[WWWI2]

#1060092

During our first meeting, I asked my newest endo (# 3) her perspective on Armour. She’s respected and works in tandem with a major hospital and has been in practice 15 years. Her response was as follows:

Armour is pig thyroid. It is good for pigs but since we are not swine, it is not appropriate for us.

Has anyone else received that kind of response? She’s also not a big proponent of T3. I really want to trust this doctor since she’s the third endo I’ve had in a years time, but that doesn’t seem to be a valid argument.

Anyone?

[ChristinaDe]

#1180260

Kind of had to laugh at that response. Docs can be so funny sometimes…or not. I asked mine about it a few weeks ago. She’s my 2nd endo & I really like her, has a good rep, etc. Her response was also negative, but a bit different. She doesn’t like Armour for the same reason she doesn’t like generic versions of Synthroid. She feels the dose can vary from batch to batch & make things hard to manage (and as we all know, swinging levels are a nightmare!).

However, she does believe in T3 replacement in patients who are in the “normal” range on T4, but with low T3 levels. She also believes in it for patients who are “normal” on all labs but still report feeling hypo – since feeling well can be subjective. She told me that the president of one of the professional associations that she belongs to (can’t recall which one – maybe Kimberly knows about it) recently sent a message to all members saying that although the studies aren’t really conclusive yet, antidotally there are some patients who just don’t feel well even when they’re within normal ranges & for some of them adding T3 helps. He also said that it’s time that all the endos get on the same page on this issue…and this is the page he recommends. Wish I could remember who she said it was.

[Raspberry]

#1180261

Actually Armour is strictly regulated by the FDA – it’s not supposed to be variable and random how much hormone is in each pill. Here’s the full prescribing information for Armour from their webiste

editing to remove ranting!

[ChristinaDe]

#1180262

It would certainly be nice if all these physicians would get on the same page with each other…and even nicer if it was an evidence-based page!

[WWWI2]

#1180263

Thanks for responding and for the link. Just to elaborate, I was put on block and replace (Meth, T4 and T3) by my previous endo. That has been stopped by this endo and I think it was reasonable. However, until the T3 was added late in the game, I felt pretty miserable on just Meth and T4 and I responded well to the addition of T3. This could be that something was off with the block and replace dosages, but in my mind this suggests that perhaps I’m one of those who don’t convert T4 to T3 well.

My new endo took me off all drugs to get a new baseline a few weeks ago since she didn’t agree with endo #2 protocol. We are also attempting to see if I’m in remission since I’ve been on Meth for 11 months.

My fear is that ultimately I will required either RAI or TT and since she doesn’t believe in T3’s benefit or need, I will either have to agree to her protocol or find yet another endo.

I’m with you all on all endos being on the same page….

[snelsen]

#1180264

Hi WWW12, and all others who are on this thread.
I’m another Grave’s patient, weighing with some thoughts, plus my experience.

I don’t think doctors are on the same page about much of anything, except some very basic stuff. They train different places, their own personal beliefs enter in their treatment regimens. Some docs do not take the time to “keep up” with the current evidenced based literature, some do. Some are conscientious practitioners, some are not (scarce, I hope.) Some care, some don’t. If they care, and regard a patient as a person, the doc is likely to spend more time thinking, consulting, and trying very hard to help the patient.
And, sometimes, the current thinking and standards of care are simply wrong and dangerous. sometimes it is known, and other times, it takes years and years to find out, by looking at poor outcomes and retrospective studies.

AND. There is rarely one answer to most things,and I’d hazard to say Graves’ is certainly on that list. That is why we have 2nd and third opinions.

AND. Because of the reasons I listed in my first paragraph, plus that we are all different, I think the health of ALL of us would greatly suffer, if we received “cookbook” medicine. Which is what would happen if docs were all on the same page. There is always the human element involved, other variables of our bodies, perhaps other conditions that contradict the same treatment that is usually prescribed.

I don’t recall, WWW12, are you in a country other than US? This is a good example of contradictory thinking. Doing block and replace is much more common in Europe and other countries than it is int he US.
You new endo sounds like a good one, to get a baseline. I am hoping you are very careful to report how you are feeling during this time of no drugs, so you don’t slip in to hyPER territory, which requires your reporting and labs. Presume this is the case.

I’d like to add that I imagine that there might be some of us, very few, who might profit from T3. I think that T3 is more frequently suggested by patients, and occasionally thought of by endos. So for @@@12 But there are distinct disadvantages of it.

If you get to that point, and have exhausted all other options to get to feeling better,I suggest you say something to this new endo like, “I know how you feel about T3, but Please, I’d like to try it anyway.” She might say yes.

My experience with T3 follows.
That is what I did, some years ago. ***My endo said his main concern was that almost all the time it did not seem to help, although he said that, as usual, there were instance when someone believes it helped, it could be the drug or the belief.
AND T3 has a main disadvantage, which is its’ short half life, IF TAKEN ONCE A DAY, (this is not as relevant if there is a divided dose, which neither docs or patients want to do, of either two or three times a day,) which is a significant one, and it did not take me long to experience it, it is not dispersed gradually in the body over a period of time. It tends to “dump” pretty much all at the same time, and you feel GREAT, AND ENERGETIC, until it is gone, then there is a “crash” where energy is gone,and you feel sluggish. That was my experience.

Here’s a brief and interesting reference summarizing what I am referring to about half life of T3 and divided doses. I learned when I was working, that patient compliance of divided doses is pretty bad, and there are good studies to document that. It is recent, from a respected journal.
Notice the last sentence, but read all if it.

Int J Pharm Compd. 2012 Sep-Oct;16(5):376-80.
Bioidentical thyroid replacement therapy in practice: Delivering a physiologic T4:T3 ratio for improved patient outcomes with the Listecki-Snyder protocol.
Snyder S, Listecki RE.
Source
Midwestern University, Chicago College of Pharmacy, Downers Grove, Illinois, USA.
Abstract
Effective thyroid replacement therapy may be elusive to some patients, and compounding pharmacists have an opportunity to deliver more effective therapy. Goodman & Gilman’s The Pharmacological Basis of Therapeutics 12th edition states that the body usually secretes T4:T3 in an 11:1 ratio but cautions against pursuing combined thyroid replacement due to the short halflife of T3 that necessitates multiple daily dosing; no commercial availability and lack of benefit were shown in trials. Commercial combinations of T4/T3 such as Armour Thyroid and Nature-Throid have a 4.22:1 T4:T3 ratio. Applying the same concept as bioidentical hormone replacement therapy, compounding pharmacists can deliver an 11:1 ratio using a commercial T4 product and taking into account oral bioavailability of each entity. The short half-life of T3 can be remedied by taking the patient’s daily T3 dose and dividing it into two slow-release capsules to be dosed every 12 hours.

Shirley

[Gabe]

#1180265

Hi all, I asked my endo about Armour at my first post TT appt with him. He’s not a believer and actually used the word ‘quackery”. However admitted he will prescribe for ‘subjective symptoms’ once the patients labs are within normal ranges yet still not feeling well. I asked a biologist friend of mine her thoughts on this and her opinion is that she would never take anything derived from an animal because you never know what other things you are inheriting from that animal….interesting thought. She believes any kind of hormone based replacement should always be synthetic and well regulated. My opinion is that I will consider Armour IF I find that I’m still not feeling right once levels are ‘normal’. Good discussion.

[Stymie]

#1180266

Great discussion!

I was just reading an article on how armour and its ndt counterparts were the only hormone replacement used for 100 years and is strictly regulated by the FDA. This article actually said it had significantly fewer recalls on their med than said generic T4s.

That said I find it funny that drs are calling this med quackery since for many years that is all that was available to us was this quackery.

There are many people out there that feel their best on armour or some sort of T3 added to their T4. It may be the way I go eventually if I don’t get to the point where I feel mostly myself again.

Diane

[Kimberly]

#1180267

Hi all – Just a few comments…

1. I heard a representative from the FDA speak at a meeting this spring, and she stated that manufacturers of products like Armour, Nature-Throid, etc. “think they are grandfathered drugs, but they are not”, because they were in use as early as the 1800s, long before the FDA was formed. In 1997, the FDA required that all T4 products (Synthroid, Unithroid, etc.) go through the rigorous New Drug Approval process to ensure that potency and stability are consistent. However, products like Armour have not gone through this process. I suspect that this is part of the reason some doctors are reluctant to prescribe Armour.

2. We’ve heard mixed reviews from patients who have tried Armour. Some felt that it literally gave them their lives back…but others felt that it brought on a return of their hypER symptoms.

3. There have been a couple of recent studies indicating that some patients do have a preference for products like Armour. But as one presenter that I heard this spring said, “Most of us feel better in the morning after a cup of coffee. But does that mean we are *deficient* in caffeine – or *responsive* to caffeine?” Clearly, this is an area that needs further research.

[Stymie]

#1180268

Hi Kimberley!

You’re saying armour never went through the new drug approval process, or they are not FDA approved? Just a little confused…

Thanks!

Diane

[snelsen]

#1180269

Stymie, what do you mean by armpit and net? I have no idea.
And, what reference were you reading? The net is full of unreliable stuff, you really have to look for the reliable.

Please send it or mention it, or if it is something that should not be on the forum, send in a PM. I’m interested in reliable studies if they exist.
Most of what I know is anecdotal about it, and my own experience, which described in my long post today. I felt better, then I crashed, felt better, then crashed, hyper/feel good, sluggish/feel crappy.
Shirley

[Stymie]

#1180270

Hi Shirley

Sorry I edited my post. It should have said armour and it’s natural dedicated counterparts. (Ndt).

I belong to a Facebook group called thyroid sexy. I believe the article came from there. I will have to look though. If I find it again I will send it to you.

I try to read as much as I can about this disease but I don’t have alot of spare time. It’s hard to find truly reliable sources.

Diane

[snelsen]

#1180271

Hi Diane! THAT is pretty funny!!! Armour, armpit! Ha.
Ok, will check.
Thank you very much
Shirley

[Kimberly]

#1180272

Stymie wrote:

You’re saying armour never went through the new drug approval process, or they are not FDA approved? Just a little confused…
Diane

My takeaway from the presentation I attended was that the FDA does *not* consider Armour as “FDA Approved”.

In terms of resources, there are certainly plenty of patients out there who have some knowledge of thyroid issues. However, the GDATF recommends relying *only* on reliable, established sources (American Thyroid Association, American Association of Clinical Endocrinologists, peer-reviewed journals, etc.) in terms of getting medical information. If you read something on a patient site, it’s a good idea to dig a little deeper and determine exactly where the information is coming from and if the source is credible.

[WWWI2]

#1180273

What I’m not clear on is why the European Journal of Endocrinology ( http://www.eje-online.org/content/161/6/955.full )appears open to investigating T3 in tandem with T4 as a protocol for a small percentage of patient who do not do well on T4 alone, but both the American Journal Endocrinology and the AEA fundamentally dismiss it.

I am aware of the short half life of synthetic T3 and while on block and replace took it in split doses. There is a form of T3 that is sustained release but requires compounding by a compounding pharmacy. It is my understanding however that this is at risk because of proposed legislation http://www.pharmacist.com/senate-considers-drug-compounding-bill

It has been surmised that one reason that sustained release T3 is not in favor by these organizations is that this formulation is not patentable which in my mind suggests reasons outside of my “best interest” that T3 is not being pursued.

WWWI

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