Armour Draws Laughs During Year’s Biggest Meeting of Thyroid Doctors

I am reporting to you from this year’s meeting of the American Thyroid Association now taking place at the opulent Breaker’s Hotel in balmy Palm Beach, Florida. Cushy job if you can get it, I’d say.

Not a lot of laughs during the typical lecture at this three day meeting of the world’s experts on thyroid diseases and treatment but I did hear a few guffaws, giggles and snorts today during the single lecture devoted to using combination t4 and t3 therapy for treating hypothyroidism. The speaker on this topic, Dr. Michael McDermott a Professor of Medicine and Pharmacy at the University of Colorado, was actually significantly more open minded about using combination t4/t3 therapy then speakers from previous meetings on the same topic. He prefaced his comments by acknowledging that about half of patients treated with synthetic t4 continue to experience symptoms typical of thyroid hormone deficiency. What, if anything, doctors are to do to help their patients in this situation appears to still mystify the experts.

The laughs came when Dr. McDermott polled the audience of professionals about their opinions regarding treatment of a hypothetical hypothyroid patient with normal thyroid function blood tests continuing to complain of symptoms suggestive of thyroid hormone deficiency. The speaker put up a slide with 5 or 6 treatment options which the audience then voted on. Although a good portion of experts here gave a philosophical shrug of the shoulders by not choosing any of the options, it was reassuring to see a significant portion of the audience agreed with the statement that some hypothyroid patients appear to improve when t3 is added to traditional t4 treatment. This is far short of a strong endorsement of combination therapy but I would say it is a least a nod to those of us who routinely make use of this treatment option. The laughs and giggles came when the next to last option was read to the audience, proposing that Armour Thyroid was the best choice of treatment in this case. The last choice, that this type of patient should see a psychiatrist also got a few chuckles.

Not much more about dessicated thyroid treatment was mentioned after this curt dismissal but Dr. McDermott expressed his opinion that Armour Thyroid was a poor choice for treating hypothyroidism because it contains too much t3 and that synthetic t3 should be used exclusively if combination therapy was attempted. No one seemed aware that as of this month Armour Thyroid and similar dessicated thyroid medications were no longer available in the United States.

Despite the disturbing aspects of the first part of Dr. McDermott’s lecture he did end with some exciting ideas that I will soon be reporting on. The main idea he reviewed is that a genetic defect may cause resistance to t4 treatment in hypothyroidism. Those with the genetic defect would require the addition of t3 to achieve a healthy thyroid balance and elimination of the symptoms of hypothyroidism. I am sensing that this may be a breakthrough in thinking about why some people require combination therapy with t4 and t3. If so, endocrinologists will be forced to reconsider their reluctance/refusal to provide combination therapy for treatment of their symptomatic and dissatisfied hypothyroid patients. More to come on this breakthrough in my next installment.

Gary Pepper, M.D.

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  • Eric Pritchard

    It is quite amazing that after 50 years of abusing some patients with the T4-only therapy, that medical is begining to recognized that some patients do, in fact, require T3. It is about time for the practice of medicine to catch up with medical science. In 1960 Dr. Marshall Goldberg published a paper entitled “The Case for Euthyroid Hypometabolism,” which recommends a T3 therapy. About that same time researchers like Refetoff were noticing a resistance to T4. Refetoff, et al., discovered the cause, peripheral cellular hormone resistance in 1967. Subsequently, Braverman, et al., discovered peripheral conversion in 1970 and determined that 80% of all T3 comes from peripheral conversion. However, not to be swayed from the old thyroid-gland-is-directly-connected-to-symptoms paradigm, endocrinology has declared peripheral conversion to be fault free (really amazing) and simply ignores the potential for increased hormone reception. To support this wacky notion, they produced questionable studies that proved their old paradigm. These studies showed that the active hormone, T3, was ineffective and the inactive hormone, T4, was effective in spite of knowledge of the relative activity discovered by Gross and Pitt-Rivers in 1952.

    All of this reminds us of medicine’s rejection of the empirical antispetic discoveries by Drs. Semmelweis and Lister. Why it was not minute particles of the cadavers that were being disected prior to surgery and child birth, it was the bad humors in the air. The post surgical infections and deaths could not upset the bad humors paradigm. Only after concerned heads of surgury demanded washing up before operating, the invention of the microscope, and Pastuer’s discovery of bacteria, did the merchants of death and illness realize reality.

    Endocrinolgy laughed and dismissed Dr. Goldberg a half century ago, just as medicine drove Semmelweis to his death.

    There are physicians who believe that medicine is an art. I have come to that conclusion as well, but not for the same reasons. I believe that medicine is an art because medicine does not have the discipline to be a real science. Real sciences react to counterexamples. We have seen counterexamples to the thyroid gland only diagnostics and T4-only therapy prescriptions. However, endocrinology and thyroidology have dismissed these suffering souls with diagnostic excuses such as “nonspecific symptoms” and “functional somatoform disorder” to blame medicine or blame the patient for the patients continuing suffering. Both of these diagnoses could be avoided if the differential diagnostic procedures had been followed — including all possible causes for the patient’s symptoms, euthyroid hypometabolism, deficient peripheral conversion, deficient peripheral cellular hormone reception. But in a perversion of the logic underlying differential diagnostics, medicine claims that the thyroid gland is first the only possible cause of the symptoms and second, when it fails, the symptoms have many causes — which were not tested.

    Medicine is an art because it does not have the discipline to use clear language. In spite of demands for clarity of definition dating back to the 18th Century and undoubtedly earlier, and demands for clarity in medical guideline authorship protocols, “hypothyroidism” may be restricted to only the thyroid gland or may embrace the entire greater thyroid system. In either case, the diagnostics and the therapy recommendations are only applicable to the thyroid gland. Those who suffer from extra thyroid deficiencies in the greater thyroid system are simply allowed to suffer in spite of the existence of proven therapies.

    Medicine is an art and not a science because it ignores counterexamples. There are patients who require T3 without any T4 as they will become thyrotoxic on the T4, but require the T3 to overcome hormone reception resistance.

    There are patients who have had unsuccessful therapies with all synthetics but live well on desiccated thyroid. The laughter at the use of desiccated thyroid is a reminder that medicine does not have courage to recognize counterexamples and does not have the will to deal with them. Thus, endocrinology is really an art pretending to be a science as ignores suffering patients — perhaps a million in the UK and another 5 million in the US.

    One could only wish that those laughing fools develop a thyroid related malady that endocrinology choses not to recognize and then suffer the slings and arrows of mass medical malpractice that has been in vogue for the last half century.

  • Dawn

    The last choice, that this type of patient should see a psychiatrist also got a few chuckles.

    Yeah, you must have to have a warped sense of humour to laugh at that, ever heard of depression and anxiety in hashimotos endos? I suppose that must be hillarious untll you start suffering from a distressing condtition yourself.
    The T4 only bunch are going to eat their words within the next few years and see that they really do need to do their own research and not blindly follow the pharma recommendation of the time or their peers.

  • cec

    Just a thought, perhaps the thyroid has to produce 20% t3 as the body need the 20% t3 as a catalysis to enable the t4 to convert. so without this 20% of T3 the t4 is sitting in the blood reading normal. The TSH will stop rising because it’s the level of t4 in the blood that it responds to not t3, so that everything looks normal but not doing anything much at all. Perhaps if doctors still want to only test the TSH and t4 only a better test would be to see how much t4 is passed in the urine, not how much it sitting in the blood doing nothing. cec

  • Shalyn

    It doesn’t take much brain power to see that T3 is valuable, so instead of throwing Armour out the window because it has too much T3; all a doctor needs to do is add a little T4 to it. WOW! I should have been a rocket scientist!

  • Robin

    Anyone know of an endocrinologist in Chicago who’s open to combo therapy? I had this when I was pregnant and have never felt better. However, I can’t find a doctor to do this now and am sick of leaving in tears knowing that this is the answer for ME, but no one cares enough to LISTEN and TRY. I’m so exhausted I can’t stand it, and my child is really getting the short end of the stick. I can barely stay awake. I’m sick and tired of being sick and tired…

  • Eric Pritchard

    The idea that Armour has too much T3 is a red herring because it totally discounts the inactivity of T4. T3 in the cells is where the action is — not T4 or T3 in the blood.

  • Cheryl Clark

    I found Eric Pritchard’s remarks of October 20, 2009 very helpful and something I would like to share with my family doctor. Eric, if you don’t mind and the text is available, please email the same comments to me:

    What a nightmare this has been! I finally was able to fill my RX through ERFA in Montreal. Although it was initially stopped at the border (via FED EX), it did finally get through the mail.

  • Eric Pritchard

    Mary Shomon has a list of TOP DOCS on her site.

  • Kathy

    I’m looking for a pharmacy that has Armour Thyroid 90mg and 15 mg tablets. I take a 105 mg dose.
    Please let me know ASAP if you have and my doctor will call you with a Rx.


  • Nancy

    Armour has changed their formula and people are not doing well on it. Best to order Nature-throid or West-throid from RLC. That is the only Company we have left operating in the USA

  • t

    kills me that these docs base most of their knowlege of any drug on the education they get from the pharmaceudical reps (pushers) that come to their office with cute little supplies bearing logos and treats. Could anyone tell me how they can ignore the millions of people on these websites noting the amazing difference we’ve all had switching to Armour Thyroid. How many times have we seen such arrogance assholes eat their words when meds that were approved were recalled. How many times have we seen them back track from “clinical trial” result to offer up new found results that contradict. Physician…….the oath you take is to make you accountable and responsible to your patients. Listen.

  • Sheila Turner

    Dr. McDermott would learn, through just a little research, that Armour is not “a poor choice because it contains too much T3”. Some doctors won’t recommend Armour because of the higher ratio of T3 to T4, believing it could be harmful or cause adverse reactions. Evidence does not support such reasoning. Also, the variation of thyroid hormone in Armour is minimal and well controlled (maximum 5-10 %) as specified by the US FDA. (1,2)

    Armour does have a higher amount of T3 compared to T4 than the relative amounts of T3 to T4 secreted by the thyroid gland, but it’s well documented that thyroid extract is often more effective and better tolerated than synthetic T4, T3 and T4/T3 combination.[3] This is because the T3 in thyroid extract is absorbed more slowly than synthetic (purified, unbound) T3. [4] A similar ratio can be obtained by giving both thyroid extract and levothyroxione.

    The long history of successful use of thyroid extract has seen these products successfully compete with synthetic T4 and T3 preparations and there is evidence to suggest that thyroid extract is superior to combined synthetic T4/T3 preparations.[5,6]

    Doctors must stop believing that serum thyroid gland function tests are the be all and end all to reach a precise diagnosis for the symptom of hypothyroiodism. Blood tests can be influenced by many factors, any of which should be taken into consideration, e.g.

    • Labelling errors
    • Bacterial contamination
    • Yeast/Fungal contamination
    • Clotting
    • Sampling errors
    • Sample preparation errors
    • Sample storage errors
    • Thermal cycling
    • Antithyroid antibodies (any)
    • Antibodies from any other cause
    • Presence of specific ‘toxins’ in the blood
    • Presence of pharmaceutical drugs (interferences) within the blood
    • The method of analysis being carried out eg radio-immune assay (RIA)
    • ‘Systematic’ errors in analytical equipment or methodology
    • Composite errors pre-analysis (not mentioned above)
    • MCT8 mutations

    Many people are discouraged when told their TFTs are within the normal range and doctors seldom question whether they might be resistant to their body’s own thyroid hormone. Yet, a disease known as thyroid hormone resistance, can prevent thyroid hormone reaching the body’s cells..

    The discovery of MCT8 mutations explains laboratory discrepancies [7] e.g. cases in which the lab results didn’t fit a particular pattern. It also explains how thyroid hormone resistance can cause TSH to appear normal even with a low FT4. In many instances only the TSH test is performed. If the TSH result is normal, and symptoms of hypothyroidism are observed, tests for FT4, FT3 and T3 should all be performed.

    None of these types of error are ever shown as being part of the reference range, but they all add to the unquantifiable ‘unreliability’ of the final number that appears on a lab report, stated to be within/outside a reference range. The labs expect, but often don’t get, notification of antibodies found by other labs or by investigations showing antibody activity, to enable proper screening for likely errors. e.g. vitiligo, alopecia, ongoing autoimmune symptoms specific to such as lupus, autoimmune attacks on specific organs, histology samples, haematological examinations.[8] A search on Pubmed shows 126 such cases.

    1.Lowe, John. “Thyroid Hormone Replacement Therapies: Ineffective and Harmful for Many Hypothyroid Patients.” May 4, 2004
    2.Steven L. Richheimer, Charlotte B. Jensen. Response to “Liothyronine and Levothyroxine in Armour Thyroid?”: 1987.Journal of Pharmaceutical Sciences. Volume 76, Issue 4. Pages 346-347
    3.Hertoghe T, Lo Cascio A., Hertoghe J. “Considerable improvement of hypothyroid symptoms with two combined T3-T4 medication in patients still symptomatic with thyroxine treatment alone”. Anti-Aging Medicine (Ed. German Society of Anti-Aging Medicine-Verlag 2003) 2004; 32-43
    4.Alan R. Gaby, MD “Alternative Medicine Review” Volume 9, Number 2, 2004
    5.Shames, RL, Shames, KH, Thyroid Power: 10 Steps to Total Health, Harper Collins Publishers, New York, 2001.
    6.Saravanan, P., et al, Clinical Endocrinology 57 (5), 577-585, 2002.
    7.William Winter and Neil Harris, A New Type of Thyroid Disease, Advance for Administrators of the Laboratory, June, 2008: 46-50.
    8.Sapin R. [Interferences in immunoassays: Mechanisms and outcomes in endocrinology] Ann Endocrinol (Paris). 2008 Nov; 69(5):415-25. Epub 2008 Jun 5.

  • Dr. G. Pepper

    Sheila Turner

    Very interesting post. You have obviously given a lot of thought to issues related to diagnosing thyroid hormone disorders. Can you tell a little about yourself and background?


    Dr. G. Pepper

  • Eric Pritchard

    There is a pervasive language problem in this niche of a subspecialty. In common usage, the word “thyroid” can be limited to the gland or may be as expansive and the greater thyroid system from the hypothalamus to the symptom producing cells.

    When reading the hypothyroidism guidelines and evaluating them according to their plain meaning, they are limited to the thyroid gland, and to a lesser extent, the preceding glands, the pituitary and the hypothalamus. The diagnostics are aimed predominately at the thyroid gland. Taking TSH only demands perfection of the pituitary. TSH and fT4 gives us some indication of pituitary issues as well as thyroid gland issues. The prescribed therapy, levothyroxine sodium, only treats the thyroid gland and preceding gland deficiencies. It is not applicable to post thyroid functions as they produce and operate on T3.

    Thus, it is quite inappropriate to ascribe all causes of the symptoms of hypothryoidism to the thyroid and preceding glands. There can be deficient peripheral metabolism, deficient hormone reception, or deficient chemical infrastructure like adrenal hormones and enzymes. The thyroid gland function tests do not deal with these.

    By reason, then, the medical practice upoin these post thyroid functions should not be dictated by inapplicable guidelines. It is a mistake for boards of medicine in the General Medical Council to prosecute physicians on that basis. It is far past time for the victims of post thyroid deficiencies to be properly and ethically treated with a T3-containing hormone replacement, such as Cytomel or Armour.

  • Melissa

    I just was given T4 and T3 yesterday by my traditional doctor after finally using up my last bit of Armour. I have no idea why it was discontinued. I am worried about how I will react to the new therapy, as regular levothyroxine in the past did nothing for me. I was someone whose hormone levels always looked good on paper, but I would retain water, become depressed and was always exhausted. The Armour made all the difference in the world for me. I’m hopeful that the synthetic T4 + T3 will be adequate and I won’t go back to feeling terrible. I start tomorrow on the new therapy. I was surprised that my doctor had no idea Armour was discontinued. I can’t understand why this isn’t a huge deal…what would happen if insulin stopped being made? I enjoy my high level of function right now, and I hope I remain healthy and happy on this new regimen. I am just happy that my dr. went for the T3 recommendation that I proposed. He didn’t have to, and he wasn’t thrilled about it, but he did prescribe it. He knew how many times I was in his office crying about how awful I felt on just levothyroxine. He never saw me once I was on Armour. I felt awesome. I guess we’ll see what happens…

  • Ana

    I’ve researched everything you shared and…..You Rock! What is your background?

    Many many many thanks!!!
    Anastasia Jones

  • APhotoWizard

    I find it strange that no one in this entire thread ever considered that it just might be possible that no thyroid supplement is needed at all.

    Iodine has been almost completely removed from the American diet and bromine (an iodine antagonist) has been substituted. If you do not have enough iodine your thyroid can not make T4.

    Next we have over farmed our land so Selenium is in shorter supply in the diet. Why is this a problem? Selenium is required for the enzyme to work that converts T4 to the active form T3.

    I guess the propaganda from the 40’s and 50’s that made doctors afraid of iodine in order to sell Armor Thyroid is still alive and well over 50 years later.

  • Paul

    Very insightful article/report, Dr. Pepper. Janie Bowthorpe of Stop the Thyroid Madness website recently had this to say in her June 5 ’11 newsletter (and on her website


    REVERSE T4 (yes, I said it correctly)

    I’ve been having an email chat with a scientifically-minded guy named Brian who also has a sister with a major in bio-chemistry. And something dawned on both of them concerning “levothyroxine” which is the synthetic term for T4. The prefix LEVO means the ”left-hand” version of a molecule, and thyroxine is the biological term for the real T4. Says Brian: “Levo-thyroxine means it has exactly the same atoms in exactly the same order, but not the same shape (handedness), so if enzymes or proteins have to chemically “fit” it to work, they may not be able to. He concludes this can be one reason being on synthetic T4-only does not work, and knew it was alluded to by Dr. Mark Starr.

    But Brian continues: In just the same way that levothyroxine is the mirror-image or “left-handed” version of regular thyroxin, RT3, or Reverse T3, is the mirror-image or “left-handed” version of T3. If we were consistent with our terminology, in other words, levothyroxine would be known as “Reverse T4″. Says Brian, just as Reverse T3 is biologically inactive , so is Levothyroxine, thus “Reverse T4″. I love it!


    I looked it up and “levo” does mean left side or left-handed. Is it any wonder that levothyroxine works as poorly as it does? There will be “hell to pay” for Big Pharma’s drug pushers and their minions.


    “It is a dreadful thing to fall into the hands of the living God.” – Hebrews 10:31

  • Trudy

    It *IS* still available and the only thing that gave me my life back after 25+ years on synthcrap. AP? I eat no grain and I supplement with selenium so your hypothesis doesn’t include me. I rely on dessicated meds. If you say you can’t get armour or the like then you aren’t looking. I take NP thyroid by Acella available as generic at any Walgreen’s.

  • Kate

    I cannot take synthroid as i am allergic. Somehow the endo I went to couldn’t believe me when I told him I was itching and my throat felt like it was closing up. I fired him, found a doctor who WOULD prescribe Armour and i am finally feeling 100% better after months of being extremely weak and sick from full blown hasimotos and listening to that endo. My insurance has paid my new doctor thousands of dollars that the STUPID endo is not getting because he refused to LiISTEN to me. My lab reports don’t indicate need psychiatric help. Who is chuckling now? Oh, and i make sure i tell everybody to avoid going to endos…..he…he…he…

  • Paul

    Update: Since Janie’s newsletter was released, it’s been updated on her website with new information which seems to disprove the idea of Reverse T4. Regardless, her website is the best source of information for those who’ve been misdiagnosed and mistreated by endos living in the dark ages.

  • Kamala

    Having a hard time finding someone in Charlotte, NC to work with me on medication other then synthroid. Seems all that I’ve encountered are in this drug manufacturer’s pocket. Any suggestions for this area?

  • Peggy rickard

    Trudy-is it over the counter or do you need a prescription?

  • Peggy rickard

    Kate-why not endo’s?

  • Peggy rickard

    Does anyone know of a doctor in Niagara county new York who will prescribe armour or some other therapy than synthroid? I am desperate. I have no thyroid and my health is going downhill while the pounds pack on. Help!

  • sorry but i dont know any one,check youre local hospital

  • you can get nature-throid…it is prescription just like armour…has been around longer than armour…has never been recalled…and is the only prescription naturally desiccated thyroid available in every strength that synthetic is available…