February 10, 2004
Question: You read where you said that Forest Pharmaceuticals doesn’t actively market Armour Thyroid or go after those who bad mouth the product. Do you know why?

Dr. Lowe: A representative at Forest Pharmaceuticals told me that what seems like indifference by the company is strictly a business decision. Forest could pay for studies to show that Armour is as stable and effective as any other thyroid hormone product. But the studies could cost as much as three millions dollars, and this wouldn’t be cost effective for the company. The reason is that the projected increase in sales of Armour wouldn’t make the investment in the studies financially worth while. Besides, Armour Thyroid sells quite well based on its effectiveness compared to competitive products.

February 8, 2004
Question: A doctor told me that Armour Thyroid is named Armour because the shape of the thyroid gland is like a shield. Do you know if this is true?

Dr. Lowe: I doubt it, mainly because the gland is shaped more like a butterfly than a shield. Nonetheless, I’ve occasionally heard what the doctor told you about the origin of the name Armour Thyroid.

Until today, I had no idea whether or not it was true. I checked my dictionary to see if it contained any helpful information. I found that a meat-packing industrialist, who lived from 1832 to 1901, was named Philip Danforth Armour. This raised a question as to whether Armour Thyroid bears his name.

To find out, I contacted a representative of Forest Pharmaceuticals, the company that markets Armour. He told me that the origin of the name isn’t certain, but most likely, the first drug company to market the product named it after Armour Meat Company of St. Louis, Missouri. This was the company Philip Danforth Armour owned. The Forest representative said that slaughtering of animals at the meat-packing company made thyroid tissue available for medical use. 

The representative wasn’t sure when the product was first marketed, but he thinks it goes back at least to 1940. I’ve often heard, without verification, that Armour has been on the market for a hundred years or so. He commented that there's a problem in knowing the product's true lineage: Forest is the 4th or 5th company to own the right to market Armour, and former companies usually don’t pass along to successive companies a detailed history of the product. He told me that Forest, which is based in St. Louis, acquired the right to market Armour from a French drug company, bringing it back to its geographic birthplace.

Dr. Lowe: Armour Thyroid is desiccated thyroid derived from pig thyroid gland tissue. Most of our hypothyroid patients use Armour, and they respond extremely well to high enough dosages.

Sales representatives from one particular drug company have deceptively misled doctors into believing that the animal source of Armour makes its thyroid hormone content unreliable. The product's potency, however, is as reliable as that of any synthetic product. For patients who don't want to ingest animal products, Thyrolar is an excellent synthetic alternative to Armour. Armour and Thyrolar have the same ratio of T4 to T3. They are equally reliable and effective when patients use high enough doses.

Armour and Thyrolar both contain 38 mcg of T4 and 9 mcg of T3. This is 4 parts T4 to 1 part T3 (the exact ratio is 4.22 to 1).

Some endocrinologists now advocate the use of products containing both T4 and T3, but they recommend a higher T4 to T3 ratio. They prefer a ratio 10 parts T4 to 1 part T3. The lower T3 content of such products renders them far less effective than Armour and Thyrolar. In our clinical experience, the treatment outcome is inferior for patients who use products with the lower T3 content.

The inferior treatment outcome is supported by two recent studies conducted by endocrinologists.[1][2] The studies showed that patients who added only a small amount of T3 to their T4 continued to suffer from symptoms, just as did patients who used T4 alone. The ratios of T4 to T3 the patients used varied, but most used a higher T4 to T3 ration than in Armour and Thyrolar. Of course, the endocrinologists restricted the patients' dosages according to their TSH and thyroid hormone levels, and this almost guaranteed that the patients took too little thyroid hormone and continued to suffer from hypothyroid symptoms.

After four weeks, I called him and complained. I actually felt worse than before I started the Armour. He told me to come in and have blood work done, so I went in the next day. Two days later, his nurse called me with the results. My TSH 1.16 (it was 1.24 before I started the Armour), and my free T3 and free T4 were slightly above the middle mark. He told me my results were "textbook perfect," but I talked him into raising my dose to 90 mg.

I’ve been on the 90 mg for two weeks and my symptoms haven’t gotten any better. I do aerobic exercise and weight training every day except Sunday. I also stick to a low glycemic type diet. My lifestyle is good, and I don’t think it’s what’s holding me back from getting better. I’m getting frustrated and it’s hard to keep up the positive attitude. I'm slowly getting depressed about not getting better, but there’s not much more I can do. I already work my butt off. Should I press the endocrinologist to increase my dose further?

Dr. Lowe: It's good that you have an endocrinologist willing to prescribe Armour for you. Most endocrinologists are T4 bigots; yours isn’t, and that’s refreshing and fortunate for you.

Hopefully the endocrinologist won’t keep your Armour dose too low. He most likely will, however, if he adjusts your dose according to your TSH and thyroid hormone levels while ignoring your clinical response to a particular dose. To get well, some patients must use Armour doses that are high enough to produce TSH and thyroid hormone levels that upset endocrinologists. But the lab values are meaningless in themselves, as long as a patient isn’t over stimulated and has gotten well from her hypothyroid symptoms. What's truly harmful is for a doctor to keep a hypothyroid patient’s dose too low strictly for the sake of predetermined lab values.

You said that your endocrinologist scheduled you for a reevaluation ten weeks after you started using Armour. Two to four weeks is usually enough time to evaluate the benefits, if any, from a particular dose of Armour. I see no reason to wait ten weeks for a reevaluation.

On the other hand, I hope you don’t allow yourself to sink into depression because you haven’t gotten any better after two weeks on 90 mg of Armour. Impatience is understandable since you’ve suffered from hypothyroid symptoms for years. But a little more patience is necessary to find your optimal dose. Armour contains both T4 and T3. The benefits you’ll eventually get from the product will be a combined effect of the T4 and T3. If you increase your dose of Armour, and the increased dose contains enough T3 to benefit you, you’re likely to see the benefit within a few days to a week. But you may not benefit from the T4 for one to four weeks. To see how you benefit from both the T3 and T4 in the Armour, you must wait out the lag time of up to four weeks. Hopefully you’ll wait patiently; otherwise, you’re likely compound the frustration you must already feel.

If a new dose of Armour contains too little T4 and T3 to benefit you, you’ll have to go through another evaluation period. And you’ll have to do this again and again until you find what I call your "therapeutic window"—a small dosage range that optimally benefits you without over stimulating you. That optimal dosage range is highly individual, but historically, the typical patient’s therapeutic window has been somewhere between 120 to 240 mg (2 to 4 grains). There’s no way to accurately predict what your therapeutic window is. Until you find it, you may not improve much from the Armour. But once you do, you’re likely to feel that the wait was well worth it.

Dr. Lowe: No—Armour is not dangerous when patients use it properly, and it's not about to be taken off the market.

When most hypothyroid patients first consult me, they’re using Synthroid. Some of them have been using it for only six months; others have used it for as long as thirty years.

These hypothyroid patients consult us mainly for one of two reasons. First, some have suffered from the same hypothyroid symptoms at the same intensity for so long—despite their use of Synthroid—that they're weary of it. Other patients’ hypothyroid symptoms have gradually worsened to an intolerable degree, despite their continued use of Synthroid.

After we've evaluated these hypothyroid patients, a prescribing doctor on our treatment and research team switches them to Armour Thyroid—the product with which all our hypothyroid patients begin metabolic rehab. We then guide the patients through rehab. Within one-to-three months, virtually every one of the patients fully recovers her health—that is, she becomes completely free of hypothyroid symptoms.

Despite your doctor's opinion, none of these patients are harmed in any way by using Armour. Our treatment protocol includes painstaking monitoring for possible adverse effects from thyroid hormone. Our safety monitoring over many years has given us ample objective evidence that our hypothyroid patients' use of Armour is entirely safe. And our record of Armour’s safety is consistent with that in the published research literature; that literature contains no evidence whatever of a danger in the use of Armour.

The long history of patients’ safe use of Armour makes clear the professionally responsible course of action for your doctor: First, she should educate herself about Armour’s safety record. Second, she should seriously contemplate the harm she's likely to do to patients by restricting them to chronic hypometabolism through her exclusive use of Synthroid.

Some of our hypothyroid patients who recover with Armour subsequently become extremely angry. Some were ill with hypothyroid symptoms for decades, while their endocrinologists or other conventional doctors forced them to use the most expensive thyroid hormone product, Synthroid. Then they’re well after only a couple months use of the least expensive thyroid product, Armour. To me, their anger at and contempt for their former doctors is quite understandable.

Some doctors, such as yours, have recently spread gossip about Armour Thyroid being removed from the market. I've just now spoken by telephone with an official at Forest Pharmaceuticals, the company that produces and markets Armour. She was firm that the company has no intention of ceasing to produce and market Armour. Its sales are stable. They’re stable despite unscrupulous marketing methods—such as spreading malicious gossip about Armour—by some of Forest's competitors in the drug industry, and by some endocrinologists who are complicitous with those competitors.

Hence, you can disregard your doctor's opinion as false. Patients have safely used Armour for a hundred years, and it will continue to be prescribed by doctors who are committed to getting their hypothyroid patients well. These doctors will be able to continue prescribing Armour because Forest Pharmaceuticals has every intention of keeping this excellent product on the market.

I wish you the best in finding a doctor who'll switch you to Armour. After the switch, I trust that you'll—like so many of our patients—recover from any hypothyroid symptoms the Synthroid has left you with.