If You Take Thyroid Hormones

As the tens of thousands of patients who use Armour thyroid tablets have discovered, the product has simply vanished from pharmacy shelves across America. Without getting into details of why this occurred, let me say first that the product allegedly will be back sometime in mid-2010. Here’s a bit of investigative reporting on the subject. Used to treat underactive thyroid gland, Armour thyroid is often called “natural thyroid.”

Why do some people do better on natural thyroid than synthetic thyroid?
• Synthetic thyroid (Synthroid, Levoxyl) is pure T4 (thyroxine), an inactive form of the thyroid hormone. Your body converts T4 to T3 (triiodothyronine), which is the active hormone. However, some people can’t convert T4 to T3 efficiently, so even though they’re taking what they believe is thyroid replacement hormone, it doesn’t work well.

• Natural thyroid, which is made of dried pork thyroid glands (Armour, the Chicago meat packer, was the first manufacturer), is a mixture of both T4 and T3. Your own thyroid secretes a comparable mixture of T4 and T3. Natural thyroid is simply a closer match to what your own thyroid produces.

If you’re currently taking Armour thyroid, you have four options:
1. Your pharmacist may suggest that you switch to Synthroid (Levoxyl) and tell you there’s really no difference. You can try it and hope for the best. Remember, though, that if you’re doing fine on natural thyroid, you may feel sluggish a few weeks after making the switch.
2. You can order all the natural thyroid you want from Canada. You’ll have to pay for it yourself, but it’s quite inexpensive (100 tablets for $18). Go to www.universaldrugstore.com and register as a new customer. Then email my assistant Liz (Lizz@wholehealthchicago.com). Include your name, address, thyroid dose, and customer number. She’ll then fax them my prescription for 100 tablets with four refills.
3. You can take two separate prescriptions, Synthroid (T4) and Cytomel (T3). This is close to what your thyroid produces and while both are synthetic, this combination does work. Both are generic and available in any drugstore. I find the combination superior to Synthroid alone.
4. Some people respond really well using Cytomel (T3) in a slow-release form. Your dose becomes one capsule twice daily, with the active form of the hormone released slowly day and night. However, this product needs to be prepared by a compounding pharmacist. I use www.thecompounder.com .They probably have more experience making slow-release Cytomel than just about anybody. On the negative side, you pay upfront (about $54), receive an insurance form, and submit it yourself for reimbursement. Here’s an article about using slow release T3.

If you’re interested in having your current thyroid dose converted to slow-release T3, send Liz an email and we’ll fax the prescription to The Compounder. Just remember, any time you change your thyroid dose or your medication is changed, you need a follow-up blood test to ensure it’s doing the job.

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8 comments on “If You Take Thyroid Hormones
  1. stacy brockwell says:

    i have been recently changed to t4 75 and t3 37.5 compounded slow release. my tsh shot up to 89.
    previously my synthroid was 150mcg. what happened?
    Do you give natural thyroid to pts not in chicago?

  2. Dr E says:

    Your problem is not unusual. I do not know what has been happening with the compounding pharmacies lately but the product they’re sending out to patients simply isn’t working effectively. I have had to discontinue it in six patients in the last 2-3 months, all of whose TSH shot up like your (which basically means they aren’t getting any effective hormone)
    Your doctor whould be able to write Armour thyroid since it is back in all drugstores and produced by Forest Labs (an extremely reliable pharmacuetical company)

  3. Raine says:

    I started on Naturethroid a little over a month ago. The dose is only 16.25 mg. From what I’ve learned, the usual starting dose is 65 mg (1 grain) which is also a fairly low dose. Also, my re-check was after I completed an entire month’s supply and about a week into my second bottle. It seems they waited too long to check and now it shows: TSH was 8.12 uIU/mL (Reference range 0.4- 4.0)-
    Free T4 was 0.4 (Reference range: 0.7 – 1.5) . Free T3 is pending. Your thoughts on this would be greatly appreciated. One additional question is: does L-carnitine adversely affect “hypo” thyroid? Thanks so much!!!

  4. Dr E says:

    That starting dose does seem a bit low to me as well. I generally start patients at 30 mg (1/2 grain) and recheck TSH in 2-3 weeks, increasing by 1/2 grain as determined by the TSH and by symptoms. To start immediately at 65 mg (1 grain) often triggers side effects (especially palpitations). The goal is to get the TSH to land between 1.0 and 2.0.
    Carnitine can interfere if taken at the same time as the thyroid hormone. Take your thyroid on arising (empty stomach). Take your carnitine as prescribed by your health care practitioner about one hour before lunch

  5. Jennifer says:

    I’m supposed to start on Nature-Throid after just being diagnosed with Hashimoto. The starting dose is 16.25 mg, and lab work to check on TSH IN 5 weeks.I’m taking Bisoprolol because I suffer from tachycardia and ventricular premature beats. I’m really worried, cause I read one side effect is palpitations. I was wondering if this medication is safe for me to take? And can I expect palpitations from such a low dose?
    Thank you.

  6. Dr E says:

    At that very low dose palpitations are unlikely

  7. Cathy Straus says:

    I have a very complicated medical history (genetic kidney disease/transplant, HEDS, equinocavovarus (CMT?)feet, 19 surgeries, etc. Recently I was tested with borderline secondary carnitine deficiency (Free 38, Total 24. I also take 125mcg of synthroid (Kaiser insurance won’t cover armour, my endocrinologist doesn’t believe in hypo thyroidism and refused treatment with a TSH from 7-12 calling it borderline, got my primary care to prescribe it) to get TSH to 1-2 (I also have had 2 parathyroidectomies, 2 thyroid nodules removed and 2 small nodules still present). I want to supplement with L-Carnitine but am concerned with interactions. If I take L-Carnitine at night and thyroid meds in the morning would that work. I would also love to consult with an integrative/functional medicine doctor and wonder if you know of any in the SF Bay Area. Thank you.

  8. Dr. R says:

    Hi Cathy. You might try these links for referrals in your area. https://www.functionalmedicine.org/practitioner_search.aspx?id=117 and http://www.acam.org/
    Good luck.

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