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Avatar universal

questions about Armour and Erfa

I have been on NDT for the past year. I started on Armour, which my doctor seems to prefer, then switched to Erfa (asking the pharmacy to substitute Erfa for Armour when I filled my prescription), and I honestly don't know what to make of my labs and symptoms. I did not feel nearly as bad on Armour as many others report; in fact, I felt very good on it as long as I was taking the 15, 30, 60, 90 and 120 mg pills. Then, I was prescribed 240 mg pills and suddenly did not feel so great anymore.

On 300 mg of Armour (120+120+60 mg), my labs looked like this (7 June 2012):

TSH <0.001
FT3 4.1 (1.7-3.7)
FT4 1.1 (0.7-1.5)

I felt good at this point in time.

My doctor suggested I decrease the dosage slightly, to 270 mg daily, as it was summer and warmer outside. This is when I asked the pharmacy to give me Erfa instead.

After two months of 270 mg of Erfa, this is how my labs looked (12 September 2012); I realize that 270 mg of Erfa contain about 10 mcg T3 and 30 mcg T4 less than 300 mg of Armour):

TSH <0.001
FT3 3.3 (1.7-3.7)
FT4 0.9 (0.7-1.5)

I felt really good at that dosage, but started to wonder if my FT4 levels were too low. I added 25 mcg of T4 but felt no improvement, so I was beginning to wonder if I had an RT3 problem. I had RT3 tested at my own expense:

0.15 ng/ml (0.09-0.35)
0.23 nmol/l (0.14-0.54)
FT3 3.3 (1.7-3.7)

When I try to use the T3/RT3 calculator on the STTM website, I get a ratio of 220...which does not make sense at all. But I interpret these figures to mean that I don't have an RT3 problem?

I then decided to try Armour again, for the simple reason that I still had a lot of it left...I started taking one 240 + 30 mg pill a day. I did not feel as good as before. More tired, weight gain (+5 pounds which may not sound a lot but is when you are already 50 pounds overweight; I've never been able to lose more than a couple of pounds since being diagnosed with hypo and Hashimoto's ten years ago, and they are easily regained).

In December, I started feeling really cold and tired so I upped Armour to 300 mg daily. Most recent labs, from February 4:

TSH <0.001
FT3 2.9 (1.7-3.7)
FT4 1.1 (0.7-1.5)

My TSH is suppressed (my doctor has no problems with this whatsoever), my FT4 is midrange which I understand is perfect, but my FT3 could be higher, right? I am also surprised it's not higher on 300 mg or 5 grains of Armour which I understand is considered a HUGE dose or even the maximum dose for some.

I always wait for 24 hours after taking my meds before going to the lab.

I am now back on Erfa again, currently taking 330 mg daily (which more or less equals 300 g of Armour), but so far, I don't feel great. It's only my second day on Erfa and I understand some need to go through a period of adaptation before feeling good on Erfa, and I hope that will happen to me as well. I also like the fact that you can buy 500 pills bottles of Erfa which will keep the costs down.

What I don't understand is why I'd need a transitional period, when the pills basically contain the same active ingredients, and only the fillers differ?

Also, I have not been able to figure out if the best way to take Erfa is to swallow the pills, chew them up before swallowing (some recommend this as the pills are quite hard), or take them sublingually? If you sublingual them, is it possible to decrease the dose? Anyway, compared to Armour, they are almost disgustingly sweet :-)

I have also read that thyroid hormones are best taken at bedtime, as a healthy thyroid gland is most active during sleep and produces mainly T4 which is then converted to T3 around 3 am in order to stimulate the adrenals in the early morning hours. It seems many patients on T4 only meds who start taking thyroid meds at bedtime feel better and report higher FTs and lower TSH, but I don't know if it's such a good idea to take T3 before going to bed?

I have also been diagnosed with adrenal fatigue and put on Medrol.

What do you suggest I do? Continue to take Erfa and wait for my body to adapt, they see if I can get my levels optimized on Erfa rather than Armour? Most seem to do great on Erfa, although I've read some posts by patients feeling worse on Erfa and switching to NP Thyroid (not an option in Europe, unfortunately). Also, the STTM mentions the possibility of Armour having been REreformulated, and some patients not doing as bad on it anymore, but there seems to be no confirmation of this so I guess it's still just a rumour? But if it's true, why hasn't Forest confirmed it? Also, it does not seem very logical to first reformulate a drug, lose most customers, and then reformulate it again a little more than a year later without telling anyone...!

If 5 grains of Armour leave me with a midrange FT3 24 hours after latest dose, as well as a midrange T4, what amount of Armour could then restore hormones to normal levels?!

Also, before I was put on NDT (after being on thyroxine for almost 10 years), my doctor ordered a 24 h urine test. According to doc, this test is more revealing and reliable as it shows how much is actually being used and execreted by the body. The results showed suboptimal levels of T4 and T3 on 200 mcg of thyroxine:

T4 1100 pmol/24h (550-3160 BUT should be AT LEAST 2500 for optimal thyroid function according to doc)
T3 824pmol/24 h (800-2500 BUT should be AT LEAST 2000 for optimal thyroid function according to doc)

I interpret these results to mean that I don't really have a conversion problem because, if I did, I'd have higher levels of T4 along with low levels of T3, right? So it seems to me that I was BOTH T4 and T3 deficient...at least there is no other way I can interpret these figures?

So I have been thinking lately, after seeing my relatively poor response to NDT: is it possible that I need as much as 300 mcg of T4 and 60-70 mcg of T3 from my thyroid meds, that is, close to 8 grains or even 9 in the case of Erfa? That is a huge dose, I know, but not unheard of; I have heard of patients on 11 grains of Erfa, and even Dr. Mercola writes in an article (written pre-reformulation) that some overweight women may require 6-8 grains of Armour daily.

Many patients on T3 only seem to require AT LEAST 75 mcg of T3 daily, often more, to feel optimal, but I don't know if that is equally true for patients on combination drugs who are also getting a lot of T4? I'd assume high amounts of T3 are needed to compensate for the inability to convert the T4 the patient is no longer taking, which I interpret to mean that patients on combination drugs do not need as much T3 as patients on T3 only drugs.

Or is it more reasonable to assume that adrenal fatigue is behind these results?

I'd appreciate any advice and help from you, as I have no idea where to begin. My doctor is very kind and supportive, not to mention open-minded, and that's all very good, but I don't feel that I get satisfactory answers to all my questions (maybe because doctor is as clueless as I am).

Thanks a lot in advance!


8 Responses
1756321 tn?1547098925
I read the same Dr Mercola article just the other day interestingly enough. Why are you not taking 300mg of Armour if that is when you felt your best? There is a saying - if it ain't broke, don't fix it. :)
Avatar universal
Thanks for your comments.

Because free Ts are still suboptimal, I cannot lose weight and my body temp is 97,5F in the morning (before rising) and 97.7-97.8 in the early afternoon, indicative of ongoing hypothyroidism. As far as I've understood it, body temp in the morning before rising should ideally be at least 97.8, but I don't reach that until I've been moving around all day.

Also, some say that NDT is ideally taken with food (not protein rich meals), but I have not seen any official recommendation to that effect. Even Mercola says that taking NDT with food can cause levels to fluctuate less, but it just feels so wrong to take it with food after all those years of having to take T4 meds on an empty stomach and wait at least half an hour before eating...!

I also don't think Medrol is helping, but my doctor said that overweight people with a tendency to retain fluid should not take hydrocortisone. So it seems I'm stuck with Medrol.
1756321 tn?1547098925
So you still had symptoms with the first labs then i take it. Okay so it was a bit broken lol. Do you have any symptoms of insulin resistance? I lost no weight after a two month moderate/severe bout of Hashitoxicosis!

My symptoms of insulin resistance include: unable to lose weight, high hip waist ratio, acanthosis nigricans, skin tags, increase in height (grown 3cm and i'm in my 30's!) and possibly the cause of my kidney damage. My insulin levels are normal (albeit high normal) but this condition can show up with normal labs. Who knew right? :)
798555 tn?1292791151
Lots of info, I'll comment on some of this.

Your pharmacy has Erfa in stock. So your not in the US, or your pharmacy is an online one?

Switching from one brand of dessicated to another can be like starting a new med for the body. It just is. Can take even a few months to feel good if you change a lot.

Taking dessicated sublingualy can result in higher T4 levels (a good thing since dessicated has less T4). T3 absorbs easily, food or no food, so sublingual should make little difference with T3. T4 is affected by food.

saliva adrenal test gives you 4 times a day to look at adrenal levels, about $150 US dollars.
Avatar universal
Yes, my doctor prescribed Metformin, 3x500 mg. But I was a bit afraid of the potential side effects, so I tried Berberine instead (3x500 mg). My fasting insulin levels have gone from 23 go 13, and my fasting blood glucose levels from 101 to 84 in just two months. Still not ideal, at least not the fasting insulin levels, but a huge improvement. I'm thinking about going low carb to see if that can improve things further. Some say that low carb diets should include fruit as well as vegetables, whereas others say that fruit contains too much fructose/glucose. I have bought Dr. Schwarzbein's book The Schwarzbein Principle, and she recommends 15 mg of carbs at each meal (non starchy vegetables excluded). That sounds reasonable and should do the trick. Anyway, I'm definitely on the right track, and I have proven to myself (and my doctor) that it's possible to lower BG and insulin levels without prescription drugs.

One thing I dislike about Metformin is that you are not supposed to have a single glass of wine while on it. While being by no means a heavy drinker, I want to have a social life, and not one requiring me to stick to mineral water while every one else is drinking wine...I understand that alcohol is what can cause the very rare but potentially fatal side effect called ketoacidosis.
Avatar universal
No, I'm in Belgium, the only country in Europe (as far as I know) where there are several doctors prescribing NDT and other natural hormones which can then be purchased at the pharmacy.
Avatar universal
I should add that my insulin and B G levels were also high normal, as the upper reference range for insulin is 24.9 and for blood glucose 105 (mine were 23 and 101 respectively).
1756321 tn?1547098925
My insulin resistance is improving with correcting magnesium deficiency and taking thyroxine.  I'm starting natural desiccated myself next week as i have so many hypothyroid symptoms it's not funny but i am improved somewhat so the thyroxine is working to some degree.

I didn't know about the T3 absorbing easily as LazyMoose mentioned. Interesting. I'd try sublingual to see if this helps. Certainly bypasses any gut issues affecting absorption.
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649848 tn?1534637300
Avatar universal
1756321 tn?1547098925
Queensland, Australia
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