Thyroid Madness? Apparently so.

Those of us in the pharmacy world have certainly noticed the sporadic availability of Armour Thyroid and Nature-throid, but to those who rely on this form of thyroid supplementation (derived from desiccated porcine thyroid gland), the shortage is nothing less than a threat to their very well-being.

Hypothyroidism is a very common endocrine problem, affecting approximately 11 million people worldwide, and twice as many women as men. Symptoms of hypothyroidism include low energy, fatigue, cold in the extremities and constipation. For a comprehensive symptom checklist for hormone imbalance go to http://www.koshlandpharm.com/documents/Comprehensive-Symptom-List.pdf As a compounding pharmacist, the thyroid issue has been the number one concern expressed by my patients. I am glad to report that at my pharmacy we have been able to make high-quality desiccated porcine thyroid capsules with great success (patient feedback has been very positive). The thyroid powder has to be mixed with an inactive ingredient in order to properly fill the capsule and ensure that each capsule has the proper amount of active ingredient. We are able to use different inactive ingredients in addition to the standard microcrystalline cellulose (Avicel). These include acidophilus powder, and ginger root powder which have their own therapeutic benefits.

There are a couple of good discussion boards and blogs about the thyroid, namely www.thyroid.about.com and www.stopthethyroidmadness.com. Both of these sites do a good job of expressing the importance of proper thyroid testing and supplementation and hope to answer some of the questions about the current controversy surrounding Armour Thyroid and Nature-throid. Although I don’t have any answers to explain the thyroid shortage, it may be partly due to the FDA’s recent tightening of its definition of Thyroid USP, the active ingredient in these products.

As an experienced compounding pharmacist, I figure it is time to put my own two cents out there on this subject. The standard of care for hypothyroidism taught by the medical schools (and pharmacy schools) is to start a patient with levothyroxine or T4 (aka Synthroid, Levoxyl, etc.). For many patients, this is an effective treatment, but it assumes that the patient efficiently converts the levothyroxine to liothyroinine (T3), the active form of the hormone. Levothyroxine also provides no additional constituents to support the healthy functioning of the thyroid gland itself. For patients who do not respond well to levothyroxine, desiccated porcine thyroid is a viable option, and many patients do significantly better on this supplement rather than levothyroxine. One explanation as to why some patients respond better is that it contains T3 and T4 roughly in physiological doses. It also has many of other byproducts of the thyroid gland that may support healthy thyroid functioning, like T1, T2, iodine, calcitonin, and other glandular fragments. This kind of treatment harkens back to the earlier part of the 20th Century when glandulars were often used to treat many ailments, often with great success. The rise of the pharmaceutical industry in the 1950s and the marketing of single pharmacologic agents greatly diminished the use of many glandular treatments.

For patients worried about obtaining the desiccated porcine thyroid, the good news is that compounding pharmacies have been able to fill in the gap left by the manufacturers of Armour Thyroid and Nature-throid. It is important to choose a compounding pharmacy that is using a high quality form of the Thyorid USP. The FDA states that for Thyroid powder to be considered USP grade (or pharmaceutical grade), it must have between 90 and 110% of the allowed amount amount of T3 and T4. This is a very wide potency range and could potentially account for therapeutic differences between two thyroid products that are labeled as the same strength. For information about selecting a high-quality, professional compounding pharmacy see my blog post, How to evaluate a compounding pharmacy.

I also want to mention another compounded thyroid product that may be useful for some patients and has been largely been left out of the current thyroid discussion. This is a compounded capsule that has the thyroid hormones T3 and T4 in a sustained-release form. This product is similar to the off-the-shelf products like Synthroid (T4) and Cytomel (T3) with 2 distinct advantages. The first is that the T3 and T4 can be combined into a single dose and customized to a strength that perfectly suites a patient’s needs. The second advantage is that by making these capsules sustained-release, the hormones are absorbed more steadily minimizing the potential of having any low thyroid symptoms hours after taking the tablets. Since the thyroid gland produces both T3 and T4 in a steady release, this product more closely mimics natural thyroid production.

The thyroid controversy is undoubtedly going to continue for the foreseeable future. Patients educating themselves about this issue are in a good position to advocate for their health and demand relief from hypothyroid symptoms, especially if their current medications are not meeting their needs. At Koshland Pharm: Custom Compounding Pharmacy, we want to be a resource for patients and providers, as well, helping facilitate optimal health and well-being of our patients. Don’t hesitate to call us at the pharmacy if you have any questions (415-344-0600).

Live well.

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60 Responses to “Thyroid Madness? Apparently so.”


  1. 1 Adelaine Saria February 4, 2010 at 2:22 pm

    I hope you don’t mind but I posted the link to your article on the ‘Save-Natural-Thyroid’ Facebook group page. You provided valuable information that I’m sure will benefit the many members of that group.

  2. 3 Lynn February 5, 2010 at 9:30 am

    Hello Peter:

    I came across your article and wanted to mention our website to you. Dr. Shames specializes in Thyroid and uses compounding pharmacies all over the country. He may already know of you since you are local for us but I will let him know just to be sure. Canary Club does saliva testing through ZRT. As a matter of fact Dr. Shames wrote about this very issue in Dec. (http://www.canaryclub.org/mainmenu-library/mainmenu-advisor-shames/665-as-the-natural-thyroid-shortage-worsens.html).

    Perhaps we can exchange links?

    Regards,
    Lynn

  3. 5 jeffrey dach md February 28, 2010 at 6:48 am

    You might ask why is it that one of the best thyroid books out this year was written by a non-profession by the name of Janie A. Bowthorpe.

    That is because of two things, Number one, mainstream medicine has been guilty for decades of mismanaging the low thyroid condition, and number 2) patients are now empowered by the internet to collectively share notes on the internet and devise their own testing and treatment strategies that work for them.

    One of these empowered e-patients is Janie Bowthorpe who runs the Stop-the-thyroid-Madness-blog.

    In her book, she describes her ordeal with years of crippling fatigue even doctors told her that her labs were normal and she was adequetely treated with Synthroid, the mainstream T4 thyroid medication.

    She found out about a form of natural dessicated thyroid pill while visiting an internet message board, switched over from the Synthroid to the the natural thyroid, experienced a dramatic recovery and and has been well ever since.

    The first section of her book chronicles this amazing journey, and later sections are compilations of the condensed wisdom from her years as an internet thyroid expert.

    Important chapters deal with the unreliability of the TSH test, and the issue of adrenal fatigue in relation to the low thyroid condition.

    This is undoubtedly a very important book which be destined to have a strong impact and very influential on mainstream medical treatment of the low thyroid condition. Around her blog and book, Jamie has galvanized a large patient movement which has the potential to create a true a revolution for thyroid traeatment. I applaud Jamie Bowthorpe’s book and wish her strength and good fortune in her continuing efforts to reform the mainstream medicine.

    Jeffrey Dach MD

    • 6 linda January 21, 2012 at 12:21 am

      It doesn’t matter if the doctor’s won’t listen to you, trust me I am going through it and been through several doctors even at cleveland clinic. I give up.

  4. 8 Lasca July 20, 2010 at 11:43 am

    Can you tell me the name of the product you mention that contains both T4 and T3? I currently take Levoxyl and Cytomel and would love to take just ONE pill a day instead of the 4 I currently am on.

    I would also like to mention in regards to the fellow who mentions the book about the woman who struggled for years…
    That was me too, it took my pharmacist to notice one day after several years that, once again my dosage and medication changed for my thyroid. He started talking to me about Cytomel, I researched it, discussed with my doc and the rest is history, I have finally been stable and feeling so much better.

    • 9 thecompounder July 20, 2010 at 11:51 am

      Hi Lasca,

      At my compounding pharmacy, we do a T3/T4 sustained release capsule, which is basically cytomel and synthroid combined and made sustained release. The advantage of this form of supplementation is that they can be taken together in one capsule, the dose can be optimized to any possible dose of T3 or T4, and by making it sustained release, the T3 (which has a short half-life) has less of a wearing off effect.

      It seems like this might be a good option for you.

      Peter

  5. 10 Laurie August 23, 2010 at 9:45 pm

    Hello, I am currently taking a compounded T4 (65mcg) + T3 (25 mcg) Slow Release twice daily. After reading Janie Bowthorpe’s STTM blog regarding cellulose vs. acidophilus fillers, I called the compounding pharmacy and was told the thyroid filler was methyl cellulose. They said methyl cellulose is the only thing they knew to use to make the T3 a slow release. The pharmacist hesitatingly said they could use another filler (acidophilus) but it would not be slow release and would cost more and I would have to take the hormone three times a day. Is this really true?

    • 11 thecompounder August 25, 2010 at 4:04 pm

      Yes. As far as I know, In order for a compounding pharmacy to make the T3/T4 capsules sustained-release, they must contain a special form of cellulose that creates a gel matrix and slowly allows the dissolution of the contents of the capsule (i.e. the T3 and T4). In order to completely avoid cellulose, the capsules will have to contain an alternative filler and will not be sustained-release. For the T4, this shouldn’t be much of a problem since it has a long half-life, but for the T3, which has a short half-life, this may mean that you will have to take it more than once a day to avoid any wearing off effects.

      I hope that answers your question.

      Peter

  6. 12 Rosita October 7, 2010 at 8:35 pm

    I have just realized that I probably have a hypothyroid condition, mainly because I reacted to a situational stress situation by exhibiting hyperthyroid symtoms which could not be ignored: extreme anxiety, near-panic attacks, seriously elevated blood pressure which did not respond to normal medication, inability to sleep properly, nightmares and the sudden onset of multiple eye “floaters”, first in one eye than more in the other.

    I have no doubt that the situational stress was what caused the acute attack. Treating it with beta blockers and an SSRI (Lexapro) resulted in massive side unwanted side effects. The Lexapro side effects (which I’ve never had before on this drug) subsided after a couple of weeks but the beta blocker symptom (acid reflux) got worse, and so bad that I was not sleeping once more, this time from burning pain and discomfit.

    Moreover, I then crashed to the floor and spent most of the day, as well as the night, sleeping. The beta blocker did not control the blood pressure, which fluctuated all over the place, both up and down.

    My psychopharm finally suggested that I have a thyroid test. It took me two weeks to get myself organized and physically motivated to the point where I could drag myself out of the house and visit the pathology. The TCH came back as sub-clinical (in the upper third or the “normal” range). While I was waiting for the results I did some internet investigation and was utterly stunned to discover that the odd collection of symptoms which had been developing over the last couple of years were all listed under hypo-thyroid syndrome: cold intolerance/heat seeking, disappearing eyelashes, thinning hair, dry cracked skin, severe skin flaking and peeling, dandruff, pimples in the hair, other scaly skin problems, excessive sleepiness, increased (but successfully CPAP treated) sleep apnea, massive and intractable weight gain, signs of increasing mood disorder (successfully treated with the Lexapro, thank goodness), fluid in one ear and noticeable hearing loss in that ear, weeping nostril and eye on the other side followed by repetative bacterial eye infections, sneezing attacks, fatigue from simple tasks, sitting and lying around most of the day instead of walking around, and so on and on and on. I am post-menopausal but I have been experiencing a resurgence of the hormone triggered migraines with HRT had removed. My gynaecologist also discovered that I had a huge vitamin D deficiency. I was extremely surprised at this test result considering that I craved sunlight and sat out in it for significant periods most days.

    Today I paid a visit to an endocrinologist who ultrasounded my thyroid gland and found a sprinkle of nodules and cysts which had not significantly enlarged since my last examination (for a newly and accidently discovered goitre) four years ago. He pronounced them as benign. Good news, of course. But he then told me that my TSH was within the normal range and that therefore none of my symptoms had anything to do with thyroid dysfunction or vitamin D deficiency.

    I acknowledged that he was better trained in endocrinology than I but that I was cynical about the significance of the tests and I had a sordid history of ending up with acute problems (iron deficiency, cholecystitus aka gall bladder inflammation, bile duct blockage, etc.) which got that way because tests during the long chronic build up to these conditions were all pronounced to be “within normal limits”. In every case the doctor blammed me for leaving the problem untreated for so long. How unfair!

    Do I have reason to be distrustful of U.S. endocrinologists in this current instance? If so, what could I do that is safe but that might help remove the increasingly debilitating symptoms which have not responded to any treatment prescribed so far?

    I

    • 13 thecompounder October 10, 2010 at 10:10 pm

      As you can easily see on the internet, there is lots of controversy surrounding the way mainstream medicine diagonses and treats thyroid disorders – for a good forum on the topic, see http://www.stopthethyroidmadness.com. In my practice, I find that some endocrinologists are so trained to see the extremes in endocrine disorders, that they can be insensitive to the more subtle disfunctions that may significantly affect quality of life.

      First of all, TSH alone is not sufficient in diagnosing thyroid disfunction. You also need to test free T3 and free T4 to get a clear idea of what you thyroid gland is putting out – if stress is an issue, a reverse T3 wouldn’t hurt either. Second, from what I see in my practice, many people can have significant symptoms and still have their TSH be in the “normal” level. I believe that the “normal” levels for thyroid are too wide and that we need to pay attention to symptoms as much or more than the lab values in determining whether to provide someone with thyroid supplementation. Most of my patients tend to see the best relief of their hypothyorid symptoms when the free T3 and free T4 is at or slightly above the mean of the normal range. TSH should be paid attention as an indication of the brain signalling the thyroid gland to produce the thyroid hormones but does not always correlate well with the actual production of the thyorid hormones and conversion to the active T3.

      If stress is an issue, it will definitely negatively effect thyroid hormone output and the optimal functioning of circulation thyroid hormones, so it is definitely an important area to address.

      I hope that answers your questions.

      Peter

  7. 14 Rosita October 7, 2010 at 8:41 pm

    P.S. I live in the SF East Bay region so that obtaining medicine from “thecompounder” is within the bounds of possibility for me. It is just that I am skeptical, by nature as well as professional training, about trying things which are recommended by non-medically licensed people for the purposes of making money without being subject to the ethics imposed by relevant the licensing boards controlling professional health practitioners.

    • 15 thecompounder October 10, 2010 at 10:16 pm

      If you’re wondering about my cridentals, I have a doctor of pharmacy degree from the University of California, San Francisco and am a licensed pharmacist in the state of California. All the prescribers that I work with are licensed to prescribe in the state of California and have extensive training in their areas of expertise.

      If you are interested in a referral, give Koshland Pharm a call at 415-344-0600 or check out our referral page at http://www.koshlandpharm.com.

  8. 16 Dolores Seames January 7, 2011 at 7:19 pm

    Can you tell me if sustained released Levothyroxine from a compounding pharmacy will cause it to have a longer half life than the 7 days of the usual medications? We have been very slowly raising my SR compounded Levothyroxine for a few years (I have Hashimotos). I have suddenly become hyper, so now we are slowly decreasing it. We had been increasing by 5 mcg anywhere from one week to 3 weeks, depending on how I felt and lab tests. I have bad reactions every time a change is made.
    Thank you.

    • 17 thecompounder January 17, 2011 at 10:18 am

      Hi Dolores,
      Of course a sustained-release form of T4 will last longer in the body than the immediate-release form, but it is probably such a small amount as a total percentage of the half-life that it is probably not going to make much difference clinically. Since you have Hashimoto’s, it is far more likely that antibody effects on your thyroid gland would contribute to your changing symptoms.
      Good luck.

  9. 18 Michelle February 3, 2011 at 11:43 pm

    My mom was recently diagnosed with Hypothyroidism. She has a allergy to milk – not an intolerance.

    I was wondering if there are any thyroid medications that do not have a lactose filler as she will react to all the ones that do. Her family doctor is unaware of any thyroid medications that currently do not have a lactose filler.

    I have to tried a few different sites and books to find the information I am asking you about, and have had no luck so far. I am hoping that you can help me before my moms thyroid condition goes untreated any longer.

    Thankyou.

    • 19 thecompounder February 5, 2011 at 2:28 pm

      Hi Michelle,

      That is a good question and one that I had to do a little research to answer. Of course, when we compound any thyroid medication, either levothyroxine, liothyronine, or desiccated porcine thyroid, we never use lactose as a filler because it is known to bind the thyroid hormone and impede its ability to absorb into the body. Surprisingly, Synthroid does contain lactose. Levoxyl and levothroid apparently do not.

      So my recommendation for your Mom, if she is on levothyroxine, is to get either Levoxyl or Levothroid brands and have her pharmacist double check the inactive ingredients when you pick those up. Another alternative is to have the medication made by a reputable compounding pharmacist who can be sure that every ingredient in her medication is acceptible.

      Good luck.

      Peter

  10. 20 Sharon August 26, 2011 at 6:58 am

    Hello,
    I just read your blog “desiccated porcine thyroid”. Thank you for a great article.
    Can you tell me how a person can be sure of the ingredients in a compounded prescription for desiccated porcine thyroid? Can the ingredients be tested?
    Thank you!

    • 21 thecompounder August 30, 2011 at 8:51 pm

      Yes can be tested, but it costs over $1000. Desiccated porcine thyroid is difficult to test because the T3 and T4 have to be isolated from all of the other constituents in the gland which makes testing an arduous process. If you got the thyroid compounded, you can always ask the compounding pharmacy for a certificate of analysis (c of a) on their bulk thyroid powder which amy give you an idea of the purity of your medication. I hope that helps.

      Peter

      • 22 Sharon August 31, 2011 at 9:24 am

        Peter,
        Thank you for the reply. Yes, your answer helped. We will ask for a certificate of analysis.
        Thank you!

  11. 23 Marilyn Perry September 11, 2011 at 11:58 am

    I have a “different” question.
    I was diagnosed with Graves disease several years ago and subsequently had the i-131 ablation rendering me permanently hypothyroid. I have been treated with Synthroid / levothyroxine since with a roller coaster ride ever since. If I take the 112mcg, I remain sluggish, brain fogged and unable to function. If they increase to 125, I find myself with anxiety, rapid heart rate, heat intolerance. We tried adjusting to 112 + half (56) but that cause an up and down cycle that drives me crazy.We constantly moniter my TSH ( always in the normal range). Would there be a compounding solution? If so-How do I do this?

    • 24 thecompounder September 14, 2011 at 10:47 am

      Hi Marilyn,

      I would recommend starting with a more comprehensive thyroid panel. Get a free T3 and free T4 level in addition to your TSH. This may give you a rmore complete idea of what’s going on with your thyroid hormones. Then I would consider a compounded sustained-release T3/T4 capsule. You will have much more control over the absolute levels of each hormone and because it’s sustained-release, there is less of a blood spike and trough of the hormone which often contributes to the type of symptoms your are mentioning. I recommend finding a good compounding pharmacy in your area (see my earlier blog bost How to Evaluate a Compoundng Pharmacy at https://thecompounder.wordpress.com/2009/02/27/how-to-evaluate-a-compounding-pharmacy/ for good questions to ask) and see if your doctor is willing to work with them to come up with a customized doseage form for you.

      I hope that helps.

      Peter

  12. 25 katie January 3, 2012 at 6:34 pm

    Hi I had my right thyroid removed i am on compound dessicated thyroid med with acidophilus filler and one hour after med I feel tight chest can anyone recommend different or is it possible to just have thyroid med without fillers
    thanks very much great forum

    katie

    • 26 thecompounder January 21, 2012 at 11:21 am

      Hi Katie,
      It is very difficult to fill a capsule accurately without filler. However, can ask your compounding pharmacy to put your medication in the smallest capsule possible. This way, at least, there is only a minimal amount of filler.
      Peter

  13. 27 vince August 30, 2012 at 8:42 pm

    I refer to the post of Aug 23, 2010 “Laurie” re slow release T3/T4 fillers.
    1. Would your answer be the same today?
    2. Are there now Slow release fillers that would give different lengths of time for release?
    3. What is estimated time over which release occurs if using methyl cellulose?
    thanks

    • 28 thecompounder September 4, 2012 at 10:28 am

      Hi Vince,
      I would say that the information in that post is the same today as when it was written. Compounding pharmaices realy only have one good option for creating a sustained-release capsule, although we are always looking for new technologies that we can utilize on the small scale that we operate in – i.e. there are new enteric coated capsules that just came on the market recently allowing compounding pharmacies to make almost any oral medication enteric coated. The time of release of a compounded sustained-release capsule is variable among different people. We estimate that the average time of release is about 6 hours. I hope that answers your questions.
      Peter

      • 29 vince September 12, 2012 at 9:36 am

        Hello, thanks for your answer. I now refer to your post of Oct 10, 2010 where you note that for FT4 and Ft3 you target the mean or slightly above. Can you refer me to or post the mean values you use? I can only find “reference ranges”. Another question – have you had a patient with very high Reverse T3? If so, how did it take to resolve when appropriate T4/T3 were taken. This is my situation and I am using T4 and SRT3. Thanks again.

      • 30 thecompounder September 12, 2012 at 10:58 am

        Many labs have different reference ranges so you have to take that into account when looking at lab values for T3 and T4.

  14. 31 Nancy Yarley January 17, 2013 at 9:22 am

    How long does it take Armour Thyroid to get out of your system…what is the half life, where it no longer affects blood work?

    • 32 thecompounder February 23, 2013 at 3:49 pm

      Hi Nancy,
      That is an excellent question and a tricky one. There is no reported half-life for armour thyroid, but we know it contains T3 with a reported half-life of 2.5 days and T4 with a reported half-life of 6-10 days.
      Peter

  15. 33 Jeannette Hayward October 8, 2013 at 7:04 pm

    I just started with a compounded SR T3 (90 mcgs) and T4 (150 mcgs). I can not believe how much worse I feel. I have heard that the T3 is only 1/3 to 1/2 the strength of cytomel. Is this true and do some people feel better on NDT and cytomel then the compounded. My understanding was that the compounded was far superior to any other medication for thyroid disfunction but because it is so much more expensive most doctors try pill first. Is this true? And is there an upper limit of how much thyroid medication the body can handle? Thank you for all the information. Jeannette

  16. 35 Renie November 14, 2013 at 3:40 am

    I was put on a T3 T$ compound and since this have had elevated blood pressure levels. Could this compound be the problem?

  17. 37 Catherine January 3, 2014 at 11:45 am

    Hi Peter,
    I have two questions: does SR T3 need to be taken twice daily, or just once? I have conflicting info from drs on this, having just switched to a new one.
    Also….my FT3 is reasonably good, with the supplementation of course. My FT4, however, is just below the normal range. I wondered if I still need to supplement T4, considering the T3/active version is what I need? I have tried to take Armour with little luck as the T4 in it is immediately converted to RT3. But I think I need T4 also, and remain hypothyroid without it, correct?

    • 38 thecompounder January 7, 2014 at 7:32 pm

      Many of my patients take sustained-release T3 just once daily but it can be taken more often if needed. It’s difficult for me to answer you second questions. I would discuss with your doctor not just your lab values but your symptoms and body temperature to evaluate your thyroid status.

      Peter

  18. 39 Petru March 13, 2014 at 11:20 pm

    Hello Peter,
    I am glad I found this forum to ask for advice.
    Currently I am taking 66% Armour & thyroid 33% nature thyroid.
    at 3 grains. This that ratio i feel best at.
    Like the others mentioned I do crash from the t3 due to its fast acting properties at ~4.5hours.
    . I am wondering if the slow release version (12 hours) will evenly distribute the t4 & t3? Also, is there a way to get the 6 hour release pills as well? For instance most days are 12 hour days, but on the weekends nights can go longer than usual and crashing is not fun.

    Thanks,
    Petru

  19. 40 vince March 17, 2014 at 10:38 am

    Hello,
    if I may offer some advice to Petru. I am in Canada and I take the desiccated product called ERFA Thyroid. I suggest you split up your dose and take 2 grains in the morning and 1 grain in the afternoon. Evidently this is a common way for Armour users. Of course remember to take them away from food.
    Also – I would not assume that ‘crashes’ are related to thyroid medication. You could have other issues. In my case blood sugar was getting too high.
    all the best.

    • 41 Petru March 20, 2014 at 3:35 am

      Thanks for the feedback! My ERFA should come soon. If it has the right ratio ~23% t3 as opposed to ~28% of Armour I should be ok. Armour is too strong for me .The crashing also happens very often. What i found works for me is taking nature, which has less cytomel along with small does of cytomel under 5mcg per day. Armour makes my memory turn into rubble, and i hate it! Right now its either the erfa works, and Ill try your suggestion to see what works. Regardless of what works i want to get slow release t3 because the crashes are hell and taking the medication 3 times a day is excessive. I rather have peace of mind than judging by symptoms and feeling like crap.

  20. 42 Karen April 7, 2014 at 5:03 pm

    I tried Armour and had a serious allergic reaction. I tried naturethoid for a year and it did not really clear out my symptoms. When I raised the dosage I went hyper and then found two specialists because Internist didn’t know why I was not responding. One put me on tirosant 63 mg and cytomel 5mcg – 10 mcg for a month and nothing happened. Maybe it was a tad less effective than naturethoid. Should I have given it more time to work?

    Another doctor said I could stay on the tirosant and try slow release compounded T3. I’m at a mcg starting dose and don’t feel much different.

    Do you think I didn’t give Cytomel a chance? The one grain of Armour cleared my brain fog for only one day, and I’m searching for that magic to come back again. I have nutrient deficiencies that are taking a long time to correct. LDN took down all my antibodies 100% to normal and my levels are perfect for the first time in 40 years. But I have severe hypo symptoms remaining. No reflex, dry skin, slow digestion, brain fog. Did not being on medication when I had this since I was 11 create cellular damage from being
    hypo?

    • 43 thecompounder April 8, 2014 at 10:30 am

      I appreciate the time you have taken to write your question about thyroid medications on this forum. On this blog, I can comment on general questions, but not specific treatment questions. I encourage you to meet with a health care practitioner who can help you find answers to your specific questions.
      If you are looking for a practitioner to work with in your area, you might ask a local compounding pharmacy for a referral, as pharmacists often have the chance to meet doctors who work across a range of different fields and areas of expertise. To find a compounding pharmacy in your area that has met the standards of the Pharmacy Compounding Accreditation Board (PCAB), you can visit PCAB’s website. If you live in California, you can check out Koshland Pharm’s practitioner referral page
      I wish you the best as you work out the best treatment approach with your practitioner.

  21. 44 Vicki October 15, 2014 at 7:14 am

    Hi, first of all thank you for taking the time for answering everyone’s questions, you are a wonderful person,
    I had been taking slow release desiccated pork thyroid (compounded) and wasn’t absorbing it very well so the doctor put my dosage from 150 up to 250 as my TSH was at 21 well fter a few weeks on that I had to go to,the hospital my t3 was at 14 and my tsh was at 0.08 and I had a horrible arrythmia, they put me on beta blockers and told me to go off meds for two days and then start at 150 again, my heart rate dropped from 105 bpm to 40 in three days ,on the beta blockers, so they took me of those and now my heart arrythmia is back and my pulse is 46-58 because I think I am lacking in t4 now, how long does the NDT take to drop in ones system before you can get bloodwork done again, thanks so much for your time, Vicki from Canada

    • 45 thecompounder November 12, 2014 at 4:25 pm

      Hello Vicki,
      I’ve noted your general question about when a person can get their thyroid levels checked again after dose changes for a future post Peter can write about thyroid medications.
      Thanks for writing into the blog. All my best,
      Krista Shaffer, Outreach Director at Koshland Pharm

  22. 46 vinny October 24, 2014 at 7:25 pm

    Speaking in general terms from my experience with desiccated thyroid and arrhythmia, taking too much T4 (in the desiccated) increases your reverse T3 (rT3), which inhibits the action of your T3 in your body. Then the inability of T3 to work properly can give you hypo-like symptoms and give the false impression that you are not taking enough, when in fact you are taking too much. This is why a lot of bloggers suggest keeping your free T4 level at or below the mean of the normal range. Reverse T3 subsides if you lower the T4 component of your dose. The reverse T3 problem is not widely known.

    Generally people wait 4 to 5 weeks after a dose change to get blood tests, but I have found that my levels are not completely stable even after 8 weeks, especially TSH.

  23. 48 karen November 9, 2014 at 9:17 am

    If you take too much synthetic thyroid medication will elevate reverse T3, not just desiccated.

  24. 49 Jeannette Hayward November 13, 2014 at 9:04 am

    Are there people who can not take the filler Methylcellulose because it inhibits the absorption of the T3? I just started a compounded SR T3 only med on Monday and by Wednesday my symptoms were worse and today my brain fog and fatigue are back. Thank you Jeannette

    • 50 thecompounder November 19, 2014 at 4:16 pm

      Thanks for writing, Jeanette. I’ve noted your question so Peter can write about this issue in an upcoming post about common questions related to thyroid medications. I do know that acidophillus and ginger root powder are alternative fillers that compounding pharmacies can use. This could be a good question for the compounding pharmacy you are working with. All my best,
      Krista Shaffer, Outreach Director at Koshland Pharm

  25. 51 krishnanunni prakasan March 13, 2015 at 3:11 am

    i am from India there is no way to get t3 here do u sell sustained release t3 online ? or ship to india i am really desperate

    • 52 thecompounder March 20, 2015 at 4:38 pm

      We cannot ship outside of the state of California. Ordering it in the United States probably isn’t possible because it is a prescription medication. — Peter Koshland, PharmD

  26. 53 vinny March 13, 2015 at 10:29 am

    With sustained release T4-T3 combination therapy, can you possibly make a general comment on what are typical or most frequent doses that seem to work for people? For a person without a thyroid, what would be the lowest dose that seems to works? It seems to me from looking at a lot of blogs that so many people have problems because they take too much. Thanks.

    • 54 thecompounder March 20, 2015 at 4:44 pm

      It would be impossible to recommend a dose for every patient. Many factors have to be taken into consideration, such as existing thyroid function, gut function, receptivity at the cellular level, gut function, pituitary function, etc. Taking too much thyroid is definitely not recommended. Not only can too much thyroid cause diarrhea, hair loss, and rapid heart rate, over time it can lead to osteopenia and even osteoporosis. Appropriate thyroid therapy is neither too little nor too much. –Peter Koshland, PharmD

  27. 55 Carrie April 18, 2015 at 7:05 am

    I am curious to know if you recommend refrigeration for your compounded T3/T4? I have come across many references to this online but have not seen this on the bottle I take from my compounding pharmacy and I appear to have issues with absorption. After taking it for 7 months increasing the dosage along the way my FT3 and FT4 have not changed but they also didn’t change during the 4 months I was on Naturethroid. Just wondering if this could be the cause. Do you get good feedback from people with this issue after switching them to an acidophilus/ginger root filler? Thanks!

    • 56 thecompounder May 20, 2016 at 11:38 am

      This is a great question about whether compounded T3/T4 should be refrigerated. I will have Peter write another blog post about thryroid medications and incorporate the answer into that post. Thanks for bringing it up! I’ve also noted the question about whether a different filler like acidophilus or ginger root can help when absorption appears to be an issue. Thanks again for writing,
      Krista Shaffer, Outreach Director at Koshland Pharm

  28. 57 Clara October 15, 2015 at 8:00 am

    Hello everyone,

    I was diagnosed with hypo-thyroid in January of 2014 and took first Levothyroxine for 5 or 6 months with little relief. I read about Armour and tried it but my left thigh went numb after just one month. I then went on Synthroid and did not feel any relief from symptoms for 6 months. Fast forward to Summer 2015 and i have gone to an integrative Dr. who prescribed the SR T3 which is great but i am having itching every time i start taking the T3 again. I have started and stopped it 3 times and every time after about a week i start itching again. Could i be allergic to the ingredient that makes it sustained release? Please help, have not been taking anything consistently for months and am feeling terrible. Hair falling out, joint pains, and exhaustion among many other symptoms are wrecking my life as you all know.

    • 58 thecompounder May 20, 2016 at 12:14 pm

      Hi,
      Thanks for writing into the blog last October. You’ve raised a great general question here about whether SR T3 can cause itching – I’ve noted this for a future blog post by Peter about thyroid medications. This would also be a great question for the compounding pharmacy you work with. Thanks again for writing. All my best, Krista Shaffer, Outreach Director at Koshland Pharm

  29. 59 Jennifer February 26, 2017 at 6:34 am

    Looks like it’s been a while since there was much activity, but I thought I’d try a question. I’ve been on compounded SR T3 for years, the past five from a single compounding pharmacy. Throughout that time, my symptoms have been worse or better without a change in prescription (100mcg).

    I recently noticed that the pharmacy has filled the same prescription in two different capsule sizes, one larger than the other. I spoke to the pharmacist and he is doing some additional research, but said they have filled it with two different formulas. I’m keeping close tally of how I feel and interestingly I believe it’s the “smaller capsule” formula that keeps my energy level higher and more consistent throughout the day.

    So now I’m trying to gather additional information for my next conversation with him. I’ve found that you can compound with different formulas, but what I haven’t found is any information on whether the formula can affect how it performs.

    As a compounding pharmacist, do you know if the formula can affect time release or effectiveness of T3? Meaning can one formula help a patient feel better than another? Or would putting more of the filler reduce the ultimate effectiveness of the active compound in some patients?

    Would different formulas indicate different suppliers of the active compound? And, if so, is there such a thing as a more reliable source?

    Finally, is it normal practice for compounder a to alternate between formulas for a single patient? Should this make me consider changing pharmacies? If so, what should I look for when choosing a pharmacy?

    Thanks

  30. 60 Fayley Arthur March 2, 2017 at 6:02 am

    I’ve read a bit about a treatment involving T3 compounded in a 12 hour slow release capsule. My local compounding pharmacist insists that I’ve been conned and that there is no such thing as 12hr slow release (she says max is 6 hrs). Is this true ?


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