Thyroid Disorders Community
Should I switch from Synthroid to Erfa???
About This Community:

This patient support community is for discussions relating to thyroid issues, goiter, Graves disease, Hashimoto's Thyroiditis, Human Growth Hormone (HGH), hyperthyroid, hypothyroid, metabolism, parathyroid, pituitary gland, thyroiditis, and thyroid Stimulating Hormone (TSH).

Font Size:
A
A
A
Background:
Blank
Blank
Blank
Blank Blank

Should I switch from Synthroid to Erfa???

I have had HAshis for over 8 years now. I have been on Synthroid mostly the whole time. I added Cytomel to the mix last year to help with lingering symptoms, and have had one issue after another with it. I started with one Cytomel (5 mcg) once a day and did ok. I then after a few months was put on 2 Cytomel (5 mcg) twice a day.
After about 6 months and having insomnia, heart palps and diarehha, I went back to one Cytomel once a day.
The whole time though my Free T3 was not at the top of the range. About 3 months ago the heart palps and diarehha started again, So I stopped Cytomel all together.
THese were the labs before I stopped: 4-26-11
TSH        0.425 L         (0.45-4.5)
Free T4    1.32             (0.82-1.77)
Free T3    3.6               (2.0-4.4)
Ferritin      38               (13-150)  I have been fighting anemia too

I then stopped Cytomel and went Synthroid only at 147 mcg and these were my labs:
6-9-11
TSH         3.53              (0.40-4.5)
Free T4    2.47               (1.4-3.8)
T3 uptake  29                 (22-35)
T4 total      8.5               (4.5-12)

This NEW doc did not even check my Free T3. She even said my TSH was fine, which I know is not.
I had her up my Synthroid to 150 mcg from 137 mcg.

Here is the problem. I do not want to do Cytomel. It did not work for me after doing it for a year and a half.
My question is now, should I try erfa? Will this help with symptoms? Will I get heart palps again from adding more T3? I need any help I can get? I am lost and cannot find a good doc to figure this out.
My symptoms are:

weight gain!!! (20 lbs more in the last 6 months)
insomnia
dry skin
awful OCD and anxiety
thinning outer eyebrows
brain fog!!

PLaese anyone that has switched to Erfa, is it worth it? Should I keep looking elsewhere? Is this just my thyroid???
Related Discussions
35 Comments Post a Comment
Blank
Avatar_m_tn
With you still having those symptoms, and from those lab results, I'd say that you likely need to increase your FT3 level.  Since you have had poor results trying to use Cytomel and Synthroid, Erfa may well be the best way to go.  Interestingly I tried your combination and just did not like the results, so I switched to the new Armour.  I have slowly tweaked my dosage upward and now I am feeling best ever.  

I am a bit leery about your doctor also, based on not checking FT3, but testing for T3 uptake and TT4, and using the old reference range for TSH.  My definition of a good thyroid doctor is one that will treat a hypo patient clinically by testing and adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH.  Symptom relief should be all important, not just test results.  Test results are valuable mainly during diagnosis and thena afterward to monitor FT3 and FT4 as meds are revised to relieve symptoms.  You can read more about clinical treatment in this link.

http://hormonerestoration.com/files/ThyroidPMD.pdf

If you will tell us what area you live in, perhaps a member might be able to recommend a good thyroid doctor, based on personal experience.

Blank
1369218_tn?1282427484
When taking Erfa though and getting more T3, I worry about heart palps again. Being more natural though I wonder if I will be ok.
The last labs were done by a new endo I had seen. It amazes me how off most of them are!! I have yet, and I have been to so many, find a doc that gets any of what this forum talks about!!! They all look at me like I am crazy!!! I think one though might write a script for Erfa though. He still though is clueless!!! I am just miserable and want to get out of the dark and into the light!!! I will need help too from this forum about how to ween off and get on.
Blank
1369218_tn?1282427484
I live in Colorado Springs, CO. I am about an hour from Denver.
Blank
Avatar_m_tn
I meant to ask you to double check the 6/9 test results.  You show a FT4 as being 4.9, with the range of 1.4-3.8.  The reason I ask is that I have never seen a range for FT4 that was anywhere close to that.

I think you should make sure to get tested for Free T3 before making any change in meds.  I expect that you will find your FT3 to be in the low end of the range and thus consistent with having those hypo symptoms. Of course members tell us that heart palps can occur with hypo as well as hyper, but you also had some other symptoms as well.  I wonder if you were getting very close to an optimum dosage, but then went a bit too far with T3 and some hyper symptoms occurred.  Personally I think I would consider changing to the Erfa and gradually and carefully increase the dose until symptoms are relieved.  This can take some time so you have to be very patient.   I'm sure that goolarra would be glad to relate her experience in this area.

If it would be of interest to you my listing of good thyroid doctors I have been compiling for the last couple of years shows one doctor in Parker Co.  
Blank
231441_tn?1333896366
I take Erfa and love it.

Feel the best ever with it.

I'd think it's worth a try.

If you do get palps, you can try a combination of ERFA and synthroid, to get a little less T3.
Blank
1369218_tn?1282427484
Gimel-

I did not see the FT4 range at what you said on 6-9. It said 2.47.
I would love the name of the doc you have in Parker!! I am very close to there, about a half an hour. I truly wonder if my issues are from my thyroid!!

Super Sally-

I tried Cytomel and I am done!!! I am eager to try something else and feel better!!

I will need help converting when I get there! I am scared, but need to take the risk!
Blank
Avatar_m_tn
Sorry, I used the  wrong number.  The 1.4-3.8 range was what I could not understand as being for FT4.

I am sending the doctor's name by PM.
Blank
1369218_tn?1282427484
so, the test is actually labeled as:

Free Thyroxine index:           2.47       (1.4-3.8)

it does not show the units used. Doesn't that mean Free T4???

I am going back to the doc in 2 weeks that ran the tests on 4-26-11. I have lab order and he does check Free T3 and Free T4. I will post and talk to him about trying erfa.

How do you order though? I am currently on 150 mcg of Synthroid.
Blank
798555_tn?1292791151
I'll just say ERFA is the 'smoothest' while efective source of T3 I've used.

I've used 3 brands and 2 generics of both types of T3.  Thats more than what is currently available today.

You n ever know till you try it.
Blank
Avatar_m_tn
The Free Thyroxine Index is a mathematical calculation using Total T4 and the T3 uptake results.  How useful is that?  I have read that not many doctors even understand what it means, much less how to use it.

When you go into the lab for blood draw for testing, make sure they know it is to be for Free T3 and Free T4, not Total T3 and T4.  You'd be amazed how often they run on auto pilot and do their usual tests.    
Blank
1369218_tn?1282427484
I was referred to this doc, who is an endo, and she still does not know to much about thyroid!!!
I am amazed at how little these docs know!!

Is Free triiodothyronine serum, Free T3 then?

So confusing!!! Anyways, how do I take Erfa if I am on 150mcg of Synthroid?

LazyMoose~

Did you have any issues with Cytomel and side effects?

I am still concerned about getting heart palps from it.
Blank
Avatar_m_tn
Yes on the question about Free triiodothyronine.  

Not as familiar with Erfa as with Armour.  Assuming it to be fairly comparable, one grain would be approx. the equivalent of 75 mcg of T4 med.  Calculating the total amount is the easiest part.  Making the transition can be a bit trickier, due to the T3 acting faster than T4.  Some people have transitioned faster, but to be very cautions, you could replace only 1/4 of your Synthroid at a time and allow a week or so for the T3 portion to be fully effective.   That is just my quick response, since I have to leave for a while.  Back later.

Blank
798555_tn?1292791151
Cytomel seemed very fast acting and didnt last very long, even if taken 2X a day, Headaches too. Was like a roller coaster. Its good for a lot of people though.

I do take ERFA 3x a day, and it can be taken sublingually (I do that in the afternoon), foods not an issue.
Blank
1369218_tn?1282427484
What dose of Erfa should I start with? I take 150 mcg of Synthroid currently,
Blank
Avatar_m_tn
I was on 150 mcg of Synthroid and diminished it by 25 mcg per week while cutting, crushing, and sublingually taking 1/4 tab of Erfa. I continued until all Synthroid dose was zero and Erfa was 125 mg. I've been on this regimen for 3 weeks now and loving it. Go to www.stopthemadness.com and you'll find a wealth of info.
Blank
1369218_tn?1282427484
I am hoping to do the switch soon. I was having heart palps pretty bad that I went to a cardiologist that ran some tests. I want to make sure I am ok before starting though.
Thanks for the input!!
Blank
798555_tn?1292791151
Havnt been hear in a while.........

The switch is best if blended over a few weeks something like virgnbul said. Erfa website have a comparison chart, look it up and bring to your doctor. Its not exact, differs for all people. You will have high T3 on this med verses T4, but not as high as the
Naturethroid brand.

Takes a while to get used to. Took me one year on Erfa  before I 'leveled' and symptom relief no longer occurred. What few symptoms I still have I attribute to Hashi being an autoimmune disease - we're vary rarely 100% again on any thyroid med. However, if you live a stress free lifestyle and do not physically push yourself in forms of exercise, you might not notice, just my observation.
Blank
1369218_tn?1282427484
So, I got new levels after 4 weeks on 150 mcg of Synthroid and they are awful.
The new endo gave over phone, but said TSH was over 4 and my Free T's were pretty low.
I am tired, tired of feeling crummy.

I am calling tomorrow and getting a script for Erfa. How does he write? I am on 150 of Synthroid, what do I start with??
Blank
798555_tn?1292791151
You will not feel good on any thyoid med without the correct levels. From what you say, your Synthroid needs to be increased.

A thyroid med cannot be 'judged' on its symptom relief until your Free T's are higher than the low end.

If you had those same lab #'s while on Erfa, you still wont feel better.

It only makes sense to up your Synthroid before changing.

About Erfa in the future - I cannot suggest a starting does, MH rule. Look at the Erfa website - for comparable dosing chart.

Blank
798555_tn?1292791151
I just re-read you thread. And I see where your coming from now. You could just try the synthroid only for one more or two month at a higher dose.Hopfully the doc will do this for you. If you do , ask for a FT3 test (same as Free T3) after that time period, not uptake.

If you are positive its not relieving symptoms, then maybe go with Erfa - I PM'ed you on that one.
Blank
1369218_tn?1282427484
2 years ago before trying Cytomel I was on the Synthroid game alone. I got up to 175 mcg and went hyper. I felt so awful. I then backed it to 165 mcg and was achey (achy).

I actually found some labs from back then when I was on 165 of Synthroid :
7-22-2009:
Free T3    2.54   (2-3.9)
Free T4    1.09   (.58-1.64)
TSH         1.40  ( .34-4.00)

3-18-2009
Free T3    2.4    (1.71-3.71)
Free T4    .97    (.70-1.48)
TSH         2.24   (.35-4.94)

Anti-Thyroid ABS    542  H  (0-34)
Antithyroglobulin        <20   (0-40)

As you can see I do not convert T4 to T3 very well. I had many symptoms too!!
Synthroid only worked for me for years, but I also did not get labs back then and only started 2 years ago. I have had depression, anxiety, weight gain for about 10 years now.
Probably had bad levels and bad doctors. I just did not question it back then. Thought it was just me.



Blank
798555_tn?1292791151
If you went hyper on synthroid in the past (per your new posting above), then backed off a little and still wernt well, maybe it is time to try something new.
Blank
1369218_tn?1282427484
Here are my levels drawn in the am on 7-13-11:

TSH      4.51  H   (.40-4.5)
Free T3   2.5        (2.3-4.2)
Free T4   1.1        (0.8-1.8)

So, no wonder why I feel so awful!!! I was on 150 mcg of Synthroid. I am going to try one more time to add in a Cytomel to see if that helps. I have a hard time sleeping on it though.
Maybe it could be adrenals?
Blank
798555_tn?1292791151
All hormones work together to some extent. When some are low, it can throw the others off.

Low thyroid T4 and T3 creates an anxiety condition and insomnia in many people - kind of the opposite of what we might assume.

Do not let the doc hold your med levels by TSH only - look at the frees.

Dont take cytomel within 6 hours before bed. Synthroid does not matter though, some take it at night, but no sooner that 45 min after food.

The best way to test adrenals is the 24 hr, 4 point saliva test. An MD will not recognize this test, only naturopaths, chiros ect. About $130-$160.
Blank
649848_tn?1357751184
I've been on generic T3 med for nearly 3 yrs and doing great on it.  If you're going to add in some T3 again, you should start at a very low dose, possibly by splitting pills; give yourself a chance to get used to each tiny increment before increasing again, so you work up very slowly, in an effort to avoid the palps.

Depending on your schedule, don't take the T3 med after about 3:00 pm or as Moose said "within 6 hours before bed".  

Blank
1369218_tn?1282427484
I only started on 5 mcg once a day. I take around noon with no food. I have done now for 2 weeks and again I have horrible insomnia and anxiety. I am scared to switch to Erfa because it is more T3 than I am used to. My levels are really low, so maybe it is adrenals??
Here are my levels drawn in the am on 7-13-11:

TSH      4.51  H   (.40-4.5)
Free T3   2.5        (2.3-4.2)
Free T4   1.1        (0.8-1.8)

Blank
798555_tn?1292791151
Its best take T3 as soon as you wake. When I took Cytomel, I split the 5 mcg pill in two. one half at 6AM, other half at 11 AM.

Every time I switched brands of any form of T3, I felt terrible for at least 3 weeks. I need T3, but am very sensitive to its increases or changes.

Funny thing is for me, Natural (pig) thyroid T3 is smoother than synthetic. Some of us are that way. But with any thyroid med you half to just 'rough it' for a while and bear any discomfort to truly test the compatibility of the med for you.

Blank
649848_tn?1357751184
I get up at 3:15 am, take my T4 med, get ready for work...... I'm at work by 5:00 am - take my 5 mcg T3 med at 7:00 am - it keeps me going for the day and unless my stress levels are high, I don't have a problem sleeping.......

Agree with LM - either take the entire dose earlier in the day (like I do) or split the pill and take the first dose early in the day, then the second around or before noon (like he did)....

Unlike T4 meds, Cytomel/generic T3 can be taken with or without food.......
Blank
1369218_tn?1282427484
thanks, I will try that
Blank
Avatar_m_tn
to find another end dr I hope this helps:
http://www.thyroid.org/patient-thyroid-information/endocrinology-thyroid-doctor

I am having drug issues and heart probs too on just synthroid but just got a great fam dr my endo recommended so they work well together. Keeping my fingers crossed!
Blank
Avatar_m_tn
to find another end dr I hope this helps:
http://www.thyroid.org/patient-thyroid-information/endocrinology-thyroid-doctor

I am having drug issues and heart probs too on just synthroid but just got a great fam dr my endo recommended so they work well together. Keeping my fingers crossed!
Blank
Avatar_n_tn
At your original dose of 137 ug T4, adding 5ug of T3 was too much. You ought to have only been using about 2.2ug Cytomel to achieve a balanced physiologic ratio of 98% T4 to 2% T3. Since Cytomel only comes in 5 and 25 ug tabs, a compounding pharmacy could have provided you with the correct dose. Like so many patients, thinking to add more T3 when they lag is a natural but incorrect assumption. The presence of T3 can increase your body's need for T4. In your case, you doubled an already too high T3 dose to 10ug. This was four times more than the physiologic dose, hence you suffered thyrotoxic symptoms. If you are now on 150ug T4, you require 3ug of T3 and no more. In proper physiologic doses T3 is a life saver.

Your query as to whether or not to switch to Erfa should be carefully thought out. Erfa has about a 75% to 25% T4 to T3 ratio. Again, unless a doctor can find a way to balance it out with enough T4 to attain a physiologic ratio of 98:2, I would be very leery of switching. Switching may leave you feeling as bad if not worse.

I strongly suggest you read Dr. Blanchard's "What Your Doctor May Not Tell You About Hypothyroidism". This book will give you an excellent understanding of your disease, your meds, options, and how to get what you need from your doctor. Empowering yourself with accurate information will ultimately help you get the kind of control over your hypothyroidism that you want. As Dr. Blanchard points out, "Don't settle for less".
Blank
798555_tn?1292791151
Welcome to the forum. Its easy to miss the comments posting dates, some advice is time sensitive, some is not.

In non-hypothyroid people, it is not usual for people to have higher Free T3 than free T4. However, once on hypothyroid replacement for years, it is not uncommon for people to feel better with Free t3 in the upper third of the ranges as long as they dont have hyper symptoms. This has been proven many times from patients triing this here and many other forums. Some people dont convert well either. And some just feel better changing from synthetic combo meds to natural dessicated like Armour or Erfa regardless of the T3/T4 ratios. It takes a while to get used to natural dessicated meds, but many feel better, this is a fact.

Some do add synthetic T4 to their daily dessicated replacement, but , oddly, they don't feel much different, its mostly makes lab results look better. Probably because T3 has more symptomatic relief  effects over the storage T4 hormone.

It all comes down to what works for symptomatic relief for the individual person..

There are many books written on hypothyroidism. Unfortunately, many of these authors do not have hypothyroid so this limits their personal experience. They do provide good info on the basics. This site is one of the best places to learn what Drs fail to tell patients about thyroid disease.

Again, welcome to the forum.
Blank
Avatar_f_tn
You need to inform yourself. Often eating gluten is killer and a cause of Hashi or many thyroid issues. The worse thing is if you keep eating gluten eventually your thyroid will sto functioning all together. http://thyroidbook.com/blog/eating-gluten-increases-need-for-thyroid-hormones/.  This is a basic article but do some research and you find out that it is a must to cut out if you have these issues, conditions or diseases etc.
Blank
798555_tn?1292791151
As if we aren't informed?

Many here have studied the gluten thing and have gone gluten free, to find it did nothing for thyroid improvement.

What many gluten free people dont know is they are limiting digestive Canida growth when limiting gluten, sweets, and carbs. Candida overgrowth has many identical symptoms as low thyroid. When Candida is gone, you lose weight, think better, feel better. We all have candida, the question is how much?

If some people are very sensitive to gluten that does NOT mean everyone is.

Once the thyroid is physically damaged, as in many Hashi people, (but not regular hypothyroid), its not reversable (yet, without stem cell regrowth). Some damaged thyroids will never produce what they once could, so these people will need hormone replacement for life. This post was about hormone replacement choice.

Hows that for being informative?
Blank
Post a Comment
To
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
Thyroid Disorders Community Resources
RSS Expert Activity
242532_tn?1269553979
Blank
The 3 Essentials to Ending Emotiona...
Sep 18 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Control Emotional Eating with this ...
Sep 04 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Emotional Eating Control: How to St...
Aug 28 by Roger Gould, M.D.Blank
Top Thyroid Answerers
649848_tn?1357751184
Blank
Barb135
FL
Avatar_f_tn
Blank
goolarra
Sisters, OR
Avatar_m_tn
Blank
gimel
MI
168348_tn?1379360675
Blank
ChitChatNine
1756321_tn?1377771734
Blank
Red_Star
Queensland, Australia
Avatar_m_tn
Blank
flyingfool
WI