Question: Larry, what are your thoughts on cellulose fillers being used in desiccated thyroid prescription capsules? A blog that I read titled Stop The Thyroid Madness posted this a few years ago. It also mentions using Acidophilus as a filler in place of the cellulose. What are your thoughts?
Link to reference post from 2010: Cellulose IS a problem with desiccated thyroid.
Larry’s Response: Thank you for sharing this with me. Let’s see if I can respond appropriately.
I’d first like to comment on the suggestion that a compounder could use “beneficial probiotic acidophilus” as a filler. While he/she certainly could, it would be inappropriate without specific instructions from the prescribing doctor. While probiotics are beneficial, they are not in the category of a standard filler substance. They are, in fact, another therapeutic substance, which cannot be merely added to the final preparation without approval from the prescribing doctor.
In addition, the prescription should state the amount of probiotic used – and whether it is just acidophilus or a combination. It gets dicey to add therapeutic agents to a prescription without authorization. It also adds to the cost of ingredients (living lactobacillus costs more than cellulose, lactose, or most of the other recognized fillers/excipients). Finally, using a living substance in the capsule would require the final preparation be refrigerated.
There are many comments in the material you sent that appear to cohere or “go together”. However, the conclusions drawn aren’t consistent. Also, there seems to be an inordinate amount of anger and hostility in the writing.
Compounders have long been preparing Thyroid, USP (Porcine source) and it isn’t new and it isn’t a manufactured product. In fact, it should be prepared for each customer according to the orders of the prescribing doctor. If the doctor fails to specify a filler, the pharmacist may use whatever standard filler is common. There are many alternative fillers and the pharmacist can use whatever the patient requests as long as it doesn’t involve adding another active ingredient to the capsule. We often use rice powder and we don’t use lactose.
I agree that microcrystalline cellulose is common and safe. It flows nicely and has never been shown to degrade active ingredients that are mixed with it. Thousands of thyroid prescriptions have been made with it and the vast majority of people do well with it. However, when it doesn’t, the patient should work with their doctor and pharmacist to find a mixture that meets their specific needs – while staying within the legal and professional guidelines. Pharmacists may not just add whatever a customer wants. It has always been, and should remain, a combined effort of patient, doctor, and pharmacist.
The comments about happy cows and cud are irrelevant. The cellulose in grass and wood is not the same as the cellulose used in pharmacies. While they may have the same sources, they aren’t equivalent.
There have been many concerns about thyroid over the years – mostly starting when the geniuses in the manufacturing world decided that T4 was preferred over natural thyroid (T4 is levothyroxine, Synthroid). That marketing decision has done much to damage the thyroid health of millions of people. Instead of being angry at a pharmacy it seems more appropriate to direct hostility at the makers of T4 prescriptions drugs. Over the decades, there have been shortages and reformulations of Armour and other brands. What they offer today isn’t what we had in the 70s and 80s. In fact, Armour isn’t even involved in the product anymore. Furthermore, we aren’t sure what’s in the commercial products.
The fact remains that compounding pharmacists can make what a doctor orders and there are no requirements that certain fillers cannot be used. Everyone needs to work together and stop hunting for villains. The market will handle the problems. If “a well-known health center in Texas” makes something its customers don’t like, those customers are still free to buy from someone else.
Personally, I am not convinced that cellulose fillers interfere with absorption of thyroid. Soy has a far worse impact on thyroid health than cellulose. However, I will not interfere with anyone’s conclusion that it is not good. If you want me to make a capsule with a probiotic, I will, provided the doctor orders it. If you don’t want microcrystalline cellulose, I can offer lactose or rice powder without authorization.
Everyone needs to keep in mind that the normal way our body gets thyroid is by making it, not by ingesting it. Using thyroid powder has been effective over the years, but it certainly isn’t “natural”. Yes it comes from pig thyroids – actually just dried and crushed glands – but it remains an artificial measure. There are numerous substances in our environment that we ingest on accident and many more we choke down on purpose – and they can cause significant damage to the thyroid (anti-acid drugs are some of teh worst offenders). The form of filler in a capsule of powdered pig thyroid probably isn’t as important to most people. For those where it is important, a competent compounder will do everything possible and legal to help.
Finally, I used to follow Stop the Thyroid Madness and I have their first book. Over time, it seems to have become more of an angry blog focused more on arguing than on sharing useful information. Yes, there are tidbits of useful information, but not enough anymore. I prefer not to associate with a group that thinks it’s for “a global mass of medically-duped individuals”.