Straight talk about Armour thyroid
Dec 08, 2023So what’s all the fuss about Armour thyroid and how can it help to treat hypothyroidism?
Let's start of by defining what Armour Thyroid is. Many physicians and non-physician thyroid experts alike advocate very strongly for Armour thyroid. Another brand, Nature-Thyroid, that was also well beloved, is no longer available on the US market. Natural desiccated thyroid, and its many brand names: Armour thyroid, NP thyroid, West thyroid, and now a new brand called Adthyza, are naturally derived thyroid hormone medications from animal thyroid glands, usually pork.
These are available by prescription in the USA. They contain the T4 and T3 thyroid hormones in a fixed ratio of four to one micrograms. They contain the other carrier proteins naturally present in thyroid glands, thyroid hormone breakdown products, and the hormone Calcitonin, also made in the thyroid, in minute amounts.They generally also contain various binders and fillers, such as Dextrose or microcrystalline cellulose. Each one is its own brand, so technically there are no generics for Armour thyroid. If a doctor writes a prescription for Natural desiccated thyroid, you could get any one of them.
One “problem” with natural desiccated thyroid medications is that they are not “FDA Approved”. This is because they are natural products that have been in commercial use since before the FDA even existed, and the companies that sell them are not required to go through the billion plus dollar process to gain FDA approval. Insurance companies will tend to use this fact to deny coverage for these medications because they lack FDA approval. There are still sites on the internet that claim “NTD is not approved by FDA due to lack of evidence that it is safe and effective for treatment of Hypothyroidism”. While technically true that no large scale studies were done, they weren’t required to.
Before Synthroid and other synthetic T4 was first synthesized in the 1950’s, Armour thyroid and similar preparations were the only available treatment for hypothyroidism. There were also no tests to determine proper dosage, so that was done by symptom relief.
Then, when the TSH test was invented in the 1970’s, and it was discovered that (most) people’s tissues could convert T4 to T3 (the active form of thyroid hormone), the medical establishment assumed (with help from the advertisers at Knoll pharmaceuticals-the makers of Synthroid) assumed that it was no longer necessary to give T3 and that synthetic was superior. Also, even though TSH tested a pituitary hormone, not the actual function of thyroid hormones in the body, it was assumed that just testing TSH was enough (many doctors still assume that - a topic for another day, but it is not correct). Of course that left the 23% of patients who didn’t get symptom relief on synthetic T4 out of luck. (1)
Another supposed problem with these naturally derived medications is the variability in potency from one brand and one batch to the next. As one would expect, a natural product will vary because the amount of thyroid hormone in any given batch is determined by the animals it comes from. The manufacturers of Synthroid made much of this for years, while suppressing studies that showed shocking variability in the potency of Synthroid, and that Synthroid was not in fact better than other then-available brands. In fact when these studies came to light in the late 90’s, and it turned out that Synthroid wasn’t actually FDA approved either, they were fined over 100 million dollars and required to submit a new application for FDA approval in 2003. (2)
That said, within a single brand such as Armour, potency is tested at the factory and varies very little, while the many varieties of Levothyroxine (generic Synthroid), are still allowed by FDA rules to vary from 80 to 125% of the stated potency. It is, however, a natural product, with a fairly short shelf life in comparison with many synthetic drugs.
How does Armour thyroid work?
One “grain” or one 60 or 65 milligram tablet, depending on which brand you're talking about, contains 38 micrograms of T4 for every nine micrograms of T3. (a four to one ratio) The reason so many people swear by these medications is the fact that they contain T3 (remember - the active form of thyroid hormone). That is particularly helpful for people whose bodies don’t convert T4 to T3 very well. It’s also one of the reasons doctors are so reluctant to prescribe natural desiccated Thyroid. Active T3 can have powerful effects on the body and too much can quickly induce HYPER thyroid side effects if given in too large a quantity at once, particularly in the presence of caffeine. This is of course also true of Synthetic T3, Liothyronine.
For some people 4:1 happens to be the perfect ratio. But for many people it's not, some people need a three to one ratio or even a two to one ratio. So if the dose that makes you feel better on the natural desiccated thyroid is actually pushing your TSH number down below the normal range, then it is not for you. It might have too much T4. Physicians and other practitioners who don’t follow T3/Reverse T3 levels and ratio tend to use this incorrectly. They tend to push the dose higher and higher, getting more T3, but also very high T4....
One consequence of over supplementing T4 or T3 for that matter is that it has the potential to cause heart problems. I have discussed why over supplementing T4 is a problem in earlier posts. Click here to check them out and learn more!
Something else to consider about Armour Thyroid is that because it contains T3, which only lasts a short time in the body, it’s better to divide it to 2 or even 3 smaller daily doses rather than one big one. This way the Levels don’t go really high, then really low over a 24 hour period. Doing this means overall you need less medication, will feel better, and tend to make less Reverse T3. And your TSH levels will not go as low for the same amount of medication. There have been attempts made by compounders to make a “sustained Release” T3, but this actually just reduces the total amount of T3 a patient can absorb from the capsule.
A final point about taking Natural Dessicated Thyroid of any kind - since it is made from whole animal thyroid glands, it has more in it besides just the T4 and the T3. There is concern that those extra ingredients contain the proteins Thyroid peroxidase and Thyroglobulin, among others. These are the exact proteins that are attacked by antibodies in Hashimoto’s disease, so it is possible that having those proteins circulating in your GI tract and blood stream could trigger a rise in the very antibodies that caused the low thyroid condition in the first place. This is another reason I personally prefer to use a combination of synthetic T4 and T3 in whatever ratio is needed, when I treat Hashimoto’s patients who have hypothyroid symptoms.
These kinds of treatment decisions are made on a case by case basis, taking into account the other conditions a patient might be suffering, the degree of symptoms, and the potential side effects of the different brands. This is not meant to be individual medical advice. If you believe you have a medical condition of any kind, consult your physician.
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Sources:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089975/
- https://www.nytimes.com/2001/07/24/science/after-46-years-of-sales-thyroid-drug-needs-fda-approval.html
