Hypothyroidism is one of the most common conditions in the United States. No one really seems to understand why there is such epidemic of underactive thyroid function.

Some chalk it up to normal aging or genetics. Others blame it on as yet unidentified environmental factors such as infection or toxins.

Regardless of the cause, most doctors have been taught for decades that the diagnosis and treatment of hypothyroidism is straightforward. A blood test for thyroid stimulating hormone (TSH) determines whether the body is trying to make more thyroid hormone. Elevated TSH indicates that the thyroid gland is not making enough. In such cases most doctors prescribe synthetic thyroid replacement hormone (levothyroxine, also sold as Synthroid, Tirosint and Unithroid).

Many patients respond well to such treatment, but some continue to have hypothyroid symptoms such as fatigue, depression, brain fog, weakness, dry skin, constipation and inability to lose weight despite treatment with levothyroxine (aka T4). They may be told that their lab tests are normal. The doctor may conclude that these complaints are psychological and such patients need to see a psychologist or take an antidepressant.

Despite the conventional dogma that patients with underactive thyroids need treatment with T4 alone, there is growing resistance to this concept. Some physicians point out that the healthy thyroid gland produces small amounts of T3 hormone (triiodothyronine) as well as T4. It is actually T3 that is active in tissues throughout the body, regulating energy use. Although muscles and organs in people with healthy thyroid activity are able to convert T4 to active T3, this may not be the case for everyone.

That’s why some physicians prescribe desiccated (dried) thyroid extract from pigs. This natural medication contains both T4 and T3.

A recent study at Walter Reed National Military Medical Center produced some intriguing results (Journal of Clinical Endocrinology & Metabolism, May, 2013). This is the first randomized controlled trial comparing Armour Thyroid to Synthroid. Almost half of the subjects preferred the extract containing both T3 and T4. They lost more weight (4 pounds on average), felt better and even scored better on a cognitive test.

One reader had a similar experience:

“Your column about Armour Thyroid saved my sanity and my life. I was on Synthroid and later Levoxyl for years. I kept telling my doctors and nurses that it wasn’t working for me, but no one listened. I even went off it and couldn’t tell the difference.

“I finally convinced someone to prescribe Armour because it contains both T3 and T4. In less than two weeks I had more energy and felt better than I had in 14 years. I only wish he had prescribed Armour sooner instead of putting me on antidepressants.”

We discuss the pros and cons of Armour and Synthroid as well as the controversies over diagnosis in our Guide to Thyroid Hormones. 

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  1. Les
    Reply

    From reading all this I am so confused. One question… my TSH was 4.5 and my free T3 and T4 were in normal range but they say I have underactive thyroid. They put me on synthroid and I got afib and actually had a minor stroke! I’m obviously off that. Do I really have a problem that needs treatment? I don’t feel that bad.

  2. James S. K.
    Reply

    Rob, I do much better on Armour Thyroid over Synthroid. Because Armour Thyroid is an extract of the thyroid rather than the flesh of pork, I think you would be okay. I think it is worth a try if you are not doing well on synthroid.

  3. ker
    Reply

    Hello Looking for feedback from anyone,
    I was diagnosed 4 years ago with Hashimoto thyroiditis with hyperthyroidism and metabolic x syndrome, post delivery of my twins. Finally switched to Armour, last month was my first month on Armour and I did not experience any heart pressure. 3 days into the 2nd month and my right side of my chest hurts. It hurts to raise my hand over my head. I cannot lose weight no matter how hard I work out or caloric restrictions. I scheduled to get my resting metabolic rate tested. Who has had this occur. I was really hoping Armour would help with the weight loss. How long does it take for it to help with weight loss and how long does the chest pressure last. Should I switch medication. why does this have to be so complicated.
    Thanks you,
    Kerri

  4. diane m.
    Reply

    Thanks for your post, wish I had read it during the hellish year I’ve had, gastro problems, nausea, kidney, insomnia, extreme muscular pains. Phoned endocrinologist I had been seeing yearly for 16 years since demi-thyroidectomy because of nodule (unnecessary surgery as cytology was benign). Have been on armour for about six years, same dose–60 in the a.m., then 30, midday. Went twice to ER since endo was on vacation and did not return my calls. Finally saw him, said my numbers were fine, no change.
    Two weeks later I had a seven hour ordeal with afib, heart skipping beats, tachycardia, etc. I phoned him a week later, he said I was fine. Symptoms returned a few weeks later and did not abate. I called, he repeated that I did NOT need to see a cardiologist. I finally did see one and the first thing he noticed was my thyroid numbers as a suspicious possible cause of heart symptoms. My TSH was .03 and free T3 was 476. He said to phone endo which I did. He took me off all armour for a week, then, 30 mg for one week, and 60 mg for a month and then see him for retesting.
    I improved steadily (echo, stress test, normal– holter showed benign PVC etc)and am symptom-free. I am so upset that my endo who I travel three hours to see, pay out of pocket for, was so delinquent in his refusal to see I was over-medicated. I had all the symptoms. I have $10,000 in out of network med bills and a ruined summer with my son. Disgraceful. I do not have an endocrinologist anywhere near where I live but I think I have outlived my loyalty and trust to this one. Hope you are doing well and thanx again for your post.

  5. CGB
    Reply

    My doctor recently changed me from obstructions (.112) to Armour (.20). I have been on thyroid supplements for 41 years and I’m surprised that Medicare will not pay for the Armour brand. Can you tell me why this would matter?

  6. CGB
    Reply

    My MD just switched me TO Armour thyroid. I was surprised that Medicare would not pay for this. Does anyone have any understanding as to why?

  7. LF
    Reply

    I was fine but my doctor said I had a thyroid problem so I was put on Synthroid. Then I became ill so she switched me to Levothyroxine. Still ill so I went to an endo doctor who reduced the dosage to 25 mcg from 75 mcg. Still feeling ill, so I requested a change to Armour and was told a resounding “NO”. It stinks, he said; it’s made from pigs, he said; you can’t control the T3 and T4 levels; it is bad for you, he said.
    So, I went to a new primary care who said, sure, let’s try it. I started feeling like my old self at 15 mcg; lost weight, had energy and all was well — EXCEPT, my hairline receded all around my face!! All the way back to my ears!! I was told it was an aging process or maybe stress or maybe this or that but certainly not my medication. Well, my once thick, lovely, manageable hair is so thin, brittle and limp I can’t do anything with it. So, my doctor increased my Armour to 30 mcg and wants me to wait another 6 weeks to be tested. Oh by the way, my last TSH tests came back at 3.95 which she says is great. However, when I questioned the T3 and T4 levels, I was told the T4 was a little low and that was why she was increasing the Amour.
    I am scared to take this new dosage after reading that possibly too much meds may cause hair loss. I took my temp this morning at it was 95.2. So, too much meds or not enough? I am calling a new endo doctor tomorrow. Does anyone have any information on the hair loss issue. Would appreciate any help from anyone out there.

  8. CD
    Reply

    Noticed several people asking, if the reduced iodine intake has anything to do with it.
    That is also my question.
    A question: why is nobody stopping the very dangerous statin drugs. It brings so much suffering to thousand of people.
    Thanks so much, for your wonderful informative website.

  9. James S. K.
    Reply

    I have found and have confirmed with a Doctor that small amounts of seaweed, ie 3-6 oz a week can be helpful. For example Nori, Kelp as in seaweed salad or Nori chips are a good natural source of Iodine. Do not just take Iodine or baldderwort.
    James

  10. Trish
    Reply

    My regular doctor put me on compounded meds to get me at a level where I could function on a daily basis … was allergic to all thyroid drugs on the market, my levels would never equalize and I could barely function on a daily basis. Am now taking a compounded T4 and T3 formula (insurance won’t pay for the prescription) I am almost back to my old self. It really is a blessing to have a doctor that listened to me and helped me get my life back.

  11. drl
    Reply

    My Hypothyroidism was initially found before I was 20 years of age. Nothing was done about it because the tests did not show that I was “out of range”. Skip from 1966 to 1991 when my TSH was at 224 and I was immediate put on Synthroid. The Synthroid brought the TSH down, but not enough to get me anywhere near “normal” but changes in the dosing were made to see if that would work. Because I was also one of those women who had been told that my long term chronic depression needed treatment, I had been under the care of various psychiatrists since 1981.
    In 1999, I started with another psychiatrist and told him of the medical history and the trials with Synthroid that were not having a good outcome. He tested for T3 and determined from that and the other Thyroid tests that Synthroid simply was not doing the job. He contacted my Internal Medicine specialist and requested that I be place on “dessicated thyroid” immediately. The psychiatrist actually warned me that it could take years for my system to have a full response to the attempts to normalize things again.
    The amazing thing is that the depression lifted within a month and was noticed because I had just had a death in the family (my Dad) and I had lost my Mom the year before. Friends noticed that I was not depressed. I was handling things extremely well and was displaying far more energy than they had seen in years. The huge amount of weight that had been gained is slowing going away. I don’t miss it. I am having a great time trying on clothes that have stayed in my closet waiting for me to fit into them.
    I am now almost 67 years old and haven’t felt this good since I was in my 20s. Whether Armour was the answer is no longer a question. My current doctor knows that he can adjust the dose, but he will never get me onto a synthetic. How stupid of the research people to not want to chase down the cause of so many problems that could so easily be helped by simply letting go of the “rote” lessons learned from the big pharma sponsors of the medical schools and medical specialty groups.

  12. VT
    Reply

    I too have had terrible experiences for last 2 years and longer with thyroid. Doctors did not deal with it well at all. Was up to 75 mcg of Levothyroxine for sometime, jumping from 50. Started having bouts of severe nausea. Announced to any doctor that would listen, but none thought it was the thyroid. Looked at other cardiac meds and got off one of those. No change. Spent 5 days in hospital with GI and cardiac problems, along with the nausea attacks leading up to fainting if I did not compensate with lowering of head and body. Finally, I knew it had to be Rx induced. I started reducing the thyroid med on my own until I got to none. Started feeling better with much less nausea.
    Knowing I had to have some dosage level of thyroid med I returned to my GP practice and started on 30 mg of Armour. Then moved to Synthroid 50 mcg where I am today, no nausea attacks, but still having some symptoms. Now with an Endocrinologist and with my second visit coming in 4 months, hope to get some further adjustments to fine tune where I should be. Tests still showing me within range on TSH and T4(F), but those few symptoms (fatigue, joint pain, hair loss,constipation, dry skin, etc.) still persist. Bottom line is – all the prior symptoms were due to the thyroid causing GI upset, then AFib via the vegal nerve and severe nausea.

  13. r h
    Reply

    I took Synthroid for years and kept going downhill, so when I requested Cytomel, an endocrinologist prescribed it. Kept having problems adjusting dosage, so my NP prescribed Armour. I’m doing better in some ways and refuse to go back to synthetic thyroid, but my TSH is non-existent (0.07), my free T3 is low normal range and my T4 is below normal.
    I feel lousy, no energy, have had fibromyalgia for some time and allodynia, depression, etc. plus suffer from constant headaches. I’m losing my NP and don’t know what to do. Most endocrinologists seem to specialize in diabetes, at least in Eugene, OR. What next?
    Peoples Pharmacy response: You may want to listen to our interview from a few years ago in which we discussed many approaches to thyroid problems. We were pleasantly surprised that our conventional endocrinologist was quite open to the idea of combined T4-T3 treatment. Here’s the link:
    http://www.peoplespharmacy.com/2012/04/14/853-thyroid-controversies/
    You may also want to consult Mary Shomon’s blog: http://thyroid.about.com
    It has a lot of excellent information. Good luck in finding a new healthcare provider to help you.

  14. NBF
    Reply

    Could some thyroid problems be related to getting insufficient iodine from there being less in the foods many of us eat these days, and also due to reducing salt in our diets (iodized salt)?

  15. JP
    Reply

    About a year and a half ago, I was diagnosed with hypothyroid. Rather than finding out why, the doctor immediately put me on thyroid medication. I took it for less than a month because my hair started to fall out. I firmly believe that a thyroid needs iodine to function properly. People with high blood pressure watch their salt intake and don’t get the iodine that’s in it. I started taking a good multi-vitamin that has iodine in it. The next time my labs were done, my thyroid was in normal range.

  16. fbl
    Reply

    It took my family Dr. years to figure out the right formula for my thyroid. The blood tests were fine but I had severe symptoms. He had me take my temperature first thing in the morning before getting out of bed. My temp was way below the bottom line! It had no number so I have no idea where we started with my body temp.
    Then came the trial and error. My body doesn’t react to meds the way most folks do. After several years of playing around with different options we finally came up with a combination of NatureThyroid and Cytomel. Have been doing great since.
    Fluoride added to our drinking water has destroyed the health of Americans-the thyroid in particular. Do not drink tap water! Get a Reverse Osmosis System or distiller. I learned that too late of course after the damage was done.

  17. Beverly D.
    Reply

    Yes, definitely! The Endocrinologist insulted me to where I was in tears.
    They will not usually work with borderline thyroid as it is NORMAL RANGE to them. The Armour Thyroid has helped me a lot. It takes a while to get better but it has slowly.
    When a physician tested ALL of my levels some were OK and some were very LOW. He now has me on several natural things plus Armour.
    I would suggest getting a Dr. who is NOT an Endo dr. and who is concerned with “wellness.” These Dr.’s generally use a more natural approach and are more in tune with treating what is actually wrong with the person, not just reading “normal” chart levels. ASK their protocal before you waste a trip and money.
    My Cardiologist is the one who explained to me the “Normal Range” is just what is “normal” in a group of a specified number of people. He said that that does NOT mean it is “normal. And what is normal and OK for one person, may be different for another person.

  18. Boone M.
    Reply

    There are many famines recorded in world history. Normal or high metabolism is lethal and low metabolism (hypothyroidism) is protective during low food supply. Children produced by these hypothyroids are also hypothyroid.
    Our major problem today is identifying the hypothyroids so they can be treated. The problem is that the lab range called “normal” is a “statistical” normal not a “physiological” normal because many hypothyroids (40% of the population) are included in the Bell Curve that is used to determine mean and standard deviations. Thus the doctor (to his financial advantage) calls many hypothyroids “normal” and leaves them untreated for the malady but treats them for many, many (60) others that are caused by hypothyroidism but treated for something else.

  19. CH
    Reply

    I am allergic to pork, not in an anaphalactic shock kind of way but more esophageal inflammation and antihistamine response – but have read for years about Armour thyroid with interest. Wondering if this would be safe for me?
    People’s Pharmacy response: We don’t know, and we would want you to be under your allergist’s supervision if you and your endocrinologist decided to experiment with this.

  20. lp
    Reply

    Thirty six years ago my twin sister, a nurse, one month after delivering her first child was seen by about 15 physicians, before an older surgeon, diagnosed her with hypothyroidism, in two minutes, just by listening to her symptoms. Two months had passed since symptoms started. She had to quit school because she was so lethargic. She was diagnosed with postpartum depression, possible brain tumor, and given Valium by almost all of these MDs, including the only endocrinologist in our town at the time.
    We informed all these physicians of our mother’s history of hypothyroidism; nothing convinced them to start treatment. Her labs were not low. Not yet. We knew and informed them all she had lost 20 pounds in the first few weeks after delivery. She had amazing energy for a few weeks,before she crashed. Apparently she had a short period of hperthyroidism followed by disabiling fall to hyopothyroidism. Remember people were placed in mental institutions before this disease was understood?
    Not long after, she got a huge goiter, that was really starting to show long before it enlarged. She began to feel better in a few days after she started synthroid, prescribed by the genius doctor, who listened to his patient.
    PEOPLE’S PHARMACY RESPONSE:
    WOW! What a story of woe and intrigue. This truly takes our breath away and we thought we had heard it all. It belongs in the chapter on thyroid in our book, Top Screwups Doctors Make and How to Avoid Them! Thanks for sharing.
    http://www.peoplespharmacy.com/topscrewups-pp/

  21. VH
    Reply

    My 18year old granddaughter is on the borderline for hypothyroidism. Two doctors, one an endocrinologist, have said that she does not need medication. Yet she has gained some weight and gets tired easily. Could this be a cause?

  22. Donnie
    Reply

    I have Hashimoto’s autoimmune hypothyroid disease. I did not feel well taking just Synthroid. I started taking Unithroid along with a small dose of Cytomel, and that worked much better for me. Most doctors will only test the TSH level and then treat the number. Testing Free T4 and Free T3 is a much better indicator of the real thyroid activity.
    There are many things that have a negative effect on the thyroid, too. Fluoride, soy, several pesticides, BPA, Triclosan, many chemicals, and a lot of other things can affect the thyroid. And should be avoided as much as possible.

  23. AL
    Reply

    Does anyone know if using Lugol’s Solution (5 drops) everyday can help with goiter conditions?

  24. SG
    Reply

    I have been on thyroid hormone (Levothyroxine) for 40 years due to irradiation therapy as a child.
    I read all of the great press about Armour Thyroid and got on the band wagon when my regular meds started to work less effectively. It turned out to be a nightmare for me! Far from helping, after 1+ year on Armour Thyroid my hormones were all upside down! My thyroid hormone (21) was off the charts, my testosterone (105) was off the charts–I’m surprised I did not grow a beard!
    I went on Synthroid and a year later am still trying to get my hormones rebalanced. It has been a trial, I gained weight which I cannot lose–it has been a nightmare and a huge disappointment because I had such high hopes for the Armour Thyroid. I can’t report anything good about the experience.

  25. Lois D.
    Reply

    I have been on synthroid for 15 years because I had several nodules on my thyroid. I have always been high energy and still am (age 75). The nodules don’t change – biopsy’s are ok — would I be okay to go off Synthroid?
    PEOPLE’S PHARMACY RESPONSE:
    This is a conversation you need to have with your physician. Your doctor is the person best able to determine if you are getting the right dose and if Synthroid is still appropriate.

  26. Rob
    Reply

    As I cannot eat pork (causes extreme constipation), would Armour Thyroid be ‘safe’ for me to use?

  27. ---
    Reply

    The cause usually isn’t much of a mystery–Hashimoto’s Thyroiditis, an autoimmune disease, is the cause of most hypothyroidism in the U.S., though no one seems interested in working to cure the underlying autoimmune response that’s causing the problems in the first place. A lot of people–read: women, as women are disproportionately affected–are told their problems are psychosomatic, misdiagnosed, and/or grossly mismanaged.

  28. Judy Z
    Reply

    I would appreciate The Peoples Pharmacy comments on diet or other suggestions when one is consistently tested as “borderline” for hypothyroidism.

  29. SWM
    Reply

    You can also supplement with T3, sold as Cytomel. It’s also available as a generic.

  30. Maggie S
    Reply

    I come from a long line of “thyroidisms” ~ hypo, hyper and goiter. In 2003 I was diagnosed with multinodular goiter. After a biopsy to determine it was benign, I was put on synthroid and was told I would have to take it for the rest of my life. That same year, I was diagnosed with fibromyalgia, which continued to get worse. In 2010 I was awarded permanent disability because between the pain and fatigue, I simply can not work any longer.
    About a month ago, my general practitioner (not an endocrinologist) increased my synthroid dose and my energy, always low, has gotten lower, plus hair thinning, dry skin, weight gain and other common symptoms of hypothyroidism.
    Through your wonderful website, I recently read some of the correlation between hypothyroidism and fibromyalgia. I’m not sure if the information I’ve read applies to goiter as well, but I KNOW the synthroid is NOT working for me. I have stopped taking the synthroid and have ordered dessicated porcine natural thyroid. I wonder if you or your readers have any pertinent information to share with me? Thank you for all that you do! I trust The People’s Pharmacy!

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