The European Thyroid Association supports the use of combination therapy, but only under very specific guidelines, and they actually do *not* recommend the use of Armour or other desiccated products:
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http://www.karger.com/Article/FullText/339444
The ETA recommends T4-only therapy for at least six months and then ruling out any other conditions that could be causing the symptoms, as well as ensuring that the patient is compliant with dosing guidelines (taking meds consistently on an empty stomach, avoiding soy/calcium/iron within 4 hours, etc.). If the patient is still experiencing symptoms after that time, they recommend a short trial of synthetic T3, with a follow up evaluation to determine if symptoms have improved.
The FDA representative that spoke at the presentation I heard this spring said there was a definite need for slow-release T3 products. I think the concern is making sure that these products are fully studied first to make sure they are *both* safe and effective.
The following article came out recently, and I believe is one reason that many doctors are wary of recommending compounding pharmacies. In this case, a compounding pharmacy sent a teenager to the ER with a heart attack (and he has suffered ongoing problems in the last year) after accidentally giving him 1,000 times too much T3. And what’s really concerning is that this complaint never came to light until that same pharmacy was implicated in a meningitis outbreak.
http://www.bostonglobe.com/metro/2013/07/08/massachusetts-regulators-backed-off-shutting-down-pharmacy-blamed-for-boy-heart-attack-records-show/ExRZUsgJsyL2vvM4VKiT1M/story.html
I do know patients who use compounding pharmacies and are pleased with the service, but this is certainly not a decision not to be taken lightly – and you want to make sure you are doing business with a reputable company.
