by Jeffrey Dach MD
We use exclusively natural thyroid in our office, and a few times every day, I find myself explaining why natural thyroid is superior to Synthroid. In this article, we will explain why natural thyroid tablets are better than synthetic T4 only tablets, also called Synthroid.
Left Image: Thyroid Gland on Radionuclide Scan Courtesy of Wikimedia Commons.
What is Synthroid? What is in it?
Synthroid contains the L isomer of Thyroxine (also called T4) ,which is produced by the thyroid gland. Levothyroxine is the generic form of Synthroid. Common brand names include Thyrax, Euthyrox, Levaxin, L-thyroxine, Eltroxin and Thyrax Duotab in Europe; Thyrox in South Asia; Eutirox, Levoxyl and Synthroid in North America. Even though Synthroid is a synthetic L isomer of Thyroxine, it is considered to have similar biologic activity .
Natural Thyroid pills are made from desiccated porcine (pig) thyroid glands which contain Thyroxine (T4), T3, T2, T1 and Calcitonin.
Left Image: courtesy of wikimedia: Natural Thyroid tablets come from this animal, the pig.
Economics of Synthroid
As of 2005, 10 million people in the U.S. take thyroxine. When one considered that Abbott’s Synthroid is the most popular form of thyroxine, and the second-most prescribed drug in the U.S., one starts to understand the financial rivalry between Synthroid and natural thyroid competitors.
What Does Mainstream Medicine Say ?
Here is a typical statement by Mainstream Medicine found on a popular medical information web site called medicine.net. Armour is a natural desiccated porcine thyroid preparation containing T1, T2, T3, T4 and calcitonin. Synthroid contains only T4.
From Medicine.Net : Answering a Viewer Question
What is your feeling regarding natural vs. synthetic replacement therapy in hypothyroid situations? Armour, for example vs. Synthroid? from L.H.
Doctor’s Answer: While it is reasonable to assume that synthetic medications are less desirable than natural counterparts, in this case- natural thyroid hormone replacement is definitely not an ideal solution for the vast majority of people.
Here’s why: Armour thyroid is derived from desiccated pig (porcine) thyroid gland. A number of years ago, these natural preparations were our only alternative. Replacement with desiccated thyroid creates dosing problems because there is no way to standardize the exact amount of the dose for each batch. As a matter of fact, these preparations do not report their dosage strength in milligrams, but rather, in grains of thyroid. This is because, they don’t really know the milligram equivalent in each dose. Dosing is also based on the assumptions that each gland has equal amounts of hormones as the next gland, and that the ratio of T4 and T3 (the more active hormone) are similar and constant in each gland from the pigs. There is no way to be certain of this, and patients on these preparations often have fluctuating hormone levels, which may or may not result in symptoms.
Regardless of symptoms, the goal of replacement therapy is to keep the hormone levels as stable as possible. This is much easier to achieve with synthetic preparations such as Levoxyl and Synthroid. These preparations come in a vast number of standardized doses, allowing for minute adjustments in hormone dosing. There is another comment that should be made. With all the issues surrounding “mad cow disease” and other ailments, I personally am reluctant to offer animal based therapy to patients when a safe effective well studied synthetic preparation is widely available.
I hope this helps answer any questions you may have. Thank you for your question.
Medical Author: RM, M.D.
“Natural Thyroid is Not an Ideal Solution” ? !!!!
This nonsense really makes my blood boil and my eyes pop out of head.
Let’s start by doing a little research. If the above statement is true, we should expect to find that the FDA HAS NEVER recalled Synthroid because of problems with stability or potency, and we would expect that the FDA HAS recalled natural thyroid pills because they are unstable, and vary in potency. So let’s ask the FDA about this. What do we find? In reality, the FDA says Synthroid is unstable and varies in potency, while natural thyroid from RLC labs HAS NEVER been recalled for instability or variation in potency.
No, Says the FDA.
Synthroid was marketed in 1955, but not FDA approved until July 24. 2002 because of a “history of potency failures…indicates that Synthroid has not been reliably potent and stable.”– United States Food and Drug Administration Letter to Synthroid Manufacturer, Knoll Pharmaceuticals, April 26, 2001 (link )
Unstable, not of Consistent Potency from Lot to lot
Here is an FDA document August 14, 1997, Docket No. 97N-0314, which says:
“The drug substance levothyroxine sodium (also called Synthroid) is unstable in the presence of light, temperature, air, and humidity. Unless the manufacturing process can be carefully and consistently controlled, orally administered levothyroxine sodium products may not be fully potent through the labeled expiration date, or be of consistent potency from lot to lot.
There is evidence from recalls, adverse drug experience reports, and inspection reports that even when a physician consistently prescribes the same brand of orally administered levothyroxine sodium, patients may receive products of variable potency at a given dose. Such variations in product potency present actual safety and effectiveness concerns.
However, no currently marketed orally administered levothyroxine sodium product has been shown to demonstrate consistent potency and stability and, thus, no currently marketed orally administered levothyroxine sodium product is generally recognized as safe and effective. ” end quote source: http://www.gpo.gov/fdsys/pkg/FR-1997-08-14/html/97-21575.htm
FDA Document [Federal Register: August 14, 1997 (Volume 62, Number 157)][Notices][Page 43535-43538]
To be completely fair, there was a recall of Armour thyroid in 2005, Lots manufactured in 2003 were found to have lost potency 2 years later in 2005, so Forest Labs recalled all tablets made in 2003.(21) Since it was 2 years later, very little product from these lots was still in distribution, so it was actually a small recall.
Left Image courtesy of wikimedia commons
Change in Armour Formulation
Armour changed their thyroid tablet formulation in 2009, after which our patients reported they were not happy with the new formulation. To avoid any questions, we use exclusively Naturethroid from RLC labs. After five years of clinical experience with Naturethroid from RLC labs, I can fully endorse the product as an excellent form of thyroid medication.
Naturethroid Manufacturer Speaks Out: Natural vs Synthetic
From John Lowe’s article: Stability Effectiveness Desiccated Thyroid VS Levothyroxine John C Lowe Thyroid 2009 (14)
“In contrast to Naturally Desiccated Thyroid (NDT) containing T3 and T4, most synthetic medications contain T4 (or T3) only. In reality, many patients don’t start to feel normal again until they switch from synthetic to NDT (Thyroid USP). Natural Desiccated Thyroid hormone replacement has been used since the late 1800s, and it is one of the safest drugs available. It contains a full spectrum of thyroid hormones, T4 and T3 and also T2 and T1 as well.
The typical indication by the proponents of synthetic T4 is that NDT is unstable and inconsistent in its dosage. However, under the full USP monograph of both Thyroid USP as an ingredient and Thyroid USP Tablet as a finished product establishing full prescription status, this conventional argument could not be further from the truth. Unlike Nature-Throid™ and Westhroid™, synthetic medications have often been recalled due to batch inconsistencies. Yet most doctors are led to believe that desiccated thyroid is unstable.
To ensure that Nature-Throid™ and Westhroid™ Thyroid USP tablets are consistently potent from tablet to tablet and lot to lot, analytical tests are performed on the raw material (Thyroid USP powder) and on the actual tablets (finished product) to measure actual T4 and T3 activity.”(14)
By the way, contrary to the Medicine.net comment above, natural thyroid tablets are labeled in milligrams. For example, Naturethroid (RLC Labs) One Grain tablets contain 65 mg of natural desiccated thyroid.
Conversion of T4 to T3
A common problem for many patients who don’t feel well on Synthroid is the inability to convert T4 to T3.(15-18)
Synthroid contains T4 which must be converted to T3 by the body for it to work. This conversion is done by the De-Iodinase Enzyme (see image above). Sometimes this enzyme is deficient or not working, and many patients have an inability to convert T4 to T3.(15-18) They feel much better on a natural thyroid medication which contains T3 and T4. In my experience, most patients feel much better, with more energy, and relief symptoms when switching from synthroid (levothyroxine) to a natural thyroid such as Naturethroid.
A 2002 article, Treating Hypothyroidism Naturally, by Mary Shoman in the Townsend letter explains why natural thyroid treatment is better, that Synthroid and Levothyroxine are unstable, with dosage varying according to batch, and subjected to multiple recalls. Natural thyroid from RLC labs has never been recalled and is the preferred solution. Mary Shomon’s blog is an excellent resource on natural thyroid. Left Image: Courtesy of Mary Shomon
Can I Get Mad Cow Disease from My Pig Thyroid Pill?
Millions of Americans have enjoyed ham sandwiches and pork products for decades without a single case of Mad Cow Disease ever reported. This essentially invalidates the fear of Mad Cow Disease as an argument. However, Mary Shomon advises caution with over-the-counter glandular supplements, which may contain unregulated meat products from areas of Europe known to have mad cow infected livestock.
Stop the Thyroid Madness
Another excellent resource is the Stop Your Thyroid Madness Blog and Book by Janie Bowthorpe. Janie suffered for years with low thyroid symptoms wven while on Synthroid, and had a dramatic recovery after converting from synthroid to natural thyroid. With her blog and book, she is one of the strongest advocates for natural thyroid medication.
Left Image: Stop theThyroid Madness Book Cover, courtesy of Janie Bowthorpe
Our Program: For diagnosis of low thyroid, we use a lengthy questionnaire which reviews over 70 symptoms of low thyroid, a complete thyroid blood panel including TSH, free T3 and free T4, Thyroid antibodies and a physical examination which includes measurement of reflex time. Also included is a basal body temperature chart filled out by the patient at home. We also measure selenium and iodine levels and supplement when found low.
Once it has been determined that thyroid hormone is likely to be beneficial, a trial of low dose Nature-Throid from RLC labs is started with a Half Grain (32 mg) tablet every other morning.
A log book is kept by the patient describing benefits of increased energy, clarity of mind, etc, or adverse effects such as palpitations, feeling of warmth, anxiety or insomnia. At the end of a week, the log book is reviewed to determine if the thyroid was of benefit.
We have found that monitoring symptoms with a log book, and the Half Grain gradual increments in thyroid dosage every two to three weeks makes this program very safe. In the event of rapid heart rate or palpitations, the patient is instructed to hold the daily dosage of thyroid medication and inform the physician. This program is also excellent for switching patients from Synthroid to Natural Thyroid, with patients invariably reporting dramatic improvement afterwards.
Instead of Natural Thyroid, Why Not Use Cytomel and Synthroid Together?
Cytomel is T3 and Synthroid is T4, so why not use the two together? The Cytomel provides the missing T3 to make a combination that is closer to the Natural Thyroid. Some patients arrive at my office having been given this combination from the doctor. The advantage for the prescribing doctor is that both items, Synthroid and Cytomel are available at the corner drugstore, whereas natural thyroid is available from a compounding pharmacy.
(Note: update 2015: Nature-throid from RLC Labs is now available at most local corner drugstores)
Natural Thyroid is still the preferred choice. Among other missing ingredients, the Synthroid and Cytomel lacks Calcitonin which is present in natural thyroid. Calcitonin production may be deficient or absent in patients after total thyroidectomy which may remove the C cells (parafollicular cells) responsible for Calcitonin. Giving back the missing calcitonin makes sense, and patients usually feel better.
Update 10/14: New study: Patients are more satisfied when converted from Synthroid to Armour: Click here to read the pdf of the study Conversion to Armour Thyroid_endocrinology-2-1055.
Update Aug 2015: Hillary Clinton discloses she takes Natural Desiccated Thyroid.
Articles with Related Content:
Hypothyroidism the Unsuspected Illness, by Broda Barnes MD
Iodine, Why You Need It and Why You Cant Live Without It by David Brownstein MD
Hypothyroidism, Type Two by Mark Starr MD
Jeffrey Dach MD
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Links and References
Willmington, Sunny, Howard Hagglund, and Mary Shomon. “Treating Hypothyroidism Naturally.” TOWNSEND LETTER FOR DOCTORS AND PATIENTS (2002): 80-81.
The Synthroid Settlement: Fair Payoff or Patient Ripoff?
By Mary Shomon, About.com December 14, 2003
3) Nature Throid RLC Labs Home Page Natural vs Synthetic
Chemical and Engineering News. The Top Pharmaceuticals That Changed The World Vol. 83, Issue 25 (6/20/05)
Today, more than 10 million people in the U.S. take thyroxine. Synthroid, manufactured by Abbott Laboratories and the most popular brand of thyroxine, is the second-most prescribed drug in the U.S.
5) Larry Frieders, the compounder,
THYROID MADNESS DEFINITION (personal communication):
1.Treating hypothyroid patients solely with T4-only meds (synthroid)
2.Dosing solely by the TSH and the total T4, or using the outdated “Thyroid Panel”
3.Prescribing anti-depressants in lieu of evaluating and treating the free T3
4.Telling thyroid patients that desiccated natural thyroid like Armour is “unreliable”, “inconsistent”, “dangerous” or “outdated”.
5.Making lab work more important than the hypo symptoms which scream their presence
6.Failing to see the OBVIOUS symptoms of poorly treated thyroid, and instead, recommending a slew of other tests and diagnoses.
Common brand names include Thyrax, Euthyrox, Levaxin, L-thyroxine, Eltroxin and Thyrax Duotab in Europe; Thyrox in South Asia; Eutirox, Levoxyl and Synthroid in North America. There are also numerous generic versions. Synthroid is the most prescribed brand of T4 in the United States. Synthroid was marketed in 1955, but was not FDA approved at that time as it was “generally regarded safe”. In the 1990s, in response to debate as to whether Synthroid was more effective than other levothyroxine preparations, (which ended up concluding that there was little difference between Synthroid and generic brands) all levothyroxine preparations were required to undergo the formal FDA approval process. Synthroid was approved by the FDA on 24 July 2002.
Synthroid Has a Long History of Problems, Says FDA
In Denying Synthroid’s Request for Special Approval Status, FDA’s Scathing Letter Outlines History of Subpotent Product, Inconsistency and Poor Stability by Mary Shomon
Medicine net web site
What’s up with desiccated thyroid & the FDA?
Between 1991 and 1997, there were ten recalls of synthetic T4, involving over 100 million tablets.9 In nine of these recalls, the tablets had been found to be subpotent, or they were losing their potency before their expiration date; in the tenth recall, the tablets were found to be too potent. For patients, such unreliability means that the synthetic T4 they receive could be either too strong or not strong enough to treat their condition properly
Source: Federal Register 62, No. 157, 14 August 1997, pp. 43535-8.
As with all drugs, Armour’s manufacturer, Forest Laboratories, holds back samples from every lot it produces, and periodically tests those samples. When Armour Thyroid is manufactured, it has a 24-month expiration date. That means that Armour Thyroid should maintain its potency for a full two years.
What Forest found in recent sample testing was that there were several lots of Armour Thyroid that were not maintaining full potency. These lots were manufactured between March 2003 and August of 2003, and therefore they were set to expire between March 2005 and August of 2005.
11) intentionally left blank.
Is There A Real Risk of Mad Cow Disease from Armour Thyroid?
An Update on Armour Thyroid and Glandulars by Mary Shomon
If you are willing to eat American pork products, you shouldn’t be any more concerned about Armour thyroid, as far as risk of mad cow disease. Caution is encouraged, however, with over-the-counter glandular supplements, which may contain unregulated meat products from areas of Europe known to have mad cow infected livestock.
13) intentionally left blank.
14) Stability Effectiveness Desiccated Thyroid VS Levothyroxine John C Lowe Thyroid 2009 Lowe, John C. “Stability, Effectiveness, and Safety of Desiccated Thyroid vs Levothyroxine: A Rebuttal to the British Thyroid Association.” Thyroid 4.3 (2009): C1-12.
15) New Study Reveals Why 1 in 6 Hypothyroid Patients Still Feels Bad on Levothyroxine by Joe Graedon January 15, 2015 peoples pharmacy
16) de Castro, Joao Pedro Werneck, et al. “Differences in hypothalamic type 2 deiodinase ubiquitination explain localized sensitivity to thyroxine.” The Journal of clinical investigation 125.2 (2015): 769.
17) McAninch, Elizabeth A., et al. “Prevalent Polymorphism in Thyroid Hormone-Activating Enzyme Leaves a Genetic Fingerprint That Underlies Associated Clinical Syndromes.” The Journal of Clinical Endocrinology & Metabolism 100.3 (2015): 920-933.
18) Panicker, Vijay, et al. “Common variation in the DIO2 gene predicts baseline psychological well-being and response to combination thyroxine plus triiodothyronine therapy in hypothyroid patients.” The Journal of Clinical Endocrinology & Metabolism 94.5 (2009): 1623-1629.
19) How to Diagnose and Treat Thyroid Disease October 28, 2015 Joe Mercola
Armour Thyroid (thyroid tablets, USP), 1/2 grain (30 mg) , each tablet contains 19 mcg levothyroxine (T4) and 4.5 mcg liothyronine (T3), 100-count bottle, NDC 0456-0458-01. Recall # D-231-2011
Lot #: 1077413, Exp. 9/30/2011
Recalling Firm: Forest Pharmaceuticals Inc., Earth City, MO, by telephone and letters on October 6, 2010.
Manufacturer: Forest Pharmaceuticals Inc., Cincinnati, OH. Firm initiated recall is ongoing.
Labeling: Label error on declared strength; some bottles are mislabeled as containing 1/2-grain tablets but actually contain 1-grain tablets. The entire lot is being recalled even though some bottles are labeled correctly because bottles of 1/2-grain and 1-grain could be shrink-wrapped together.
VOLUME OF PRODUCT IN COMMERCE
31,172 bottles approx.
Nationwide, PR, Belgium and the United Kingdom
21) Understanding the Armour Thyroid Recall of Spring 2005 From Mary Shoman:
22) The Complete Guide to using Naturethroid: Westin Childs
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