Dr. Izabella Wentz, PharmD

Thyroid Pharmacist

The History of Natural Desiccated Thyroid Medications

The History of Natural Desiccated Thyroid Medications

Medically reviewed and written by Izabella Wentz, PharmD, FASCP

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If you’ve been following me for a while, you will likely know that I am a big proponent of optimizing thyroid medications in people with Hashimoto’s and hypothyroidism. Getting the right dose of the right type of thyroid medication, can make a huge difference in one’s symptoms and is often the first necessary step in feeling like ourselves again. However, this can be a lot harder than it sounds.

In 2013 & 2014, Synthroid was the #1 prescribed drug in all of the United States (based on a number of prescriptions filled). This is a synthetic version of one of our active thyroid hormones, levothyroxine (T4). This medication works wonders for many people with Hashimoto’s and hypothyroidism, but some continue to struggle with hypothyroid symptoms, even when taking the correct dose of T4.

This is because T4 is known as a pro-drug, or a precursor hormone, as it needs to be activated to T3 (liothyronine), which is the more active thyroid hormone in the body.

In theory, this conversion should go off without a hitch, but in the real world, some people do not convert T4 to T3 adequately. In those cases, thyroid patients find that adding T3 directly to their bodies can make a big difference in how they feel.

I have heard from numerous readers about the dramatic changes they’ve seen in their symptoms after switching from a T4-only medication like Synthroid, Levoxyl or levothyroxine to a T3-containing medication like Armour Thyroid*, Nature-Throid, WP Thyroid or compounded T4/T3.

My inbox and Facebook page are flooded with patient stories from people who have seen a huge improvement in their symptoms, with just a medication switch. Here are some typical stories I’ve collected over the last few years (names have been changed for privacy purposes).

  • Lois, 43, lost 15 lbs within 2 months of switching from levothyroxine to Nature-Throid, without changing her diet.
  • Analisse, 33, saw a reduction of hair shedding within 1 month of switching to Armour Thyroid*. She began to have little “spikes” of new hair growth within the second month and is now proud of her lustrous, shiny hair.
  • Donna, 56, said that switching to WP Thyroid finally gave her enough energy to keep up with her grandkids! She saw changes within the first two weeks!

You’ll see similar stories of transformation on patient advocacy sites and thyroid patient forums all over the internet, yet most traditional medical doctors are very reluctant to prescribe anything but Synthroid!

Every system is perfectly designed to produce the results it produces. Change starts with education.

In pharmacy school, I was taught that T4 medications were the preferred therapy for people with hypothyroidism and Hashimoto’s and that medications like Armour* were unstable and should be avoided. “The only time a person should remain on Armour*,” I remember hearing my professors and supervising pharmacists say, “is if they’ve been on it for many years and are unwilling to switch to the newer, better medications like Synthroid.”

This was what everyone was taught…

During pharmacy school, I worked as a pharmacy intern at a busy Walgreens pharmacy, where we filled on average 500 prescriptions per day. Most dosages of Synthroid and Levoxyl were in our “fast mover” section of the pharmacy, or in our automated counting machine because they were prescribed so frequently. On an average day, I filled 20-30 prescriptions for Synthroid/Levoxyl, and we always had multiples of 1000-count bottles on hand to be sure we didn’t run out.

In contrast, we only carried a few doses of Armour Thyroid* for a couple of patients we had on Armour*. These tiny bottles sat on a lonely shelf in the back of the pharmacy, and we always made it a priority to check expiration dates on the bottles, as sometimes the medications would expire before we had a chance to dispense them, due to low prescription volume.

I often get letters from frustrated readers who say that their doctors are refusing to prescribe T3 containing medications. I decided to interview my colleague, Registered Pharmacist Carter Black, about why physicians (especially endocrinologists) are hesitant to prescribe anything except Synthroid, or Levothyroxine, commonly known as T4.

Here are a few issues that have made endocrinologists skeptical of any thyroid medication besides Synthroid, and its generic or branded equivalents.

  1. Liability
    Physicians are averse to any liability that may affect their practice or ability to continue their profession. Levothyroxine (T4) is often cited in studies, that it is sufficient for most patients.  Anything containing liothyronine (T3) is looked at with fear that it may cause palpitations (tachycardia), or osteoporosis resulting in over-replacement.
  2. Historical (sometimes hysterical) Prejudice
    Before the mid-1960’s, most thyroid patients were treated with Thyroid U.S.P., which like Armour*, and WP Thyroid, was derived from the thyroid glands of animals. This type of treatment has been used since the 1890’s in the United States! Thyroid U.S.P. was available in some dosage forms as tablets that were in a similar ratio to the current Armour Thyroid*, but the assay standards to test the level of active hormones were nowhere near modern standards, sometimes resulting in inaccurate dosing.
  3. Misinformation about Compounding Pharmacies
    Historically, “in between” doses were compounded with Thyroid powder U.S.P.  Any pharmacist could put an amount into a capsule.  Back in the day, this was not an exact process. The balance (scale) was not sensitive, and compounding was done by every pharmacist with a scale, some empty capsules, and some powder.  Today’s standards for pharmaceutical compounding have dramatically changed, so that most compounding is done with prediluted powders and ultra sensitive scales, by specially trained pharmacists, in specially certified compounding pharmacies. Note: when working with compounded thyroid medications, be sure to seek a pharmacist that compounds the bulk of their prescriptions, participates in organizations devoted to compounding and has an excellent reputation.
  4. Pharmaceutical Marketing Dollars
    When Synthroid came to the market in 1955, Flint Labs, the manufacturer of synthetic thyroid “Synthroid” recognized that patients and physicians alike were frustrated with inconsistent results from the glandular-derived thyroid medications, as well as the other new synthetics on the market, so the manufacturer made an effort to create a predictable product that patients and physicians could trust.This innovation resulted in more predictable outcomes from therapy, compared to the other previously available medications. Flint Labs pharmaceutical representatives began to educate physicians about the superior predictability of Synthroid to Thyroid U.S.P. Physicians and patients appreciated this; no more worries about becoming hypothyroid or hyperthyroid the next time you refill your medications! Soon enough, Synthroid became the drug of choice. But Synthroid was not the only medication with improved predictability…Eventually, Armour Thyroid* was created to address the dosage variability weakness, but by that time, glandulars had fallen out of favor. The patented levothyroxine (T4) in the name of Synthroid became a top ten seller in the United States (It has now become the #1 selling drug in the United States, as of 2013 and 2014 data). MOST patients were happy.  Armour Thyroid* did have a sales force but nothing compared with Flint Labs. There has been quite a bit of controversy surrounding the marketing of Synthroid. In 2000, Synthroid was the third most commonly prescribed medication in the US, due to claims by the manufacturer that generic alternatives were inferior. The pharmaceutical company funded university researchers to perform studies to test generic equivalency with Synthroid. When the studies showed that the generic products were equivalent and would offer cost savings to patients and insurance companies, the researchers were allegedly discouraged from publishing their results, and the information was suppressed. This study was done in 1986, but suppressed from publication until 1997! The company settled, agreeing to pay $87 million dollars in a class action lawsuit. Harold J. DeMonaco, in MGH Drug Therapy, Vol XI, Issue 8[1] called it a “Made for TV Movie” situation.  It was a point in history when two other levothyroxine products were FDA approved and the maker at the time refused to seek approval because Synthroid was the standard product.Meanwhile, Forest Lab, the manufacturer of Armour Thyroid*, just kept making their product, without dedicating much of a marketing budget to the product. According to Carter Black, RPh, Synthroid the brand and others have been recalled many times, and Synthroid was even reformulated in 1981. In his 40 years as a pharmacist, Mr. Black does not remember a recall of Armour Thyroid*. The interest in glandular products was finally revived (in my opinion) in recent years by RLC Lab, the manufacturer of Nature-Throid and WP Thyroid. The website for RLC Lab proudly states that their products have never been recalled due to inconsistent levels, while Synthroid has gone through numerous recalls in the last decade. Speaking to a pharmacist friend of mine, who still works at Walgreen’s (we used to be pharmacy technicians and pharmacy students together many moons ago), she noted that she sees an increased number of prescriptions filled for Nature-Throid, yay!
  5. Inappropriate Medication Use/AbuseThe 80’s Also Cast T3 in a Negative Light
    Weight loss clinics started prescribing Cytomel (T3), along with amphetamines, for people without thyroid disease, inducing hyperthyroidism in their patients, which resulted in quick (but dangerous) weight loss!  As you can imagine, this combination was given to an overweight person with a normally functioning thyroid often created a dangerous situation.  Patients were admitted to the emergency rooms with life or death symptoms of high fever, palpitations, labored breathing, dehydration, delirium, nausea, vomiting, and even coma.  This is a difficult clinical situation. Death can result, as well as future problems of thyroid management (alternating hyperthyroid and hypothyroid), cardiac damage and mood disorders are among the consequences of the above. As a result of this inappropriate abuse of medications, all thyroid medications are now required to carry a black-box warning (the most strict warning given by the FDA), that warn against the use of thyroid medications for weight loss. Many of today’s practicing endocrinologists witnessed the effects of this situation first hand, as young residents and medical students early in their training.  One can certainly understand a doctor’s aversion to T3 or T4/T3 combinations, because of a history of inappropriate use. ****. Please Note, you shouldn’t confuse this with appropriate use of thyroid medications for people who are overweight due to hypothyroidism. Using thyroid medications for a person who is hypothyroid is an appropriate use of medications, and anyone suggesting otherwise should be questioned for their understanding of basic physiology. I once saw a poorly researched article written by an internet marketer who was saying that thyroid medications were not to be used by people with thyroid disease due to this warning! That’s like saying that dogs shouldn’t eat dog food because it’s not appropriate for cats! 🙂
  6. Reliance on TSH
    In the good ol’ days, before the availability of thyroid testing, patients were dosed on thyroid medications based on their symptoms – this didn’t always turn out for the best, and patients were often overdosed. Thyroid symptoms can be nonspecific, and fatigue and weight gain are not always thyroid related. With the emergence of thyroid testing, most physicians now dose thyroid patients based on their TSH levels. Of course, all health care professionals are taught to treat the patient, not the lab test, but very few seem to follow that advice. I recommend working with a practitioner that relies on not just the TSH test, but also free T3, free T4, AND your symptoms, to paint a complete picture of how to properly adjust your medications. You can read my articles When Your TSH is Normal, and You Are Anything But, 6 Types of Thyroid Tests, Top Things To Know About Thyroid Medication for more information.
  7. Research Funding Clinical Trials are Very Expensive and Require Funding
    Most studies focusing on medications are funded by pharmaceutical companies that manufacture the medications, and thus the majority of studies done with thyroid medications will focus on T4 medications.  However, National Institutes of Health, a government agency conducted a clinical trial not funded by pharmaceutical grants to see if natural desiccated thyroid therapy is advantageous to T4 alone. The authors of the study concluded: “DTE (Desiccated Thyroid Extract) therapy did not result in a significant improvement in quality of life; however, DTE caused modest weight loss and nearly half (48.6%) of the study patients expressed a preference for DTE over l-T4 (Levothyroxine). DTE therapy may be relevant for some hypothyroid patients”. Additional searches of PubMed (the largest database of published medical research) will reveal that patients prefer combination therapy of T4 & T3. A recent article stated: “Physiologic combinations of Levothyroxine plus liothyronine do not offer any objective advantage over Levothyroxine alone, yet patients prefer combination treatment.” Annals of Internal Medicine 2005 Mar 15.  Most endocrinologists do not like “subjective” evidence, and prefer “objective evidence.”  Plainly defined; objective evidence includes numbers and tests, while patient responses to questions (how are you feeling?) are considered subjective.   Objective numbers lead to less liability.

So what’s a patient to do?

If you’re not feeling well on your current medication, you shouldn’t suffer just because your doctor is not familiar with other types of medication.

Rather than getting upset at your doctor for not wanting to prescribe a medication he/she is not comfortable prescribing to you, my suggestion is for you to do the following:

1. Educate yourself. Read through the above-listed articles and get a copy of my new eBook on optimizing medications free by entering your email below!

2. If your doctor is not willing to prescribe anything besides Synthroid for you, find a doctor who has experience with the use of Cytomel, liothyronine, T3, Armour*, Nature-Throid, WP Thyroid and/or compounded thyroid medications, and make an appointment. It’s better that you work with someone who is experienced in using these medications safely and correctly, rather than convince your current doctor to prescribe them for you! After all, you probably don’t want to be someone’s first patient on a medication they are not familiar with anyway!  A database of practitioners is available on my website. If there are no practitioners are available in your area, check with your local compounding pharmacy to see if the pharmacists there have a recommendation for you.

3. If you are hoping to have your current doctor involved and he/she is open minded, I suggest a team approach. You have the option of having another practitioner prescribe the medication to you, while you keep in touch with your current doctor, or you and your doctor can work with a pharmacist who is experienced in thyroid medication use and dosing, like Carter Black, who I interviewed for this article.

Please note, some patients resort to ordering T4/T3 medications off the internet. I do not recommend this, due to quality concerns and the potential for overdosing yourself. You should always work with a qualified healthcare practitioner to optimize your medications!

*Note: While Armour Thyroid does not have any gluten-containing ingredients, it is not tested for gluten content, and cannot be certified as gluten-free. Armour does contain sodium starch glycolate, which can be derived from wheat or corn.

About Carter Black, RPh

Wentz-Carter-1024x768

L-R Dr. Izabella Wentz, Carter Black, RPh

Registered Pharmacist Carter Black is a graduate of the University of Illinois College of Pharmacy with undergraduate work at the University of Illinois at Champaign/Urbana.  He is a preceptor for pharmacy students and is a consultant by doctor referral for women and men’s health, hormone, and thyroid issues.  He is a former professor of pharmacology at Pacific College of Oriental Medicine and has over 40 years of experience working with compounded medications and bio-identical hormones. Mr. Black has extensive training through the Institute of Functional Medicine, Hashimoto’s Self-Management program, and the Hashimoto’s Institute, and is Dr. Izabella’s go-to resource for thyroid medications, compounded medications and appropriate use of hormones. He has been collaborating with Dr. Izabella since 2011.

References

SYNTHROID. Food  For  Freethought. 2017. Available at: http://foodforfreethought.weebly.com/synthroid.html. Accessed August 3, 2017.

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Disclaimer: The information contained herein is for informational purposes only and should not be construed as medical advice. Please consult your physician for any health problems and before making any medical or lifestyle changes.

Lifestyle changes can result in improved thyroid function and/or an increased absorption of thyroid hormone medications, leading to a lower required dose and possible symptoms of hyperthyroidism at a dose that was previously stable. Please discuss lifestyle changes with your physician and ensure that your thyroid function is monitored every 6-8 weeks while making lifestyle changes. Symptoms of overmedication include, but are not limited to: rapid or irregular heartbeat, nervousness, irritability or mood swings, muscle weakness or tremors, diarrhea, menstrual irregularities, hair loss, weight loss, insomnia, chest pain, and excessive sweating. Do not start, change, increase, decrease or discontinue your medications without consulting with your physician.

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Comments

  1. Dear Izabella,
    I have Hashimoto’s with a variety of gut problems. My question today is about my tinnitus which comes and goes. I notice it more around the time I have my period. Could I benefit by changing from l-thyroxin to DTE?
    Sincerely,
    Susan

    Reply

  2. Dr.Wentz,
    I have been following you.and finally had my Dr. prescribe Nature-thyroid. Just within 3 days I have noticed changes in my skin and the skin tags that I had. So far this is great! Thanks for your advice!

    Reply

    • Wanda – thank you for following this page. I am so happy you are taking charge of your health! Our skin is a window to our internal health. It is the body’s largest elimination organ, and also a canvas where toxicities, nutrient deficiencies, food sensitivities and hormonal imbalances can show up. Women with Hashimoto’s and autoimmune conditions are more likely to have dry, dull skin, rashes, hives, pre-menstrual acne and facial swelling, especially if their thyroid levels are not optimized and they are not absorbing vitamins and nutrients correctly.

      THE THYROID AND SKIN
      https://thyroidpharmacist.com/articles/the-thyroid-and-skin

      Reply

  3. I discussed switching medications with my doctor from levothyroxine to nature-thyroid. She agreed to the switch and I was on it for 3 months. I had my blood work done and my TSH was 38! I am now 6 days back on levothyroxine hoping to get my levels down. My Dr. said my body was not absorbing the Nature-thyroid:(. I was disappointed because I was still having hypoactive symptoms even though TSH levels were in normal range.

    Reply

  4. I have hashimato desease. My gland is unactive en have few nodules. The spesialist only told me that and does’nt explain me anything. He gave me a prescription for Eltroxin 1mg. What l knew about my condition are becauce of google. I’m not using sugar, wheat( because i have asthma also and the wheat trigger the asthma) and now i’ll cut the diary products. I’m using immandue booster, vitamine b-complex and osteoease. And 3x times a week i went to the gym for cardio especialy on the treadmill and the exercice bicycle’s.

    Reply

    • Kotie – thank you for following this page. Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically, is ‘dead’, or treated with radioactive iodine the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target. We need to re-balance the immune system to prevent this (sometimes the autoimmunity can be reversed as well). The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition.

      Hashimoto’s Protocol
      thyroidpharmacist.com/protocol

      Hashimoto’s Root Cause
      http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

      Reply

  5. Hello!
    I started armour thyroid about 8 months ago after being on synthroid since 2007. Its the best ive felt in years! I had some lingering issues so I started seing an endocrinologist yesterday and she immediatly told me how horrible NDT was and gave me a prescription for synthoid snd cytomel. I started taking it this morning and im back to being tired, brain fog, achy joints like no tomorrow. Do i stick with it or go back to my Armour and insist she work with this medication?

    Reply

  6. I had Hashimoto’s for YEARS and was undertreated. I developed high blood pressure during this time. Eventually I was diagnosed with thyroid cancer and had a total thyroidectomy. I am on Synthroid and Cytomel. I find it very hard to lose weight, my hair falls out in bunches and I just do not feel good. I want to try Armour, but my endocrinologists refuse because of the cancer diagnosis. Can you speak to the use of natural thyroid and control of TSH and cancer. Much appreciated.

    Reply

  7. Thank you for this history of thyroid meds. What can you tell us about storage and shelf-life of natural desiccated thyroid products? I have a year-old bottle of Armour, stored cool, dark and dry. Will it have retained it’s potency? Thank you.

    Reply

  8. Is Withania Somnifera contraindicated when using NatureThroid or other hypothyroid-supporting medications due to its potential effect on thyroid hormones?

    Reply

    • Andy – I wish I could give you more direct advice but, each person will react differently. I would advise you to ask your personal pharmacist or a trusted clinician who’s care you are under. I am not able to respond directly to these types of questions here. I also don’t recommend starting multiple supplements all at once. I recommend starting one at a time, and then adding another a week or so later once it has been confirmed that the first supplement is not causing any harm.

      I do have a full supplements chapter in my book. Have you checked it out? Not everyone should be taking every supplement and the book will help uncover your root cause. This will help you figure out your supplementation.

      Hashimoto’s Root Cause
      http://www.amazon.com/gp/product/0615825796?ie=UTF8…

      Hashimoto’s Protocol
      thyroidpharmacist.com/protocol

      Reply

  9. I have been on Armour thyroid since I was 16, I am now 71. The pharmacy recently switched me to NP which smells like the Armour thyroid of many years ago. My question is, I have developed hypoxia now but no underly8ng heart or lung problems. How do I find out if this hypoxia could be related to hypothyroidism?

    Reply

  10. I was prescribed synthroid, but an immediate allergic reaction to it. My MD changed me to Armour Thyroid, but within a few days I was covered with hives and itching. I seem to be so sensitive to many medications. My MD says I am in need of help with my thyroid, not only testing, but symptoms all show the need. He is now changing me to NP thyroid? I am becoming frustrated. Any answers?

    Thank you,
    Marchel

    Reply

  11. Thank you for putting into writing what so many of us are feeling and are trying to explain to others. I recently switched to a combo of T3/T4 and adjusted my diet and have been feeling better than I have in he last 10 years. Thank YOU for providing me with the resources to start my own research, the courage and knowledge to insist on alternative approaches and for providing me with enough supporting evidence to realize I needed to find a new doctor. I’ve been blessed to have you and my new doctors – one functional and one DO who works closely with my functional doc – in my corner and helping me on my way to healing! ❤️

    Reply

  12. I would love your take on the latest crisis with the NDTs not working for people anymore. it seems we go from one to another when the latest batch no longer works for people because of unknown manufacturing issue,,either the supplies or the fillers or whatever. people are moving from Armour to naturethroid to Ocella’s NT thyroid, the latest to have huge issues.(described generally as smelling like cat urine, and making people sick and just no longer working..) .I have three in my family on this stuff and we all are left with nothing effective to take except for synthroid. My daughters TSH jumped to 25 this last round with nothing changed otherwise. Please read up on the latest and give your suggestions as to what the alternatives are left after one after the other has production/quality issues..its almost like a conspiracy by bit pharma..

    Reply

    • cj – thank you so much for reaching out and sharing. I understand your frustration. My heart goes out to you and your daughter. <3 I have had others report that the new formulation does not work for them but, I cannot comment on the effectiveness of the medication at this time. I will be happy to add this to my list to research further. I do recommend that you discuss this further with your practitioner.

      Reply

  13. My levothyroxine worked for a month or two and now doesn’t seem to be. I have been on same dose for a year. I have tachycardia and wondering if they would prescribe me Armour if I have that… want to try.

    Reply

  14. I did really well on WP Thyroid, which they quit making. Now back on the market I need the lowest does. My Dr. Said it comes in one does which
    I would need to cut in quarters. At that point it would crumble into powder. Meanwhile I adhere strictly to wheat and gluten free diet. Frustrating, felt great on WP,..suggestions….all other meds put my intestine into warp speed…I have a 35 year old son with Celiac disease.

    Reply

  15. do you not recommend natural thyroid, for those that have Hashimoto’s, and autoimmune disease, and to stay on the T4 levothyroxine and T3 liothyronine, if so what would be the best ones for that my generic T4 with the liothronine is not working for me anymore. Thanks

    Reply

  16. I am a poor converter of T4 into T3. My T3 is very low despite my T4 being high. Is the deionidase enzyme available OTC or by prescription?

    Reply

  17. I have been on Synthroid for 20 years or more. Along with my Hashimotos , I have recently been strruggling with creeping high cholesterol and now an A1c of 5.4, I recently read that buried deep in the literature of Synthroid, it warns that this drug can cause cholesterol and blood sugar complications! Have you read any info on this? Thank you for your insightful articles.

    Reply

    • Jane – thank you for reaching out. ❤️ Cholesterol can be elevated for a variety of reasons. One of the reasons why cholesterol may be elevated is actually due to hypothyroidism. Sometimes you will get a person on a thyroid medication and their cholesterol will actually normalize. Another reason may be due to adrenal issues. A person with adrenal dysfunction might see higher levels of cholesterol occurring, because adrenal hormones are made from cholesterol. Basically, it’s the body’s way of trying to get more of a supply of cholesterol, to make more adrenal hormones. Thyroid medications can actually weaken the adrenals. As for blood sugar imbalances, they are a big contributor to Hashimoto’s. Balancing blood sugar levels should be one of the priorities for anyone who is hoping to overcome autoimmune thyroiditis and adrenal fatigue. Balancing my blood sugar made a big difference for me, helping with my anxiety levels and reducing my thyroid antibodies. I hope these articles help shed some light on the matter:

      ARE YOUR ADRENALS SABOTAGING YOUR HEALTH?
      https://thyroidpharmacist.com/articles/are-your-adrenals-sabotaging-your-health/

      WHY BALANCING BLOOD SUGAR IS VITAL FOR HASHIMOTO’S HEALTH
      https://thyroidpharmacist.com/articles/blood-sugar-imbalances-and-hashimotos/

      Reply

  18. Dr. Wentz, I have nature-thyroid 16.25 mg tablets that expired 2018. Are they safe to take? Stored in dark cool place not opened. I’m feeling horrible and waiting for my labs. Ok to try while I wait?

    Reply

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