It seems a day doesn’t go by without someone asking about thyroid medicine. When I started in pharmacy – back in the 60s – we sold a lot of a product referred to as Armour Thyroid. The Armour Company used pig thyroid glands – they had a lot of it because they were a meatpacking company.
Somewhere in the 80s or 90s, Synthroid became popular. However, many patients discovered that Synthroid did not help them feel as well as the pig thyroid pills.
The generic (chemical) name for Synthroid is LEVOTHYROXINE – often referred to as T4. It is but one of the forms of thyroid hormone that the body uses. It is the least active and it is converted to the more active form, LIOTHYRONINE (T3), in the body. Many people do fine with the T4 – Synthroid – and it is a popular treatment. Other people with low thyroid (referred to as hypothyroid) find that the T4 does not help them. Some even claim it makes them feel worse.
Therefore, Armour Thyroid – and many similar brands of Thyroid Powder, USP – have remained on pharmacy shelves.
Recently there’s been a severe national shortage of the “natural” products – the ones made from the pig thyroid glands (like Armour). There are numerous rumors about the shortage, but nobody seems to have all the facts. The only sure thing is that there is a shortage of Armour Thyroid and simply converting to Synthroid is not helping everyone.
Thyroid Powder, USP (Porcine) is available to compounding pharmacists. We can make capsules that contain the same amount of Thyroid, USP that a person had received in their Armour Thyroid product. This is better than nothing, but there have been problems. While the conversion to a capsule seems straight forward, not everyone is happy with the change. It seems that the contents of the commercial products may have actually been adjusted before being made into tablets. Perhaps additional T3 and/or T4 were added to bring the final product up to some predetermined level. Again, we don’t know. To make matters worse, we’ve heard that the Thyroid Powder, USP may not be available in the near future.
What If WE can’t Get Thyroid USP?
There is another approach – using a combination of T3 and T4 in the amounts that best meet the patients’ individual needs. Compounding pharmacies are still able to obtain pure T3 and pure T4 and can prepare combinations that exactly meet a person’s needs. It requires the cooperation of a prescribing doctor, patient, and compounding pharmacist. While it is very likely that the pharmacist can make an excellent thyroid replacement, it is not always likely that it will be perfect the first time.
There just isn’t a fixed conversion between Armour Thyroid and a T3/T4 combination. This means that the doctor must work closely with the patient and the pharmacist to arrive CLINICALLY at the best dose. The lab testing is a failure and the doctor has to learn to trust the patient’s feelings.
The compounding pharmacist must be able to adjust doses accurately. It isn’t overly complicated, but the compounder must understand how to make triturates. While Armour Thyroid is dosed in milligrams and grains, the T3/T4 preparations are dosed in MICROgrams – one one-thousandths of a milligram. It takes experience and knowledge to know how to properly make triturates in the microgram sizes needed.
Hopefully, Armour Thyroid will return to the market. Until then, take action on behalf of your own health. Talk to your doctor about a compounded alternative. Talk to your local compounding pharmacist. Don’t settle for good enough. Demand to feel like you want to feel.