Tag Archives: levothyroxine

Make Your Opinion Count About Treatment Options for Hypothyroidism


Here is a rare opportunity to let the leadership in endocrinology know how you feel about treatment options for hypothyroidism. The American Thyroid Association is asking all those being treated for hypothyroidism to complete a simple questionnaire which will provide feedback regarding your level of satisfaction with present options for treatment of hypothyroidism. If you want to have your opinion counted log on to the following site and complete the survey!

If the link above doesn’t work copy and paste the following URL into your browser https://www.surveymonkey.com/r/hypothyroidpatientsurvey

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Petition to Protect Armour Thyroid Surpasses Goal


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“I have been on Armour Thyroid for 15 years and it has changed my life. For three years prior I was on synthetic thyroid medication and I felt horrible. My doctor even tried a medication that was specifically for T4 so I could get what I was missing. I was having such horrible migraines. Now I am doing so much better. I know how physically traumatic it is to adjust thyroid medication or to go without it and it can be life threatening for certain individuals. Like myself. People are individuals not objects and they have different reactions to some medications. There are a group of people who desperately need to continue taking Armour please do not substitute the ingredients or take it off the market. I feel the adjustments that have been made in the medication since Armour was taken off of the market for almost a year. I had to resort to buying my medication from Canada!

Quote from Kathleen, a signer of the petition to Ensure Continued Supply of Armour; Read over 125 comments from other Armour supporters at ipetitions.com

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Armour Thyroid, the most popular form of desiccated thyroid hormone replacement in the U.S., has been the center of controversy for decades in the medical community. Despite over 100 years of successful use, the major endocrine specialty organization in the U.S. called for a prohibition on its use. Medicare dropped its coverage of this medication in 2008.  Forest Pharmaceuticals, the company that manufactured Armour for decades ran in to regulatory issues and was recently acquired by a succession of larger pharmaceutical companies, the latest being Allergan. Meanwhile, the public continues to demand access to this medication many thousands swear by as the best treatment for hypothyroidism.

Users of Armour have noticed that the price of the medication is increasing steadily. Some are paying three times what they did a few years ago. There is no restriction on what a pharmaceutical company can charge for a medication and within the past years companies such as Turing Pharmaceuticals have tested the limits of just how outrageous the cost increases can be. We therefore initiated a local and on-line petition, to place Allergan on notice that there exists a large and very active advocacy group insisting on continued fair access to this medication. Combining both the on-line and hard copies of signatures,  I am proud to say that as of today we have surpassed our goal of 500 signatures to support this effort.

The next step is to present the petition to the corporate leadership of Allergan in such a way as the voices of those who need the medication most will be heard. There is still time to add your name and comments to the on-line petition at ipetitions.com.

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Wall Street Journal Reporter Helps Bring Clarity to Thyroid Treatment Controversy


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On April 11, 2016 an article, Doctors Hear Patients’ Calls for New Approaches to Hypothyroidism, appeared in the Wall Street Journal regarding the growing influence of patient preference on treatment selection for hypothyroidism (sluggish thyroid). The article was written by the WSJ health columnist Melinda Beck. I might have missed it but thanks to a motivated patient I received a copy within a week after its publication.  With a glance I knew this report could be a highly significant addition in the on-going debate between specialists treating hypothyroidism (endocrinologists) and advocates of alternative approaches. Continue reading

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Can a Blood Test Identify Those Who Need T3 for Proper Treatment of Hypothyroidism?


Dr. Gary Pepper and Dr. Paul Aoun discuss recent findings about thyroid hormone treatment at the 15th International Thyroid Congress

Dr. Gary Pepper and Dr. Paul Aoun discuss recent findings about thyroid hormone treatment at the 15th International Thyroid Congress

By Gary Pepper, M.D.

According to experts, 10 to 20% of hypothyroid individuals fail to respond completely to T4-only (levothyroxine, Synthroid) treatment. Dr. Anthony Bianco, the president of the American Thyroid Association, and his associates believe this is due to genetic variations in the way thyroid hormone is converted in the body from T4 into T3. T3 is the much more potent form of thyroid hormone and unless the cells of the body receive enough T3, normal function cannot be achieved and symptoms of low thyroid such as fatigue, mental fogginess, constipation, muscle aches etc, persist. Based on the research conducted by Dr. Bianco and colleagues it is thought that in those with the genetic trait making T4 treatment ineffective, blood tests would show low T3 levels. Continue reading

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Public Support and New Research Promote Changes in Thyroid Treatment Guidelines


http://www.dreamstime.com/royalty-free-stock-photo-thumbs-up-down-image17557325In a blog at metabolism.com several months ago, website visitors were asked to join an email campaign addressed to Dr. Mack Harrell, President of the American Association of Clinical Endocrinologists (AACE). The purpose was to ask help reversing the existing practice recommendation # 22.4 published by the AACE in 2012, calling for a ban on the use of Armour Thyroid in the treatment of hypothyroidism.  With over 800 individuals participating, the campaign appears to have achieved some success as the latest AACE treatment guidelines  released last month no longer stipulate that desiccated thyroid is unfit for treatment of hypothyroidism. Instead the statement is issued, “ We recommend that levothyroxine be considered as routine care for patients with primary hypothyroidism, in preference to use of thyroid extracts. “,   and…. “ Furthermore, there are potential safety concerns related to the use of thyroid extracts, such as the presence of supraphysiologic (unnaturally elevated, ed.) serum T3 levels and paucity of long-term safety outcome data.” Continue reading

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Medical Specialists Remain Resistant to Treatment for Hypothyroidism Preferred by Patients


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by Gary Pepper, M.D.

According to government estimates, 4.6% of the US population aged 12 or more has hypothyroidism (low thyroid function). Based on treatment guidelines published in 2012 by the American Association of Clinical Endocrinologists (AACE), only synthetic thyroid hormone (levothyroxine, Synthroid, Levoxyl) is an appropriate therapy for this condition. According to these guidelines, the biologic product Armour Thyroid, is unfit for this treatment purpose. Armour Thyroid, an extract of porcine thyroid, has been available as a treatment for hypothyroidism for about 100 years. It was first used in the U.S. to treat hypothyroidism in 1892, a year after it was introduced into the United Kingdom. The impact of the AACE guidelines is more than symbolic Continue reading

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Zach’s Treatment Success with Cytomel


Zach points out that most of the posts about thyroid treatment issues at metabolism.com are from women. That makes sense because autoimmune thyroid disease is approximately 10 times more common in women than men. But man or woman, thyroid hormone treatment is still the same and his success with Cytomel is something worth noting.

Zach writes:

Hi everyone. From what I can gather, most posters here are women, well I’m a guy with similar problems. I thought my story might be useful so that men don’t think it’s a women only problem. I gained a hypothyroid diagnosis at the age of 25 due to Hashimodo’s. There was no direct cause, it runs heavily in my family. For a year, or two, maybe even three (it’s hard to tell due to widespread symptoms), I was feeling nervous, bad memory, attention problems, sleep problems, low appetite, and easily fatigued from a normal 8 hour work day. I assumed my lifestyle choices were causing these symptoms so didn’t go to the doctor for years.

Finally when I was diagnosed I was put on levothyroxine. The very first day I took it I felt IMMENSLY better. However, months down the road the symptoms gradually built up again. Every time my dose was raised, I would feel better for about 2 days, but the symptoms would gradually return. My endo decided to drop my T4 dosage and put me on a combo T4/T3 (T4 was dropped by 50 mcg and one quarter of the drop was added in as T3, so 12.5 mcg of T3). This is the first day I’ve tried it, and instantly the morning of starting on T4/T3 my body aches have almost disappeared and I am feeling much less sleepy at my desk during work.

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Michelle Gets a Boost from T3 (Cytomel)


Michelle shares her success story with T3. Michelle’s story demonstrates how combination therapy with T4 and T3 can be clinically superior to T4 (Synthroid, Levothyroxine) alone. In her story she mentions Wilson’s syndrome which I personally think is a “made up” diagnosis to help Dr. Wilson’s retirement fund but I do think her experience is fairly typical of a lot of people with hypothyroidism who eventually discover they need T3 added to conventional treatment with T4 to achieve best results.

Michelle writes:

OMG! Maybe I’m not crazy after all!
I’m 47 in December and can’t remember the last time I felt good or even okay. Same thing – doctors repeating same tests, thinking I’m exaggerating, sent to Psychiatrist…Over the past 6 years or so, major stress, low immune (sick all the time), worsening depression, borderline diabetes, high blood pressure, peri-menopause. Got to the point that I’m sooo exhausted. Don’t want to do anything. Lab diagnosis finally showed up hypothyroidism so doctor put me on Synthroid – I was so happy that I cried. Devastation set in after 6 months as this was not the miracle I thought it would be.

Started taking my temperature 3 to 4 x a day as suggested to me by a naturopath I had seen but couldn’t afford to keep going to. Again, measurements taken 3 x daily for a week averaged to 97.0. Talked to doctor about Wilson’s Temperature Syndrome; she did not believe in it and sent me for more blood tests which came back normal.

FINALLY (after 20 years at same doctor’s office) was lucky enough to be accepted under the care of a physician who hadn’t heard of WTS but had heard about the T4 not converting into the T3 (you all know the fault in the system)… so right then and there wrote me a prescription for Cytomel and told me to stop the synthroid. As the WTS website recommends sustained T3, I’m taking half the dose every 12 hours.

I started today and feel like a kid on Christmas Eve a million times over! I am so hopeful that this can get to the root of so many ailments. So many that I feel that I’m not even living my life, that I’m just here putting in everything I have just to get through the day.

With the lack of memory and concentration I have right now, I hope I remember to come back to this site and update you all!

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Suzi’s Amazing Blood Pressure Response to Cytomel (t3)


Suzi has hypothyroidism and high blood pressure. She sends the following story describing how t3 treatment appeared to help normalize her blood pressure. This is the first time I have come across this effect and thought it would be helpful to share her story on the main blog. Does anyone else have a similar (or contradictory) experience?

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Hi Dr. Pepper,

I was diagnosed hypothyroid 2 years ago and given levothyroxine. On diagnosis I had lots of symptoms and my BP was 175/115 despite my whole family having low BP. After some months on T4 I did feel an improvement in a lot of ways and my BP got better. Then after a year, things started going wrong, as if my body didn’t like T4.

I tried reducing my dose of T4 back down to 75µg but went hypo. But each time I increased above 75µg my BP increased again, then on 112µg it became a serious problem, especially the diastolic. I still had fatigue, constipation, red eyes, swollen legs and so on.

About 3 weeks ago I started on 10µg T3 and reduced my T4 from 112 to 75µg and pretty much immediately felt clearer headed and more energy, the constipation went etc….. My BP has gone down by an average of 20, which I know because I check it regularly myself. I’m doing a 24-hour BP monitor this week too, because my doctor put me on Amlopidine 6 weeks ago after being shocked by the monitor results from then while on 112µg T4 (only took Amlopidine for 2 weeks after terrible side-effects incl. overwhelming fatigue and massively swollen legs).

So, it looks as though my body goes weird on T4 tablets when the dose is above 75µg, but if I stuck to that dose I’d be really hypothyroid. The T3 has changed my life completely!!

Now I’m wondering what the ideal balance T4 / T3 tablets would be? Is that possible to say or does it depend on each individual body and genetics? My typical BP now is around 120/ 95; it goes down after eating, and gets worse when I’m hungry or tired. The T3 reduced my BP so much more than the Amlopidine did, and on T3 I feel great whereas on Amlopidine I felt half dead. I’d like to get my BP back to before I got hypo, so that’d be 110/70.

All I need to do now is find my ideal dose of T4 and T3, could you possibly advise me on that? If I started 20µg T3 instead of 10µg, would you advise a reduction in T4 from 75µg? ( I’ll be doing a TSH, fT3 and fT4 test in about 5 weeks’ time, maybe I should wait till then?).

Thank you so much!

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Behind the Disappearance of Armour Thyroid


After 50 years of exemplary therapeutic use and despite a large devoted following, Armour Thyroid and related dessicated thyroid generics have virtually disappeared from pharmacies in the U.S. An air of mystery with suggestions of conspiracy surround the shortage. The level of distress among Armour users confronted by their inability to obtain the medication, is extraordinary. Adding to the turmoil and confusion is the manufacturers’ continued reliance on flimsy and unconvincing explanations for their actions.

Several concerned individuals contacted the FDA for clarification of the Armour situation and received a prepared statement in response. A copy of the FDA’s letter explaining the government’s stance was posted to metabolism.com by an involved member. After studying the letter I believe I can offer a good explanation for the situation. The explanation, as I see it, is grounded in the fact that several thyroid medications such as Armour Thyroid but also including synthetic t4 medications like Synthroid, existed before the FDA was given full regulatory power. In 1973 the Supreme Court empowered the FDA to regulate the use of prescription medications in the U.S.. This meant that all prescription drugs would have to demonstrate to the FDA’s satisfaction, safety and efficacy for specific indications before pharmaceutical companies could promote the use of their drugs. Medications like Synthroid and Armour, already vital components of medical therapy for years before 1973 entered a grey area of legitimacy after that time.

Just a few years ago, I was astounded to hear from my pharmaceutical representatives that Synthroid faced being banned by the FDA since it never provided the FDA with the type of documentation of safety and efficacy that all modern medications had. After 30 years the FDA decided it wanted to rescind the right of the drug manufacturer to promote this medication which was considered safe and effective way before the FDA achieved regulatory power. What followed was a tense year during which the manufacturer of Synthroid went through the costly and bureaucratically intricate process needed for FDA approval, which it ultimately won.

What I believe is happening now is a similar scenario with Armour Thyroid and other dessicated thyroid products. What convinced me of this is the wording in the FDA letter which refers to Armour Thyroid as an illegal drug. The FDA has put Armour on its Most Wanted List and is intimidating the manufacturer (and prescribing physicians) by implying the law is being broken by continuing to make and use this drug. In the case of Synthroid, which enjoys the full support by the medical community and provides millions of dollars in annual sales the financial equation was a “no-brainer” in favor of putting the money into the process to gain approval.

Not so for Armour Thyroid which has been defamed by the American Academy of Clinical Endocrinologists (AACE) and who’s use is much more limited and far less profitable to the manufacturer. I can imagine that the pharmaceutical company has already done the math and decided that not making Armour makes more financial sense that to continue making the “illegal” product and going through the FDA gauntlet for approval.

Where does that leave the patients who depend on dessicated thyroid preparations and the physicians who prescribe it? With no way to force the manufacturer to make the drug or to make the FDA to back down on its stance my guess is that Armour and related products will simply cease to exist and alternative prescriptions will have to be written. Please remember, I am the messenger here and do not sanction or in anyway condone what I see as the most likely outcome of this predicament. Perhaps by recognizing the existing reality a strategy can be developed to prevent this outcome.

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

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