- Clinton’s Hypothyroid Medication Draws Interest
- Thyroid Conversion Guide: WP Thyroid and Nature-Throid
- What is Hypothyroidism and How is It Treated?
- Why Did Doctors Switch from Armour Thyroid to Synthroid?
- Evidence For The Use of Synthroid Over Armour Thyroid?
- Do Some People Feel Better on Armour Thyroid?
- Is Armour Thyroid Better Because it Contains T3?
- Is Armour Thyroid Better Because It’s Natural?
- Armour Thyroid vs. Synthroid for Weight Loss
- Side Effects of Armour Thyroid vs. Synthroid
- The Cost of Armour Thyroid vs. Synthroid
- Armour Thyroid vs. Synthroid: How to Choose Which is Best for You
- High Blood Pressure and Underactive Thyroid Gland (Hypothyroidism)
- Drugs that interact with thyroid medications
- Armour Thyroid
Clinton’s Hypothyroid Medication Draws Interest
When MedPage Today wrote that Democratic presidential candidate Hillary Clinton’s physician, Lisa Bardack, MD, had released additional health information about Clinton, one item received several comments: Bardack’s use of the porcine product Armour Thyroid rather than levothyroxine (Synthroid) to treat Clinton’s hypothyroidism.
“Armour Thyroid. One would think we could do better for our former First Lady,” wrote one commenter.
“I am glad to hear she is taking Armour Thyroid rather than synthetic substitutes which contain only T4 and not T3. I always prescribed Armour for my patients because it is more natural, safer and more effective,” wrote another.
Armour Thyroid is a thyroid tablet derived from the thyroid glands of pigs and “has a strong, characteristic odor,” according to the drug’s prescribing information. The tablets “provide 38 mcg levothyroxine (T4) and 9 mcg liothyronine (T3) per grain of thyroid.”
Although thyroid hormone extracts have been used for centuries, the first reports of use in the English-speaking medical literature were in England in 1891, explained James Hennessey, MD, an endocrinologist at Beth Israel Deaconness Medical Center in Boston and associate professor of medicine at Harvard Medical School. Initially the extract was derived from sheep and given in the form of an injection.
However, “it turned out it was difficult to make these preparations and keep them pure,” so the injections were turned into tablets “and for probably the next 50-60 years, from the turn of the century to 1970, the standard hormone replacement therapy was thyroid hormone extract,” made from either beef or pork thyroid, said Hennessey, who authored a 2015 review on the use of thyroid replacement hormone.
Humans vs Animals
At that point, the pharmaceutical industry began noticing the difference in the hormonal makeup of humans and animals — specifically the ratio between T4 and T3. In humans, that ratio is 14 to 1, compared with 4 to 1 in pigs and cows, he explained. So combinations of T4 and T3 hormones were brought on board in the early 1970s to try to better mimic what normally happened in humans.
But then researchers determined that people who were given thyroxine alone could convert it to T3, and when circulating levels of thyroid hormone were analyzed, “researchers were able to demonstrate that serum levels of thyroid hormone were very abnormal if patients were swallowing T3; they were also kind of abnormal if people were swallowing thyroid hormone extract — T4 levels on the low side and T3 on the high side,” said Hennessey.
“But when they were swallowing thyroxine alone, it looked like over the course of a day, thyroid hormone levels were in the expected range and indistinguishable for most part from those of us that don’t have thyroid disease.” So physicians began switching their patients away from thyroid extract and combination regimens to thyroxine alone.
There was some renewed interest in the late 1990s and early 2000s in adding T3 back, but the studies really didn’t seem to support the idea that doing so had superior results. And in 2012, the American Thyroid Association and the American Association of Clinical Endocrinologists issued a guideline recommending levothyroxine as the treatment of choice, Hennessey explained.
Opinions on the use of Armour Thyroid differ among physicians. “Armour Thyroid is an antiquated product and has not been the standard of care for some time, as it is difficult to know the exact dose of thyroid hormone that the patient is taking,” Danielle Weiler, MD, a family physician in Brea, Calif., wrote in an email. “It is generally not recommended by endocrinologists.”
“It has fallen out of favor and has been taken off of many drug formularies for this reason. There are better options available for treatment of hypothyroidism.”
Ronald Koenig, MD, PhD, of the University of Michigan in Ann Arbor, was more measured. “Endocrinologists prefer levothyroxine over Armour Thyroid because levothyroxine results in steadier levels of T3 in the blood, more closely mimics normal thyroid function, and makes it easier to interpret the results of thyroid blood tests,” he wrote in an email.
“However, a very small fraction of patients seem to feel better when taking Armour Thyroid. The explanation for this is not known, but this is the main reason some patients take Armour Thyroid. In general, when used in appropriate doses, either levothyroxine or Armour Thyroid should result in a good health outcome.”
“Some physicians use it in most patients, others in patients who do not do well, and others, like me, very rarely consider using Armour Thyroid,” Bryan Haugen, MD, of the University of Colorado Denver, wrote in an email. “The people who use and support it claim that some patients feel better on thyroid extracts like Armour than levothyroxine therapy alone, and there is some weak short-term evidence to support that.”
“My feeling is that is a physician is prescribing Armour Thyroid, it should be given twice daily instead of once daily like we do with levothyroxine,” he continued. “This is because of the shorter half-life of T3 and what we know from studies with oral T3 (Cytomel) therapy. We need to make sure the serum is kept in the reference range as we do for any patient with hypothyroidism on any thyroid hormone therapy. I would also be a bit worried about Mrs. Clinton being on Armour thyroid, since older patients are at increased risk for heart rhythm problems if too much thyroid hormone is given.”
Some More Favorable
Bonnie Camo, MD, a retired family physician who specialized in treating mental illness through nutrition and who practiced in Kendall Park, N.J., has a more favorable opinion of Armour Thyroid. “I prescribed Armour Thyroid because it is a more natural and complete substance, containing both T4 and T3, as well as the little known mono and di-iodothyronine, the entire range of thyroid hormones,” she wrote in an email. “The conventional approach is to use levothyroxine, which is only T4, because doctors are taught in medical school that desiccated thyroid is unstable and unreliable in terms of dosage and that synthetic is better.”
However, she said, “I saw … patients who were on Synthroid and not feeling any better, who improved when switched to Armour. I usually ordered Free T4, Free T3, TSH, and anti-thyroid antibodies to check for Hashimoto’s thyroiditis. If the Free T3 level is lower than the Free T4 level, it is useless to treat with Synthroid because the patient is unable to convert enough T4 into T3, perhaps because of a deficiency of selenium, omega-3 fatty acids or zinc.”
Hennessey noted that the big concern with Armour Thyroid is that the patient might get too much T3, and added that Clinton may have been started on thyroid replacement therapy in the 60s or early 70s, when Armour Thyroid was still the treatment of choice. If it works well for her — if she’s feeling well, and her tests show that her T3 levels aren’t too high, “then if that’s what floats her boat, leave it alone.”
Last Updated September 26, 2016 Comment
I also recommend that you look at other thyroid lab tests, but these should be what you get at a minimum.
You should also be aware how Armour thyroid changes your thyroid lab tests.
When you take T4 only medications (such as levothyroxine or Synthroid), your TSH should drop and your free T4 should increase (free T3 doesn’t always increase when taking T4 only medications).
When you take Armour thyroid (or other brands of NDT), you should see your TSH drop, your free T4 increase and your Free T3 increase as well.
This pattern doesn’t always hold true, however.
Some individuals will find that their TSH will drop, their T4 will drop and their free T3 will increase.
This pattern is not always bad, but it does typically indicate that you are someone who is sensitive to the T3 found within the medication.
But, unless you check all these lab tests you won’t have any idea how you are reacting to the medication.
When taking Armour thyroid you should try to find a dose (typically between 1 and 2 grains per day) which keeps your TSH in the low/healthy range, your free T4 in the middle range, and your free T3 in the higher end of the reference range.
You can find more information about these ranges in this post.
If you are taking Armour thyroid and you find that your TSH is NOT decreasing then that is an indication that your dose is insufficient.
This typically occurs when your doctor attempts to transition you from a thyroid medication such as levothyroxine to Armour.
The average dose of 1-2 grains per day is simply an average.
You could easily be on the high side or the low side of that average.
Some people may need doses as high as 4 grains per day while some people may need doses as low as 1/4 grain per day.
You can use your lab tests to help you figure out where you fit on this spectrum.
How to Tell if your Dose is Too High
Another issue to watch out for is accidental overdosing of your medication.
Believe it or not, this can happen either accidentally or intentionally and is probably more common than people realize.
But it is something that you want to avoid because overdosing on your thyroid medication can lead to long-term consequences if you aren’t careful.
Some patients have been chronically underdosed with standard T4 medications for many years and, when they finally feel better on Armour thyroid, may think that they need more medication than they really do.
Persistent hypothyroidism can cause a range of issues including hormone imbalances that may not be corrected even when taking the appropriate dose of medication.
This can lead patients to take ever-increasing amounts of Armour thyroid in hopes of fixing these problems.
But the reality is that taking these high doses is not helpful and may be harmful.
You can read more about the dangers of taking too much medication in this post here.
So, how do you tell if your dose is too high?
You can use the combination of your lab tests and your symptoms.
If your dose is too high you will experience symptoms which include heart palpitations which do not decrease over time, flushing, headaches, sweating, weight loss, fatigue, and hair loss.
In addition, you will most likely find that your TSH is suppressed (or very low) and your free T3 is high (flagged as elevated and outside of the reference range).
The combinations of these two things are an indication that you are taking too much thyroid medication and that you should reduce your dose.
Experiencing a high dose for a few days to weeks is probably not a huge deal to your body, but you should not continue to take medication causing these symptoms for longer than necessary.
Typically, reducing your dose will be enough to reduce these symptoms and bring your thyroid back to an acceptable level.
When & How to Take Your Medicine
For best results, you will want to make sure that you are taking your medication correctly.
Failing to take your medication correctly can cause all sorts of issues and may reduce the total effectiveness of your dose of medication and, in some cases, can render it completely ineffective.
When you go pick up your medication you are usually given instructions by the pharmacist to ‘take your medication on an empty stomach first thing in the morning’.
This holds true for ALL thyroid medications including Armour thyroid.
And the reason is simple:
Taking your thyroid medication with food has been shown in studies to reduce its absorption (4).
This means that instead of entering into your blood it is exiting your body in your stool!
In addition, you also want to avoid taking your medication with coffee which can also reduce its absorption.
Other items that interfere with thyroid medication include all supplements but especially supplements which contain calcium and/or iron (5).
These two are notorious for binding to and inactivating thyroid hormone before it enters into your body.
I typically recommend that you wait at least 30 to 60 minutes after taking your thyroid medication before you use thyroid supplements, but you’ll want to extend that out to 3-4 hours if you are taking iron or calcium.
You don’t always have to take your medication first thing in the morning as studies have shown that even taking your medication at night is effective (6).
That advice is typically given because it’s easiest to take your medication on an empty stomach first thing in the morning, but you can take it at any point in the day so long as you don’t take it with food/coffee/supplements (7).
Converting from T4 Medications to Armour Thyroid
Another important topic to cover as it relates to your dose is converting from other forms of thyroid medications to Armour thyroid.
This is an important point because typically this is done incorrectly.
The standard advice when transitioning from levothyroxine/Synthroid to Armour thyroid is to replace every 100mcg of Synthroid with 60mg of Armour thyroid.
The problem with this advice is that it typically results in underdosing of Armour thyroid.
Because each grain of Armour (which is 60mg) contains only 38 mcg of T4 and 9 mcg of T3.
When you transition from 100mcg of T4 down to 38 mcg of T4 + 9 mcg of T3, the patient typically feels worse because they are taking a smaller dose of thyroid hormone than they were previously.
So, instead of following this standard advice, just be sure that you are aware that the conversion isn’t perfect and it may require a higher dose than you or your doctor anticipate.
As long as you are aware of this, you shouldn’t be surprised if your labs look ‘worse’ upon your transition.
They will improve with time and as you adjust your dose appropriately.
In my experience, 100mcg of T4 is probably closer to 1.5 grains (or 90mg) or Armour thyroid than the 60mg that most places recommend.
Armour Thyroid vs Other Brands of NDT
Armour thyroid falls into a class of drugs known as NDT.
NDT stands for natural desiccated thyroid and drugs in this class are all similar but differ in their inactive ingredients.
Armour thyroid is the original formulation of NDT but there are many other medications including WP thyroid, Nature-throid, NP thyroid, and more.
Each comes with its own advantages and disadvantages.
Because of this, it’s important that you are at least aware of these other brands of medications.
Because it’s possible that while you may not necessarily tolerate one formulation of NDT it doesn’t mean you won’t tolerate them all.
I’ve seen many patients who don’t tolerate Armour thyroid but do tolerate Nature-throid and vice versa.
Don’t give up on NDT medications if you experience a small reaction during your transition to Armour or when you first start it.
Instead, take note of your symptoms, try to determine what is causing them, and make changes as appropriate.
You may find that your problems are dose-related, medication-specific, or related to your sensitivities.
All of these issues can be overcome with careful consideration.
Armour thyroid is a great medication and one that can potentially help a great many people.
The key to using it correctly is to get your dose right!
This includes adjusting your dose based off of your laboratory tests and based off of your clinical symptoms.
Don’t be afraid to adjust your dose, take your dose at multiple times during the day, or potentially switch to another brand of NDT if you are having trouble.
As you make these changes you will find that your symptoms improve and you should finally start to feel better.
Now I want to hear from you:
Are you currently taking Armour thyroid?
Do you feel that your dose is optimal?
Are you experiencing any side effects?
Are you sensitive to T3?
Leave your questions or comments below!
Thyroid Conversion Guide: WP Thyroid and Nature-Throid
As with any prescription medication, talk to your doctor about any existing medical conditions, and let your doctor know immediately if you experience any side effects.
Tell your doctor if:
- You have any food or medicine allergies.
- You’re pregnant, trying to conceive, or breastfeeding.
- You are taking any other prescription or over-the-counter medications, or if you start or stop any medications while on WP Thyroid® and Nature-Throid®.
- You suffer from any medical conditions other than hypothyroidism, particularly heart disease, clotting disorders, or adrenal or pituitary gland problems.
- You have diabetes. Monitor your blood and/or urinary glucose levels as directed by your doctor and immediately report any changes.
- You’re taking anticoagulants (blood thinners).
- Let your dentist know you are taking WP Thyroid® and Nature-Throid® before any surgery.
- You experience any of the following symptoms: rapid or irregular heartbeat, chest pain, shortness of breath, leg cramps, headache, nervousness, irritability, sleeplessness, tremors, change in appetite, weight gain or loss, vomiting, diarrhea, excessive sweating, heat intolerance, fever, changes in menstrual periods, hives, skin rash or any other unusual medical event.
Warnings: Don’t Take For
- Do not take WP Thyroid® and Nature-Throid® either alone or in combination with other medicines, for the treatment of obesity or weight loss. In patients with normal thyroid levels, doses of WP Thyroid® and Nature-Throid® within the typical range used for hormone replacement are not effective for weight loss. Larger doses may result in serious or even life-threatening effects, especially when used in combination with certain other drugs used to reduce appetite.
- Do not take WP Thyroid® and Nature-Throid® for male or female infertility unless it is associated with hypothyroidism.
- Do not take WP Thyroid® and Nature-Throid® if you have hyperthyroidism or are allergic to any of its ingredients.
Use WP Thyroid® and Nature-Throid® exactly as prescribed. Unless otherwise directed by your doctor, do not stop taking either medication or alter how often it’s taken. Many factors can contribute to the length of time symptoms are alleviated, though generally people feel an improvement within a few weeks. For some, though, improvement in symptoms may take up to three months. Your doctor will determine which dose is right for you. If any life changes or new symptoms occur, consult your doctor to adjust your dose. Continue to see your doctor until your dosage levels prove stable based on your lab work, then continue to see your doctor at their request. Thyroid replacement therapy is usually taken for life.
Here’s the thing, I have patients that come in so frazzled about taking their thyroid medication in the proper way and at the proper time. I’ve heard some insane expectations around doing this. Surely, these imperious rules are being implemented by someone who has never actually had to take thyroid medicine. I’ve heard to take it FOUR HOURS BEFORE OR AFTER FOOD OR SUPPLEMENTS. Are we serious, people? If we are condemned for a twice daily dose of medication, what then? I guess we must resist the temptation to eat at all! Let me preface this post with, I am all about realistic expectations. What good do dogmatic rules do us if they are so rigid it’s impossible to abide? I don’t live in a vacuum, I have children, run a business, have laundry and crazy hair. I don’t have the time or capacity for dogmatism. I’m just assuming you don’t either. If not, check out my non-vacuum-living-advice below.
1. The food debate:
NO: you do not need to wait four hours before or after eating. Who really can do this? If that’s you, I bow down to your willpower.
YES: take it on an empty stomach. Wait 30-45 minutes (ideally an hour but who’s counting the minutes) before eating and wait an hour after eating before taking it.
2. The supplement debate;
NO: Again with the four hours… Really?
YES: Wait a full hour after taking your medication for all supplements and wait a full hour after taking your supplements to take your medication.
Disclaimer: certain supplements must be taken hours away from your thyroid medication. This varies depending on what medication you take. I will save this for a blog in the near future.
3. What are the best times to take my thyroid medication?
Levothyroxine (Synthroid, Tirosent, Unithroid, etc): This is usually taken in the morning. It’s a long (and slow) acting medication so timing is less important here. Some people do say they feel best when they take it at night. Perhaps they are slow metabolizers.
Dessicated thyroid (Armour, Nature-throid, WP-thyroid, Westhroid, NP thyroid): These medications are short acting (think 6-8 hours) so they are best taken in the during the waking hours. One thing that makes my thyroid approach unique is that I believe most people actually need these medications dosed twice a day: in the morning and around 2-3pm.
Liothyronine (Cytomel): These medications is ultra-short acting. They are metabolized for most people in 3-5 hours meaning they too must be dosed multiple times during the day. I prefer to compound them to a sustained release form and still dose twice a day, similar to that of dessicated thyroid.
4. What happens if I miss a dose? What should I do?
Levothyroxine based medications: You can take this later the same day when you realize that you have forgotten it. You can resume as normal the next day.
Dessicated thyroid medications: If it’s after 4:30pm, I would skip it altogether as if you take it too late, it will keep you awake at night. Do not double up on dosage the next day.
Liothyronine: A similar concept applies to this as dessicated thyroid, skip it if it gets too late and resume as normal the following day.
I hope I’ve offered some insight into the details of taking your thyroid medication. Check out my Facebook page and post other questions about taking your thyroid medications there!
Armour Thyroid and Synthroid are medications used to treat hypothyroidism (an underactive thyroid).
Synthroid is the most commonly prescribed, however some claim Armour Thyroid produces better results.
So, which is the best treatment for you?
This article looks at the evidence for both to help you decide.
What is Hypothyroidism and How is It Treated?
Armour Thyroid and Synthroid are medications used to treat hypothyroidism.
In this condition, the thyroid gland is underactive, meaning insufficient amounts of thyroid hormones are produced.
Three main hormones are measured to determine if the thyroid is functioning properly: thyroid stimulating hormone (TSH), Thyroxine (T4) and, in certain circumstances, triiodothyronine (T3).
You can read more about these hormones in these guides to interpreting TSH levels and T4 and T3 levels.
It’s important to remember that the thyroid gland produces mainly T4, even though the active hormone is T3. An enzyme in the body converts T4 into T3 when needed.
Currently, there is no cure for hypothyroidism and, in most cases, medication will need to be taken for life.
Armour Thyroid is the brand name for desiccated thyroid extract, made of dried and powdered thyroid glands, usually from pigs.
It contains a mix of both T4 (around 80%) and T3 (around 20%).
Desiccated thyroid extract is measured in grains.
One grain contains around 38 micrograms of T4 and 9 micrograms of T3. Grains can be taken in multiples or fractions (e.g. half a grain or two grains) to achieve the correct dosage.
Desiccated thyroid extract also contains unmeasured amounts of calcitonin, diiodothyronine (T2) and monoiodothyronine (T1). However, these components are not thought to have any significant effects in the body.
Other brand names include:
- WP Thyroid (previously known as Westhroid-P)
- NP Thyroid
Synthroid is the brand name for a synthetic thyroid medication also known as levothyroxine sodium.
It contains only synthetic T4, which is biologically identical to the T4 produced by the body. Once ingested Synthroid is converted by the body into T3, the active thyroid hormone.
It’s taken in pill form and comes in a range of doses.
Synthroid is one of the most popular, but other brand names include:
There is an additional thyroid medication called liothyronine.
This is a synthetic version of triiodothyronine or T3. Brand names are Cytomel or Tertroxin.
Summary: Thyroid stimulating hormone (TSH), Thyroxine (T4) and triiodothyronine (T3) are measured to test thyroid function. Armour Thyroid and Synthroidare the two main medications used to treat hypothyroidism. There is also a third type of medication made of synthetic T3.
Why Did Doctors Switch from Armour Thyroid to Synthroid?
Desiccated thyroid extract was the original medication used to treat hypothyroidism.
During this time, thyroid hormones were not completely understood and there was a lack of reliable diagnostic tools (blood tests) to measure circulating levels in the blood.
This lead to the following problems:
- Difficulties determining the correct dose for the individual.
- Difficulties measuring the exact amount of T4 and T3 present in desiccated thyroid extract.
As a result, the dosage was often too high and serious side effects were often reported. Also, due to inconsistencies in the strength of medication, some people were not seeing any improvements.
Conversely, Synthroid (levothyroxine) was thought to offer a safe and consistent dosage. Two things lead to this switch:
- The discovery that most T3 was converted from T4 via an enzyme in the body. This meant medication need only contain T4 to be effective.
- The diagnostic tools for measuring blood levels of thyroid hormones advanced. Scientists were able to see that Synthroid was effective at normalising blood levels of thyroid hormones (1).
Summary: Desiccated thyroid extract was the first type of medication used to treat hypothyroidism. Eventually, a synthetic T4 medication was created and found to be a safer and more effective option.
Evidence For The Use of Synthroid Over Armour Thyroid?
Synthroid (levothyroxine) is the recommended treatment for hypothyroidism and prescribed by most doctors.
The American Thyroid Association along with other international thyroid organizations agree that Synthroid is the most effective treatment option.
There is no strong evidence to suggest Armour Thyroid or a combination therapy of synthetic T4 and T3 produce better results than Synthroid in most people (1).
More specifically, Synthroid is recommended over Armour Thyroid because it:
- Efficiently reduces symptoms of hypothyroidism
- Has minimal side effects
- Is well-absorbed by the intestine (around 70-80%)
- Provides consistent blood levels of thyroid hormones with minimal spikes of T3 or T4
- Is low in cost (2).
The European and American guidelines also acknowledge that experimental use of synthetic T3 may benefit some people. This will be discussed in more detail below.
Summary: Current thyroid association guidelines recommend Synthroid as the first treatment option. There is little evidence to support the use of Armour Thyroid over Synthroid.
Do Some People Feel Better on Armour Thyroid?
Anecdotal (personal) reports claim Armour Thyroid leads to increased feelings of wellness and reduced symptoms as compared to Synthroid.
Studies suggest up to 15% of people with hypothyroidism don’t see complete improvement on Synthroid (2, 3).
In a double-blinded study of 70 participants, those taking Armour Thyroid lost nearly three pounds more than those taking Synthroid. Also, 49% of participants said they preferred Armour Thyroid based on improvements in symptoms and mental wellbeing (4).
However, this is only one study of many.
It’s possible a small percentage of people feel better with Armour Thyroid because of the T3 component. This may have to do with genetics.
Some people with specific genetic mutations may not be able to either convert T4 into T3 or transport T3 in and out of cells from the blood. Blood tests do not always accurately reflect the levels of T3 inside tissues such as the brain and liver (5).
This means people may still experience the side effects of hypothyroidism, yet appear to have blood levels of T3, T4 and TSH within the normal ranges.
Summary: Some people claim to feel better when using Armour Thyroid, but there is limited evidence supporting this opinion. It’s possible increased feelings of wellbeing could be attributed to low T3 levels.
Is Armour Thyroid Better Because it Contains T3?
One of the main arguments for the use of Armour Thyroid is that it contains T3 as well as T4.
It’s possible that a minority of people will do better on a combination of T3 and T4 replacement therapy. However, there is only a small amount of evidence available to support this theory (5).
A trial of combination T4 and T3 therapy is recommended for patients who do not experience symptom relief on Synthroid. This is experimental and should be stopped if no positive results are seen after three months (3).
While it may be beneficial, there are some issues associated with using Armour Thyroid to replace T3, including:
- Inconsistent dosage in Armour Thyroid: There may still be inconsistencies and stability problems in the preparation of Armour Thyroid. This can result in fluctuating blood levels of thyroid hormones.
- Difficulties maintaining T3 levels: The ratio of T4 to T3 in Armour Thyroid is much higher than that typically excreted from a healthy human thyroid. Additionally, T3 does not last as long in the body and is much more difficult to maintain a consistent level.
T3 levels may spike or become elevated and symptoms such as heart palpitations and others seen in hyperthyroidism can occur. Slow release or multiple daily doses of synthetic T3 are likely to produce much more consistent blood levels and less side effects (2, 5).
Summary: A certain subpopulation of hypothyroid patients may do better on a combination of T4 and T3. However, the best results will likely be achieved with synthetic T3. The ratio of T4 to T3 in Armour Thyroid is not ideal for humans and can lead to side effects associated with elevated T3 levels.
Is Armour Thyroid Better Because It’s Natural?
Many holistic blogs claim that desiccated thyroid extract is superior because it’s natural.
However, all of these products contain synthetic fillers to hold the pill together, meaning they are never 100% natural (6).
Because synthetic T4 and T3 are biologically identical to the natural hormones, they produce exactly the same actions within the body (2).
The only difference is that Armour Thyroid also contains calcitonin, T1 and T2, which may be biologically active (meaning they produce effects in the body).
However, there does not appear to be any evidence that they produce any significant effect in these amounts.
Summary: Synthetic thyroid hormones are biologically identical to animal hormones and will produce the same effects. No pills are 100% natural; all contain synthetic fillers regardless.
Armour Thyroid vs. Synthroid for Weight Loss
Many people with hypothyroidism have difficulties with weight loss.
Losing weight can often help bring thyroid hormone levels back to normal. This can be achieved with both Synthroid and Armour Thyroid.
As mentioned earlier, a study on 70 people saw greater weight loss in participants taking Armour Thyroid (4).
However, this was only one single study and these results have yet to be replicated.
For more information on managing weight with hypothyroidism read this article and this one.
Summary: Both Armour Thyroid and Synthroid promote weight loss, which can help bring hormone levels back to normal.
Side Effects of Armour Thyroid vs. Synthroid
As with all medications, there are potential side effects, sometimes a result of the dosage being too high.
Synthroid side effects include:
- Unintentional weight loss
- Overheating and sweating
- Nervousness, anxiety, irritability
- Digestive problems such as pain and diarrhea
Some Armour Thyroid side effects are similar to Synthroid but also include the following:
- Allergic reactions
- Chest pain
- Irregular heartbeat
- Swelling of the hands and feet
Armour Thyroid is not recommended during pregnancy and should be discussed with your doctor.
Summary: Both Armour Thyroid and Synthroid have potential side effects including increased appetite, hair loss, headaches and more.
The Cost of Armour Thyroid vs. Synthroid
Thyroid medication needs to be taken for life, so the cost can be an important factor.
Price typically varies depending on the strength of the dose. Per 30 pills (in USD):
- Synthroid: $27-$36.
- Generic levothyroxine or other brand names: $12-$35
- Armour Thyroid: $19.50-$50
Summary: Generic levothyroxine is cheaper than branded Synthroid, while Armour Thyroid is typically the most expensive option.
Armour Thyroid vs. Synthroid: How to Choose Which is Best for You
The first line of treatment for hypothyroidism should be Synthroid (levothyroxine).
This is due to the possible side effects and lack of evidence for the use of either Armour Thyroid or combination therapy. Essentially, T3 given in medication (Armour Thyroid) makes regulating blood T3 levels difficult. As a result, acute or chronic side effects may occur.
Synthroid produces more consistent hormone levels and fewer side effects. For the majority of people, Synthroid will correct thyroid hormone levels and symptoms will resolve.
A minority of people may not find symptom relief with Synthroid. In this case, experimental therapy with a combination of synthetic T4 and T3 may be warranted under the supervision of an endocrinologist.
While there are anecdotal reports of Armour Thyroid producing superior results, there’s a lack of evidence to support this. It appears that using synthetic T3 is more reliable than using Armour Thyroid.
It should be noted that hypothyroidism associated with thyroid surgery, cancer or pregnancy may require a different treatment plan. The information in this article mainly refers to idiopathic (no known origin) or autoimmune causes of hypothyroid such as Hashimoto’s disease.
Wish you could go back to how you felt before thyroid symptoms?
Now you can.
Introducing my Thyroid “Time Machine” meal plan. .
So, how do you reconcile the fact that you feel better on these medications and yet you are still experiencing negative symptoms?
It has to do with how thyroid hormone influences different cells in your body.
Your heart tissue is much more sensitive to thyroid hormone (especially T3) when compared to other tissues in your body.
If you flush your heart with a large amount of T3 (exactly what happens after you take thyroid medication and it is absorbed into your intestinal tract) you may experience an elevation in blood pressure.
The good news is that this can absolutely be managed and the way to do it is by reducing how quickly thyroid hormone is absorbed into your bloodstream.
Let’s stay that you are taking 10mcg of Cytomel each day.
If you take all 10mcg at once then it will be absorbed into your body about 2-3 hours after you take it by mouth.
Around that time your heart will be flushed with this hormone.
But what if you split it up into 2 or 3 doses throughout the day?
By doing this you are still getting the same TOTAL amount of Cytomel but your heart gets slightly different doses instead of getting hit all at once.
This strategy works when dealing with both heart palpitations and elevated blood pressure from Cytomel and liothyronine.
Another option is to switch to a sustained release version of T3 medication.
SR T3 is specifically formulated to delay the release of T3 into your system, so you can still take your total dose all at once but instead of it being absorbed rapidly it is absorbed slowly throughout the day.
In order to get this medication, you will need a prescription to a compounding pharmacy from your Doctor.
#3. The third step is to consider switching thyroid medications.
What if none of these options work for you?
Your last option is to simply switch to a different medication or to switch to a T4 only thyroid medication.
T4 only thyroid medications such as Synthroid and levothyroxine tend to not be associated with high blood pressure (unless your dose is extremely high).
Maintaining high blood pressure for years and years is not something that you want to do.
It is well known in the scientific community that high blood pressure leads to vascular conditions, increases your risk of organ damage, and even stroke.
These consequences are usually only seen after years and years of high blood pressure, though, so don’t let them freak you out if you just noticed your blood pressure is slightly elevated.
You have a few months to play around with your medication to try and lower your blood pressure, but it’s certainly not something you want to ignore.
Taking Blood Pressure Medications
It’s also entirely possible that you may suffer from high blood pressure from an unrelated cause!
The people I am talking to in this article are those who have normal blood pressure before they start taking thyroid medication and then suddenly experience high blood pressure.
If you have high blood pressure at baseline and then it stays high after taking thyroid medication then you probably just have high blood pressure from some other cause.
What’s important here is that some blood pressure medications can interfere with your thyroid function.
Medications like beta-blockers can slow down thyroid peripheral conversion (6) which may make your thyroid medication slightly less efficient.
This can be a good and a bad thing.
If you find that you are incredibly sensitive to heart palpitations from your thyroid medication then using beta blockers may be the only way you can use thyroid medication without experiencing heart palpitations.
But, on the other hand, taking a beta-blocker for blood pressure can negatively impact your thyroid function and potentially make you feel worse.
The moral of the story is to try and AVOID taking blood pressure medications if you have thyroid disease on any type.
This means you will need to focus on the underlying cause of your elevated blood pressure instead of trying to cover it up with anti-hypertensives.
One of the major causes of high blood pressure is insulin resistance (7) and obesity (8) (both of which can be worsened by hypothyroidism).
But, in addition to obesity, other conditions such as stress, smoking, a poor diet, and a lack of exercise can all contribute! (9)
If you address insulin resistance and lose weight, there is a high chance that your blood pressure will not only improve but your thyroid function will as well.
Thyroid medication can definitely impact your blood pressure in a positive or negative way.
The goal when using thyroid medication is to try and normalize your blood pressure and get you back to a healthy level.
Sometimes, if you take too much medication, or if you take certain medications which contain T3, then your blood pressure might start to rise beyond normal.
If this happens to you then you can get your blood pressure back to normal by modifying your dose (or potentially switching your medication).
Now I want to hear from you:
Are you dealing with high blood pressure from your medication?
Have you been able to take any steps to reduce your blood pressure?
What has worked for you? What hasn’t?
Leave your comments or questions below!
High Blood Pressure and Underactive Thyroid Gland
Hypothyroidism, or underactive thyroid gland, leads to significant increases in blood pressure according to recent findings. This is all the more reason to carefully monitor blood pressure in your patients who may be complaining of symptoms of hypothyroidism. We have commonly associated hypothyroidism with low blood pressure, but new reports show the opposite. One international study published in 2007 showed that individuals with hypothyroidism had significantly higher mean 24-hour systolic blood pressure, 24-hour pulse pressure, and 24-hour systolic blood pressure variability compared with healthy volunteers. Since many practitioners still associate hypothyroidism with low blood pressure, we may now have to revise our thinking about abnormal blood pressure in the hypothyroid patient.
The study, by Kotsis et al in 2007 and published in the Journal of Hypertension, evaluated 100 individuals recently diagnosed for hypothyroidism. The mean 24-hour systolic blood pressure in the hypothyroid individuals was 139.0 +/- 9.7 mm Hg. In the control nonhypothyroid group, the 24-hour systolic blood pressure was 112.3 +/- 8.8 mmHg. The patients had never been treated before with blood pressure medication and never received drugs for hypothyroidism. All study participants underwent 24-hour ambulatory blood pressure monitoring. The control group of volunteers consisted of 100 people matched one-to-one for gender and age with the hypothyroid patients. The study also found that “white-coat” hypertension was increased in patients with hypothyroidism. The incidence of white coat hypertension was 23.2% in hypothyroid patients and 4.2 % in control individuals. Statistical differences were also found between hypothyroid patients and control individuals for mean 24-hour pulse pressures. The 24-hour systolic blood pressure variability and daytime and nighttime systolic blood pressure variabilities were also significantly higher in patients with hypothyroidism.
Although one report in the journal Clinical Endocrinology (2006, 65:486) showed that subclinical hypothyroidism was not associated with hypertension, it did reference the fact that overt hypotension is associated with diastolic hypertension, and may contribute to the risk of atherosclerosis. Subclinical hypothyroidism is defined as normal thyroid hormone serum levels with raised serum thyroid stimulating hormone (TSH) levels. Overt hypothyroidism is characterized as diminished output of thyroid hormone from the thyroid gland. Other reports have indicated a high prevalence of systolic and diastolic hypertension in hypothyroid individuals. A report in 2003 by Danzi S and Klein I, (Curr Hypertens Rep, 2003, Dec; 5(6):513-20) showed that manifestations of increased blood pressure in hypothyroidism included increased systemic vascular resistance and a narrow pulse pressure. A 1998 report by Fletcher AK (J Hum Hypertension, 1998, 12(2):79-82) described hypothyroidism as an overlooked cause of significant hypertension. As far back as 1985, it was reported that hypothyroidism was associated with hypertension. In a study of 169 women with overt hypothyroidism, the prevalence of hypertension was significantly higher than in normal thyroid individuals (Saito I and Saruta T, Endocrinol Metab Clin North Am, 1994, 23:379-86).
As mentioned above, the Kotsis study examined the differences between hypothyroid patients and healthy volunteers in 24-hour ambulatory blood pressure parameters. They looked at 100 individuals (82% women), diagnosed for hypothyroidism as characterized by elevated serum TSH levels of at least 5.0 µU/mL. The subjects had not been treated previously with antihypertensive treatment or received drugs for hypothyroidism. All subjects underwent 24-hour ambulatory blood pressure monitoring. A control group of individuals consisted of 100 healthy volunteers matched one-to-one for gender and age with the hypothyroid patients. The results were as follows:
Clinic systolic and diastolic blood pressures were significantly higher in patients with hypothyroidism. Clinic blood pressures taken at the beginning of the 24-hour period were 138.4 +/- 21.1 systolic for hypothyroid subjects and 121.3+/- 10.3 in control subjects; 87.2 +/-12.9 diastolic for hypothyroid subjects and 77.9 +/- 6.9 diastolic control subjects. The mean 24-hour systolic blood pressure and 24-hour pulse pressure were significantly higher in patients with hypothyroidism compared with volunteers. The 24-hour ambulatory blood pressure monitoring was performed using ambulatory blood pressure monitors and readings taken every 15 minutes during the working day. The results were 139.2 +/- 11.1 systolic for hypothyroid subjects and 112.3+/- 8.8 in control subjects; 72.8 +/-9.2 diastolic for hypothyroid subjects and 71.4 +/- 5.9 diastolic for control subjects. The 24-hour ambulatory pulse pressures were 48.6 +/- 10.2 in hypothyroid subjects and 45.0+/- 7.2 in control subjects.
The fasting serum cholesterol levels tended to be higher in patients with hypothyroidism compared with volunteers, but the difference was not statistically significant. Fasting triglyceride levels were significantly higher.
The authors concluded that hypothyroidism may be an important predictor of higher mean 24-hour systolic blood pressure, 24-hour pulse pressure, and 24-hour systolic blood pressure variability, parameters of ambulatory blood pressure monitoring that have been previously associated with higher cardiovascular target organ damage.
The etiology of hypothyroidism is autoimmune, which includes Hashimoto’s thyroiditis and silent thyroiditis in 80% of the cases. Other causes are thyroidectomy, head and neck irradiation, goiter, Riedel’s thyroiditis, and hypothyroid nontransient stage of subacute thyroiditis. It most often affects middle-aged and older women. Some frequent symptoms include increased sensitivity to cold, depression, weight gain, muscle aches and weakness, and joint stiffness.
The mechanisms for hypertension in hypothyroidism are increases in peripheral vascular resistance and arterial stiffness and blood vessel vasoconstriction. The vasoconstriction may be due to the absence of vasodilatory thyroid hormone effects on the vascular smooth muscle, or may be the result of circulating norepinephrine levels with a decrease in the number of vascular beta-adrenergic receptors. The increases in blood pressure in hypothyroid individuals may also be related to obesity. Hypothyroid individuals are significantly more overweight and obese than normal thyroid people.
It is a good bet that patients exhibiting symptoms of hypothyroidism most likely will have an elevated blood pressure and associated arterial stiffness. It is suggested to monitor blood pressure carefully in these patients and, if necessary, postpone dental treatment – particularly those procedures requiring the use of anesthesia with vasoconstrictor – until the patient receives proper medical evaluation. Medical treatment of hypothyroidism usually leads to normalization of blood pressure. A report in the American Heart Journal (Dernellis J and Panaretou M, Am Heart J, 2002, 143(4):718-24) showed that arterial stiffness was decreased in all hypothyroid patients and hypertension was completely reversed in 50% of the patients by simple thyroid hormone replacement therapy.
Drugs that interact with thyroid medications
Published: March, 2014
Hypothyroidism is usually treated with a daily dose of synthetic T4 (levothyroxine sodium) in pill form. Once the right dose is established, your TSH will be checked every six months or so.
Taking a daily pill is simple, but you need to be aware of some possible interactions—for example, antacids and supplemental iron can interfere with thyroid hormone absorption and should be taken at a different time. Below is a list of medicines and therapies that can interact to greater and lesser degrees with your thyroid medication.
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Brand Names: Armour Thyroid, Nature-Throid, NP Thyroid, Westhroid, WP Thyroid
Generic Name: thyroid desiccated
- What is desiccated thyroid?
- What are the possible side effects of desiccated thyroid?
- What is the most important information I should know about desiccated thyroid?
- What should I discuss with my healthcare provider before taking desiccated thyroid?
- How should I take desiccated thyroid?
- What happens if I miss a dose?
- What happens if I overdose?
- What should I avoid while taking desiccated thyroid?
- What other drugs will affect desiccated thyroid?
- Where can I get more information?
What is desiccated thyroid?
Desiccated (dried) thyroid is a combination of hormones that are normally produced by your thyroid gland to regulate the body’s energy and metabolism. Desiccated thyroid is given when the thyroid does not produce enough of this hormone on its own.
Desiccated thyroid treats hypothyroidism (low thyroid hormone). Desiccated thyroid is also used to treat or prevent goiter (enlarged thyroid gland), and is also given as part of a medical tests for thyroid disorders.
Desiccated thyroid should not be used to treat obesity or weight problems.
Desiccated thyroid may also be used for purposes not listed in this medication guide.
What are the possible side effects of desiccated thyroid?
Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Common side effects may include temporary hair loss (especially in children).
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What is the most important information I should know about desiccated thyroid?
You may not be able to use this medicine if you have a thyroid disorder called thyrotoxicosis, or an adrenal gland problem that is not controlled by treatment.
Call your doctor if you have signs of thyroid toxicity, such as chest pain, fast or pounding heartbeats, feeling hot or nervous, or sweating more than usual.