to no avail. When I last checked with Forest they had stocks of 120 and 360 dosages available, but most of our patients require much less. While I will still use Armour and prescribe it, when we can get it again – as will my colleagues mentioned above – we are thoroughly annoyed at Forest for the reformulation. Most people tolerated the product very well. Patients should not have to have their effective medication routines switched out from under them. No one wants to change horses mid-stream.

  • sue

    How ridiculous the constant ‘black is white’ attitude of the medical establishment over the T4/ Armour argument.
    For MANY people, myself included, Armour works, synthetics don’t.
    WHY this witch-hunt??? They wouldn’t deny insulin to a diabetic – why must thyroid patients be made to suffer??
    The whole thing stinks.

  • leslie

    Medical school education is quite slanted by whatever drug company is currently paying the perks. We need to do our homework and find doctors who will help us, and not let ourselves be bullied by docs who hold absolute opinions about things. Medicine is not a “one size fits all” proposition. And I wouldn’t trust ANY doctor who takes an absolute stand against natural thyroid treatment, Such a doctor is arrogant and probably getting kick-backs from the makers of Synthroid!

    We also need to get reconciled to the fact that drug companies, just like insurance companies and many doctors do not have our best interests at heart….they are concerned with their bottom line, and prescribing synthroid is “easier” for those lazy docs who don’t care to even educate themselves about natural thyroid treatment.

  • Amy

    I just wanted to add that since this thread started many have had a problem finding any natural desiccated thyroid in the US due to the FDA shutting down two generic manufaturers and the increase in demand on RLC’s Nature-throid and Westhroid. It appears that the FDA will require RLC and Forest to go through their new drug application process for the NDT they are currently manufacturing and while it does not appear these products will be taken off the market during this costly and lenghty process, it remains to be seen if the manufacturers will actually go though with this. The rumors abound and it’s hard to sort out the actual facts of the situation but many, many NDT users have found their supplies shut off and have been forced back onto the synthetics.
    I’ve found a decent supply of NDT in Canada, manufactured by Erfa and I’m very pleased with the product. It has far fewer filler ingredients than the US made NDT and it dissolves sublingually very well. I can order it legally through online pharmacies witth a US doctor’s prescription (hopefully the FDA will continue to allow this… they’ve relaxed their rules with this medication, which seems to point to a possibility that they are not completely anti-NDT). Many are also very happy with the Thai made NDT, Thyroid-s and Thiroyd, which appears to be available without a doctor’s prescription. There is also a new organization called Save Natural Thyroid Coalition and I suggest all join to help keep NDT available to those of us who have made a choice to be treated with this product.

  • J Franklin

    Dr`s don`t know it all, the endocrinology speciality in in a mess, it treats the thyroid and not the cause, which is autoimmune in origin. to treat a disease first you need to no the cause.! duhh.! you can memerise the longest book but do you understand it?
    this is a great cause for concern, we rely on doctors to make us well,or do we! I was brainwashed from birth to believe them, but I now do my own research and have found them wonting.they are many years behind as they don`t keep up with uptodate ideals on their speciality . god help us ,because if you have some thing wrong , don`t ask them
    for help because it is not their. when we they start to take any notice, when i am dead
    they will say ,”we will learn by these mistakes” but by then it will be to late.

  • debra

    Lyme Disease is usually accompanied by a change in Thyroid. Those of you who exhibit rashes, hives and such should see a Lyme Specialist; although many DRs. will warn against this as they do Armour Thyroid.

  • april

    I am a patient who also has nodules on my thyroid and hypothyroidism. I was diagnosed about 5 yrs ago. I started on the synthroid. I felt worse instead of better. After a little over 2 yrs of switching doses, etc to try and make things work, I begged my MD to give me something different. He started me on the Armour thyroid. I thought this would have to be adjusted to work and was expecting a long ride with yet another med. I was in for a great suprise! This worked for me and I felt so much better in no time. I have been taking it for over 2 yrs and it is still working and keeping my levels where they should be as well as helping me feel like a human again. I have a sister who had thryoid cancer and had her thryoid removed about 8 yrs ago. She did the synthroid and cytomel and I believe one other med (not at the same time) and was so miserable and feeling worse than before. After the armour worked for me I asked her to check with her MD about it. He switched her to it about 1yr ago and she thanks me all the time for telling her about this med. She said she hasn’t felt this good since before her cancer. She was constantly up and down on her levels, weight gain, mood swings, hair loss, you name it. She now is doing great. The only problem? It’s on a shortage so now we fight over where to go and get our prescription filled lol..Please keep the Armour thryoid coming to help those of us who couldn’t function on the other meds!

  • Helen

    I have just had a tremendous struggle to keep my Armour Thyroid. I switched my doctor because he refused to keep prescribing it for me saying it was “not FDA approved” and he wasn’t comfortable prescribing it for me any more. He tried to push me into taking Synthroid and I refused. I have been taking 60 mg of Armour for 3-4 years and feel fine on it. My recent blood/TSH/T4/T3 levels came out great. Why should I be pressured into taking a synthetic medication when the natural Thyroid works so well for me? I know a lot of people are ordering the ERFA now from Canada, which is the equivalent of Armour and is approved there. I think it sucks that they are trying to outlaw Armour here in the U.S. I will keep fighting for my right to take the medications I want and which work for me and I urge others to do the same. We all have to take responsibility for our own health.

  • Carol Jean Vogelman

    Am 62, have been on Armour since I was 12! In May, just when the new formula hit the market, I became more and more grief stricken over my recently deceased husband, at sugar like a mad woman, cried all the time over everything, sat and stared and by the end of the first month had a broken blood vessel in my left eye! All my thyroid symptoms were back, more pain and fatigue to die for, my dear! I still had no clue, and when you are thinking you are on medication but you are not, that is really nasty! I lost valuable resources because I couldn’t open the mail and didn’t have another adult to help me.
    Now I am in all sorts of trouble. I figured out the problem 4 months later; just last sunday
    the pharmacist at the Walgreens near my place said he also had heard that the porcine
    had been switched to horse thyroid~all of it without anyone being told!
    I hear Naturethryoid is returning, it took a full two months on that and then Westhroid for me to recover; but I “felt the love” from my first Naturethryoid; I have FMS and can detect at once when such a thing occurs, but when your thyroid is being un medicated and you think it the same drug, that is criminal behavior. I want to take part in any lawsuit anyone wants to start. If they returned to the exact original formula that would help because too many people are sitting and staring instead of living just because of the greed and ignorance of a formerly fine company.
    Also, read Broda Barnes; he pioneered the medication at the Armour Institute and was in the field for 60 years and he knew his stuff!

  • Shahzad Khan

    Hi everybody,
    I was diagnosd with hypothyroidism based on my blood works i have been taking thyroxine, however i did not feel good, later on i was diagnosed with hashimotos, and my pulse and bp were regularly high, pulse was around 90-100 and bp was 140/90 usually, so after a lot of research i decided to switch to armour thyroid, i did feel better on half a grain but my pulse and BP did not normalize, when i consulted my doc he threw a fit and made me switch back to thyroxine and blamed armour for my high pulse and BP, and he also gave me a beta blocker 10mg Inderal, however inspite of that at night my pulse and BP shoots up even if iam resting, iam currently on 75 mcg of thyroxine and 10 mg inderal, could anybody shed light on how i can get my raging pulse under control, as this is really driving me mad, iam 36 years old and i feel like iam 60, help please.

    • Dr. G. Pepper

      His Shahzad
      Is it possible you have more than one problem? Reading your post I am wondering if you could have a rare cause of hypertension called pheochromocytoma which causes high blood pressure and rapid pulse. This is a usually benign tumor of the adrenal gland that produces the hormones we refer to as catecholamines (the fight or flight hormones). Other symptoms with this are tremor, sweats and headache. A 24 hour urine collection for catecholamines, VMA and metanephrine diagnoses 95% of this type of adrenal problem.
      It is far more common however for anxiety to cause high BP and rapid heart rate then for it to be caused by pheochromocytoma.
      You should discuss these issues with your physician.
      Let us know how this resolves and best of luck

      Dr. G. Pepper
      This information is for educational purposes only and does not represent medical care or substitute for the advice of your own physician.

  • Shahzad Khan

    Thank you Dr. pepper for your response, i did have a 24 hour urine test also as my physician wanted to check my adrenal functions, the VMA came out normal it was 9.0 mg/24 hours and normal range is less than 13.6, i forgot to tell you that i have vitamin D deficiency and i have pinched nerves in my neck as the C spine discs have become thin, taking vit D injection once a month for that. I do have anxiety attacks and i take a quarter lexonatil at night it helps me sleep and also keeps my heart rate in check, however the minute i get up at night even if it is to walk to the refrigerator my pulse starts racing, very wierd, iam taking 100mg neogap twice a day for the pinched nerve otherwise i start gettin tremors in my left leg and numbness and tingly sensations, i know iam quite a mess:)

  • Shahzad Khan

    p.s.I have had a 24 hour holter test also, that came out normal thankfully except for 13 ectopic beats during the day, i also have major acidity problems so i avoid caffeine red meat but i cant avoid chocolates and since its almost impossible for me to gain weight so i cant quit on the chocs, for acidity i take a teaspoon of apple vinegar with water that works wonders..

  • Hi,
    I have all the symptoms of hypothyroidism and have struggled with intense fatigue for years…I was hoping to try Armour Thyroid but if the company changed the ingrediants, is there some other brand that resembles the old Armour formula that I can try? Thanks so much

    • Dr. G. Pepper

      Hi Hannah

      I have been treating many people with the standard manufactured version of Armour Thyroid without problem. You might consider using it before spending lots of money on other substitutes. Compounding pharmacies may be able to help but in general the cost is a lot more.

      Good Luck

      Dr. G. Pepper

  • Margie

    Hello, Everyone

    I was diagnosed Hypothyroid 10 years ago, I have two sisters and several aunts with the same problem. I was prescribed synthroid and it was a Godsend for the first three years even though I was up and down, however I began to be more and more tired and just generally did not feel good, my dosage was up and down, finally doctor prescribed cytomel to go with it. still no good my bones hurt all the time especially my hip going down my leg and in the middle of my upper back, my beautiful teeth damaged. I finally told my Doctor to either give me the Armour or I was going to find another Doctor who would, He did and shazamm all symptoms disappeared, I feel great Like before I ever had this problem, I Thank God for Armour, and I also avoid flouride, chlorine

  • Leslie

    After suffering through Synthroid, then being unable to get Armour, I finally found a doc who would prescribe compounded natural thyroid….but his goal seemed to be to keep lowering my dose. It was terrible. Then I found a “Functional Medicine” doc who not only worked with me, but who actually knows something beyond what the drug company funded medical education teaches! One of the suggestions my new doc made in reference to my on-going fatigue was to go gluten free. I thought it was nuts, but did it anyway. Within a few weeks, most of my fatigue and fibro pain was gone. He also treats my thyroid according to symptoms….if I feel good, then he leaves it alone…no more of the constant tug-of- war over medication. Could have been saved from almost 8 years of suffering if other docs would listen and think outside the box. If your doc won’t help you, dump him/her and find someone who will! also, like Margie, I avoid fluoride – I live in a community that does not fluoridate the water, and avoid bottled beverages (which most likely are made with fluoridated water) and processed food…and no fluoride toothpaste! The stuff is poison, and deadly to your thyroid!

  • Anna

    Does anyone know if Armour was reformulated again in 2011? I have found some posts claiming this was the case…I was prescribed Armour in late 2011 and I can verify that the pills do not turn into a chalky paste when I put them under my tongue (as described by many other patients). However, it does not have a strong, characteristic odor either although it says so on the bottle. I managed to get the pharmacist to give me one bottle of Erfa as well, just to be able to compare the two, and I find Erfa to be more effective and definitely easier to take sublingually.

    But it would be interesting to know if there is some truth to the rumors that Armour was reformulated a second time in 2011?

    • Catherine S

      Dear Dr. Pepper,

      I would be interested to know if you find the reformulated Armour to be as effective as the old one? Do you still prescribe Armour instead of Nature-Throid, Erfa etc? As far as I’ve understood the posts I’ve read, thyroid advocates such as Mary Shomon and Janie Bowthorpe have switced to other brands of desiccated thyroid, after years on Armour. But would you say that Armour is still as effective (that’s how I interpret your answer to Hannah?) Is it, like some claim, only a question of how you take that; that is, chewing it up vs taking it sublingually? But what about the increased amount of cellulose in Armour; could that not cause malabsorption and hence reduce the amount of thyroid hormone available to the body?

      I would appreciate a reply from you as I am currently hesitating between Armour and Erfa. My doctor is herself on Armour and has been for years, and she claims she never noticed any difference whatsoever after the reformulation. Armour is also more easily available than Erfa. But I’ve read hundreds of posts about how the new Armour destroyed people’s lives, made their hypo symptoms return with a vengeance, etc.

      • Gary Pepper M.D.

        Hi Catherine

        When it comes to people’s preferences for medication I never say “never”. It is amazing how one person is totally happy with a certain medication and another person absolutely hates the way the same medication makes them feel. This applies frequently to thyroid medications. Recent research has shown how genetic differences can cause some hypothyroid people to require more T3 replacement than “normal” to achieve a good thyroid balance. When it comes to dessicated or “natural” thyroid hormone replacement some people claim the new formulation of Armour reacts differently than other formulations and brands. This has not been the experience of my patient’s. For the hundreds of people who I have treated with Armour I can think of only one or two who prefer one of the other formulations of dessicated thyroid. I have a whole chapter in my book Metabolism.com which addresses the Armour issues.

    • Gary Pepper M.D.

      When a drug is reformulated the FDA is involved which is included in the public record. When the reformulated drug is released to the medical community that information must be updated to all prescribing medical professionals. I have not received any alerts either public or professional that confirm another reformulation of Armour. Hope that info helps.

      Dr. P.

  • Cathy

    I’ve had the opportunity to try both Erfa and Armour in the past two months and Erfa was not at all optimal for me. I followed the advice given in various forums, that is, to take the pills sublingually and multi-dose. This made me both hyper and hypo at the same time. I could have enormous amounts of energy one minute and then suddenly crash. I could feel cold one minute and start sweating the next. With Armour, it’s completely different. I follow my doctor’s instructions and chew the pills up before I swallow them with water. This works wonders for me! I have even levels of energy throughout the day, I feel refreshed when I wake up in the morning, I feel naturally tired at night, I have no problems falling asleep and I don’t even feel like I’m on medication (which I did on Erfa). So I guess it’s very individual. For me, Armour is the best choice and I’m going to stick with it.

  • Anna

    Dear Dr Pepper,

    Do you know WHY Armour was reformulated in 2009? I have read so many strange explanations – that the FDA forced Forest and RLC Labs to reformulate their products so that people would stop using them and switch to Synthroid, that the manufacturer of Synthroid was behind the reformulation for the same reason, that this is only the first step to banning NTH altogether…apparently, the amount of cellulose was increased and the amount of lactose/dextrose was decreased. Can you find a rational explanation for that, as it is often said that cellulose binds thyroid hormone, hence making the drugs less effective?

    • Gary Pepper M.D.

      Anna
      Your question is very important but this type of information is not public. Adding binders like cellulose is a common approach to create a “timed release” effect of the hormone medication. Compounding pharmacies use this strategy to make “time released T3” out of pure T3. It isn’t a very precise method but it does a reasonable job of extending the time it takes for the hormone to be absorbed into the circulation. Perhaps that was in some way behind the Forest decision to reformulate. As you see from my previous post and posts from members like Cathy (posted Feb 7) I haven’t noticed a dramatic change in the effect of Armour since the reformulation but that doesn’t exclude the possibility that certain individuals can tell the difference.

      Dr. P.

      • Catherine

        I have a question about this. In several forums, I have seen the advice that Armour needs to be chewed up before being swallowed, otherwise the thyroid hormone in the pills won’t be released properly. What is your opinion? Do you recommend that your patients swallow the pills or chew them up first? I have read that swallowing them or taking them sublingually render them useless, and make the thyroid hormone pass through your intestins undigested, so chewing them up before swallowing them is the only way to make it work…I’d appreciate your opinion on this because there is GREAT CONFUSION??? This is said to apply to all NTH meds with an increased cellulose content (Armour, Westhroid, Nature-Throid).

        • Gary Pepper M.D.

          Hi Catherine

          The approved method for taking Armour Thyroid and other dessicated thyroid hormone pills is to swallow them along with a glass of water. I suppose the idea behind chewing the medicine originates with the thought that you need to release the hormone from the binder. Extensive studies by the manufacturer show that swallowing the tablet whole results in good hormone absorption. That has been my observation with hundreds of patients. Some people prefer to split the dose in two because the T3 portion can be expected to be metabolized (used up) within a matter of a few hours after taking the medication. Whether it is worth the inconvenience of having to take a medicine two times daily vs. only once is an individual matter.

          Does that answer the question?

          Thanks for your post.
          Dr. P

          • Catherine

            Thank you, Dr. Pepper, that’s was exactly the answer I was hoping for!

  • Anna

    Dr. Pepper,

    Do you recommend that your patients take NTH once daily or multi-dose? My doctor (who’s on Armour herself) said that NTH can safely be taken once a day in the morning as it is more stable than synthetic combo drugs, but it seeems that most people multi-dose. Of course it’s easier to take once a day, especially if you swallow your pills like I do and then have to wait for at least half an hour before eating. But many claim that that puts too much stress on the adrenals and the heart, especially if you take large doses (I take 4 grains daily during the cold season).

    I would really like to know what you recommend?

  • Anne

    Dear Dr. Pepper,

    Thank you so much for this enlightning explanation on how to take NTH. This was a great relief to me as I have discovered that swallowing the pills is the only way to make them work for me. I have tried them sublingually and chewing them up; the first method made me hyperthyroid and the second one rendered the pills useless. However, having read on the Stop the thyroid madness website that NTH needs to be taken sublingually for optimal absorption, I followed this advice, since STTM seems to be the Bible for hypothyroid patients…but it did not work for me. I guess we all have to find out what works best for us, regardless of what “most people” think…

    Anne

  • Christine

    Dear Dr. Pepper,

    This is a great forum! I have some questions that I hope you will be able to answer:

    I was recently prescribed NTH and asked the pharmacy to give me both Armour and Erfa (I wanted to be able to compare the two). Luckily, the pharmacist agreed. So now I have been on NTH for three months and have discovered the following:

    – I seem to need around 5 grains a day for optimal results and symptom relief (I used to be on 250 mcg of thyroxine)
    – on 5 grains of Armour, I get more stable results than with Erfa. With Erfa, I feel slightly hyperthyroid at times, even though 5 grains of Erfa contains slightly less hormones than Armour (181 mcg of T4 and 40 mcg of T3 as compared to 192 mcg of T4 and 45 mcg of T3 in 5 grains of Armour). How is that possible?

    – many reputable sites, like Stop the thyroid madness and Mary Shomon’s thyroid.about.com claim that Armour was reformulated in outmost secrecy and that neither patients nor doctors or pharmacists knew anything about it. They go on to claim that it was discovered only because many patients became hypothyroid again and went back to the pharmacy to check if they had indeed been given the right drug. They even say that Forest has refused to communicate with patients. But according to what you write in a post above, “When a drug is reformulated the FDA is involved which is included in the public record. When the reformulated drug is released to the medical community that information must be updated to all prescribing medical professionals.”, it would not be possible or even legal to reformulate a drug without informing anyone. So what is true???

    • Gary Pepper M.D.

      Hi Christine

      You and Anna, whose post I just responded to, have a very scientific approach to thyroid hormone use, which is very inspiring. There remains a tremendous amount of individual variation in response to medication and hormones which complicates explanations and treatment, however. The differences in hormone amounts between Armour and Erfa are so small I consider the two medications interchangeable. The fact that you can tell the difference is not uncommon but I wouldn’t explain it on the basis of these small differences in T3 and T4 amounts. What is the difference for you personally, I can’t say but the solution seems simple to me; pick the one you feel best on as long as your thyroid levels are not out of bounds, ( and as long as your health provider agrees)

      Mary Shomon has been a great ally in the fight we had a year or two ago during the Great Armour Shortage. Fortunately for all, that crisis has passed. I am aware of this controversy about the reformulation but I am not nearly as concerned as some others like Mary. I believe we know whatever there is to know about the reformulation and my patients are responding just as well to the new formulation as the old. Very rarely I have someone who wants a different product but I get that with every medication. Such is the differences between individuals and I accept that.

      I have a chapter on the Armour Shortage and controversy in my new book, Metabolism.com. Have a look! http://www.metabolism.com/shop/metabolism-book

      Thanks and I hope that helps.

      Dr. P.

  • Anna

    Dear Dr. Pepper,

    I have read several times that pigs produce less T4 and more T3 than humans do, so that patients taking Armour and other desiccated thyroid meds end up having low free T4 and high free T3 levels. I recall seeing the figures 5%T3-95%T4 in humans as opposed to 20%T3-80%T4 in pigs. It was also stated that T4 to T3 conversion is normal in hypothyroid patients.

    So my question is: why aren’t all patients on NTH put on a combination of NTH and thyroxine, to duplicate what a healthy thyroid would be doing?

    I read recently that a healthy thyroid gland contains about 200 mcg of T4 and 15 mcg of T3, but that that does not represent the amounts of thyroid hormone circulating in the blood as T4 is converted to T3. But would you say that those are the amounts of hormones produced by a healthy thyroid gland each day, and something one should aim for when on thyroid med replacement?`

    • Gary Pepper M.D.

      Hi Anna

      I like the way you think. You have done your research and your facts are pretty good. What is important to remember however is that what you are quoting are the average amounts of the various hormones in humans which cannot be applied to individuals. (The ratios in Armour are standardized and are more or less constant). I like to use the analogy of shoe sizes. The average shoe size may be size 7 but that doesn’t mean everyone with a normal foot can fit in a size 7 shoe. My thyroid may produce a very different amount of thyroid hormone in different ratio’s then your thyroid but both of us are normal. Do you see the point? The situation becomes even more tricky when the thyroid is not working properly.
      Finding the proper dosage for thyroid replacement is harder than just treating the averages. Also I disagree that everyone converts T4 to T3 at the same rate or with the same efficiency and there is recent research to explain that.

      In my book Metabolism.com I devote a lot of time explaining my philosophy and approach to these issues. Have a look!http://www.metabolism.com/shop/metabolism-book

      Thanks and I hope this helps.

      Dr. P.