Q&As
Dietary or Over-the-Counter
Desiccated Thyroid

[Q&As are placed in reverse chronological order. In other words,
the latest Q&As come first. Earlier ones are further down the page.]

October 2, 2011
Question: I have had a few phone consults with you and am on Thyro-Gold. My recent order turned out to be the bunk product you wrote about. I am leaving for yoga teacher training and the physical demands of the training are great. I'm without the good Thyro-Gold now so was forced to order porcine dessicated thyroid from Nutrimeds. I've read on the Stop the Thyroid Madness website that it's a pretty weak product. I've been taking 2 caps of Thyro-Gold. Could you please give me a comparable dosage of the 130 mg porcine caps offered by Nutri-Meds? Thank you.

Dr. Lowe: Before I begin answering your question, I strongly caution you about one thing. In finding your optimal dose of any dietary desiccated thyroid product, be gradual in increasing your daily dose. If you start by taking a set number of capsules, say four or five, you may overshoot. In that case, it may take several weeks for you to work your way back down to your right daily dose. Hence, repeating for emphasis, be gradual in moving up to your optimal dose.

You said you were previously ingesting two capsules of Thyro-Gold per day. Each capsule of Thyro-Gold contains 300 mg of thyroid powder. The two capsules you were taking contained a total of 600 mg of powder. If you switch to whole (unopened) Nutri-Meds capsules, the closest you can get to 600 mg of Thyro-Gold powder is to take five capsules of Nutri-Meds. Nutri-Meds capsules contain 130 mg of thyroid powder, so by taking five capsules, you’ll be taking in a total of 650 mg of powder.

You may want to ingest closer to the 600 mg of Thyro-Gold powder that you were taking daily. If so, you could remove a small amount of power from one of your five capsules of Nutri-Meds. You would be guessing whether you’re on target with the dose, but that’s as good as it gets with dietary desiccated thyroid products.

However, keep in mind that Thyro-Gold contains forskolin (a derivative of the Coleus forskohli plant). Forskolin adds to the metabolism-raising effects of Thyro-Gold. Nutri-Meds doesn’t contain forskolin. Because of this, you may have to take even more Nutri-Meds capsules to equal the benefits of Thyro-Gold.

Finding a dose of Nutri-Meds that equals your two capsules of Thyro-Gold will depend on trial-and-error. This means experimenting with yourself to find a dose of Nutri-Meds that gives you the benefits of the two capsules of Thyro-Gold.

This need for trial-and-error shouldn’t be cause for you to feel frustration or despair. Dosing with dietary supplements—as with prescription drugs—is always a matter of trial-and-error. Consider that nowadays, most hospitalized near-death patients in severe pain are allowed to manipulate their own individual dose of pain-killing drugs by merely pressing a button. The amount of a powerful pain-killer that works for one patient won’t for many others. Biology and perception are highly individualistic. This is just a fact of life, one that makes it next to impossible to tell an individual person, with trial-and-error, what amount of dietary desiccated thyroid will work well for him or her. I hope this explanation helps you.

By the way, we're very sorry about the temporary problem with Thyro-Gold. Within about four weeks, the original product should be available again.

April 14, 2011
Question: I'd like to stockpile some Thyro-Gold and some other thyroid products. How long are these products good when they are stored?

Dr. Lowe: Our biochemist tells us that from the time the thyroid glands are collected from animals, the thyroid powder produced from them is good for about three (3) years. It's at the end of three years that a follow up certificate of analysis is required for a particular numbered batch of thyroid raw material.

Various conditions, of course, may decrease the potency of any thyroid product before three years have elapsed. In my criticisms of the British Thyroid Association's false claims and misleading statements about desiccated thyroid (section "Instability of T4 Products," p.3), I quoted Eric P. Duffy, PhD, Director, Division of the Post-Marketing Evaluation Office of New Drug Quality Assessment at the FDA.

In 2006, Dr. Duffy wrote of T4 (levothyroxine sodium) products: "Levothyroxine sodium (T4) is labile to [prone to reduced potency] by the following: Heat, moisture, oxidative conditions, chemical reactions. These conditions typically occur during levothyroxine formulation, tableting, packaging,
and storage.”

He also wrote, “Many levothyroxine drug products have exhibited [a] history of suboptimal stability profile, significant loss of potency over shelf life, [and] inconsistent stability profiles within an individual manufacturer’s drug product line.” (Italics mine.)

Dr. Duffy was talking about products that contain only T4, such as Synthroid and Levoxyl. I don't know whether the range of other thyroid hormones in dietary desiccated thyroid are as vulnerable to deterioration as is T4. But the shelf life may be maximized if you store Thyro-Gold and other thyroid products so as to avoid the degrading conditions Dr. Duffy listed that can cause instability of the potency of T4 products.

October 12, 2009
Question: Why do endocrinologists like Dr. Richard Guttler bash desiccated thyroid and push T4? I don't understand the differences in opinion between alternative doctors like you and regular endocrinologists like Guttler.

Dr. Lowe: In her September 2009 newsletter titled Stick Out Our Necks, thyroid patient advocate Mary Shomon announced an article I wrote for Thyroid Science on Guttler's idiotic views on desiccated thyroid. I'll quote parts of what Mary wrote as an introduction to my article. Then I think it would serve you well to read my article itself to see how truly nutty are Guttler's statements about desiccated thyroid.

Mary titled her article, "Dr. John Lowe Debunks Dr. Richard Guttler's Controversial Claims about  Natural Desiccated Thyroid." She then opened with: "Researcher Dr. John Lowe, editor of the journal Thyroid Science, has made it his mission to get to the truth of issues surrounding thyroid diagnosis and treatment."

Mary then eloquently gets directly to the point: "Dr. Lowe's latest analysis focuses on the science behind natural desiccated thyroid (NDT) drugs, and the criticisms of natural thyroid made by a controversial and frequently volatile California endocrinologist, Richard B. Guttler, who for decades has been an extremely vocal and volatile opponent of natural thyroid drugs, synthetic T3 medications, and patient rights to choices in thyroid hormone replacement medication."

"According to Dr. Lowe," Mary wrote, "In this paper, I provide more evidence that [Dr. Guttler's] allegation against NDT is false. I believe it is crucial to the health and well-being of many hypothyroid patients that Guttler open-mindedly acknowledge the falsity of his claim that NDT does not provide benefits. Some clinicians may accept without question his false claim and deny patients NDT as a potentially effective alternative when they fail to benefit from T4 replacement." Maybe he believes the old Nazi line that, "Repeat a falsehood loud enough and long enough and everyone will eventually believe it's true."

Mary then wrote in conclusion, "Find out more about Dr. Lowe's analysis." The link is below, and I trust that you'll see how wrongheaded Guttler is by reading the article. She provides a link to it on her webpage below, and she provides links to other relevant Guttler issues.

http://thyroid.about.com/b/2009/09/28/john-lowe-richard-guttler-natural-thyroid.htm
 

September 26, 2009
Question: I’m confused. I read a study of yours at Thyroid Science and you say in it that Thyro-Gold, which doesn’t require a prescription, works as well as the T3 thyroid hormone called Cynomel. But I keep reading statements on web sites that the over-the-counter thyroid products don’t work well. At one website I read this morning, somebody asked about an over-the-counter thyroid product called Nutri-Meds. She wrote: "I was wondering if anyone takes Nutri-Meds thyroid medication. Are you satisfied with this product? Just if anyone has personal experience to share cause Armour is hard to get without a prescription."

Here’s the answer somebody gave her: “Nutri-Meds is a non-prescription brand of natural thyroid. Patients report that over-the-counter thyroid products, including Nutri-meds[sic], are FAR weaker than all the above [referring to Armour]. Yes, they may be good in a pinch for help, but not for long term support."

In your study, you found that Thyro-Gold works as well as Cynomel. If that's true, then why do these people say that the over-the-counter thyroid products don’t work all that well?

Dr. Lowe: The person who gave the answer is right only in one sense: If you compare the effects of a dietary (nonprescription) desiccated thyroid to prescription desiccated thyroid, and you use the exact same weight of each, you’ll see that the dietary product is weaker. But if you use enough of the dietary product, you'll induce the same measurable physiological effects as you can with any other type of thyroid product.

No offense intended, but the person's statement that such products are "good in a pinch for help, but not for long term support" is simply wrong. I know this for two reasons. First, over the years in my clinical practice, I consulted with scores of patients who recovered their health—and maintained it for years—by using a variety of dietary desiccated thyroid products.

However, for a more solid reason, I know that some of the products, such as Thyro-Gold, work as well as any other thyroid hormone products, over-the-counter or otherwise. I know this because for the past three years, I've conducted (and am still conducting) clinical trials with dietary desiccated thyroid. The main product I’ve tested, as you obviously know, is Thyro-Gold. But Thyro-Gold isn’t the only preparation I’ve tested.

As a result of this year of extensive research, I've done hundreds of metabolic measurements and other objective tests. I’ve statistically analyzed the massive data, and the results show unequivocally that when used properly, these products do indeed usually work. However, those three italicized words—when used properly—are crucially important to getting satisfactory results from using the products.

No matter which of the products a person uses, he or she must use it properly. I’ve provided a good deal of information on proper use at ThyroidScience.US. (You can learn a lot at that site from free chapter downloads, and from three particular Q&As at the site. One Q&A is on how to find the dose that's right for you, keeping track of how your treatment is progressing, and how to avoid overstimulation.)

I've read some distinctly negative criticisms of dietary desiccated thyroid by some highly-vocal naysayers on the Internet. From my communications with a few of them, I got the distinct impression that they negatively judge the products for one main reason: They used one or more of the products expecting them to work like magic bullets. Their attitude was, "Swallow the capsules for a week or so, and if they're any good, that's all I should have to do to get well.

These people's attempts to get well failed because they failed to learn a simple fact—precious few people get well simply by taking thyroid hormone, whether it's over-the-counter or prescription thyroid hormone.

Most anyone who's going to recover his or her health with thyroid hormone must—absolutely must!—at minimum engage in lifestyle practices that are synergistic to thyroid hormone. That means adopting a wholesome diet, taking a wide array of nutritional supplements, exercising to tolerance, and declining to use a number of Big Pharma's drugs that impede metabolism.

I worked with countless patients when I was in clinical practice, and since then, untold other consulting clients,  who didn’t benefit much from dietary desiccated thyroid until they adopted such health-inducing and health-sustaining lifestyle practices. 

In short, then, I respectfully disagree with the people at various websites who denigrate dietary desiccated thyroid products. When used properly, and within the context of a health-sustaining lifestyle, most such products effectively help maintain normal metabolism and optimal health. I italicized the word "help" because most people must have those other factors working along with thyroid hormone on their behalf.

 

—Continued at top of right column

Q&As
Armour Thyroid, Erfa Thyroid

 

—Continued from lower right-hand column:

November 8, 2004
Question: I've had hypothyroid symptoms for years, but they’ve been diagnosed as fibromyalgia and chronic fatigue. I don’t have health insurance, I have very little money, and can’t pay your fees or those of other consulting doctors either. I would like to know how to get desiccated thyroid without a prescription. Please let me know. Thank You.

Dr. Lowe: I sincerely regret that you've suffered so long from hypothyroid symptoms. I am also sorry that you’re in a compromised financial circumstance; I understand and sympathize.

Over-the-counter (OTC) desiccated thyroid is available through many websites on the Internet. All you have to do is type into any search engine the words "desiccated thyroid." Many sites that sell products will come up.

If you're going to use an OTC desiccated thyroid product, you should first read all of this page of Q&As and my Q&A page on desiccated thyroid. You should also get a copy of my book Speeding Up to Normal: How to Safely Get Well with Thyroid Hormone.

The book is a by-the-numbers guide to self treatment, and it includes important educational information on using thyroid hormone safely and effectively. We wrote the book mainly  for patients such you, whose limited personal finances prohibit them from paying for professional services.

I also recommend that you get a copy of Dr. Barry Durrant-Peatfield’s book, The Great Thyroid Scandal and How to Survive It. In the book, Dr. Durrant-Peatfield gives a great deal of practical information that's important to patients guiding themselves through metabolic treatment with desiccated thyroid. The publisher’s website for the book is http://www.baronsdownpublishing.com/ordercc.htm.

These books will give you more accurate and advanced information about thyroid hormone therapy than most conventional doctors have in their heads. With the information, you’ll stand a far better chance of recovering than you would under those doctors’ care. If you run into obstacles along the way, we'll be happy to help you through brief long-distance consulting. Many patients get themselves well through self treatment, and I sincerely hope you're soon one of them.

 

November 25, 2003
Question: For many years, I was on T4 for my hypothyroidism. It kept my TSH level at about 2.0, which my doctors consider normal. Unfortunately, I had hypothyroid symptoms the whole time. Based on one of your newsletters, I went out on the Internet and purchased an over-the-counter [OTC] natural desiccated thyroid product. The company I bought it from advertises that you recommend their product. The product claims to have 130 mg of dissected thyroid hormone in each capsule. After four weeks on the product, my TSH level went up from 2.0 to 96! My conclusion is that there are no hormones in this product!

When my doctor saw how high my TSH went up, he put me on 60 mg. of Armour Thyroid. He prescribed Armour because I refused to take another T4 product. After four weeks, my TSH went down from 96 to 2.29! I'm doing very well on the Armour. In fact, I haven't felt this well in many years, even though I was taking T4 all that time!

I don't know whether the OTC product I took really contains 130 mg of desiccated thyroid. But no one should have to experience what happened to me! I really want to hear what you think about this. What, if anything, do you intend to do about it?

Dr. Lowe: You're not the first person who has written to us about this issue, and it certainly deserves comment.

Your increased TSH level while you were using the OTC product indicates one of two things: (1) you were taking too few of the capsules, or (2) the capsules had little or no thyroid hormone in them.

You didn't tell me how many of the capsules you were taking each day; because of that, I don't know whether you were taking too little to keep your TSH down.

Assuming for the moment that you were taking enough, the capsules may have contained too little thyroid hormone. The thyroid hormone in all brands—both prescription and OTC—is highly susceptible to degrading. Because of this, all thyroid hormone products are subject to losing some or all of their potency. When they do, we say the products are "subpotent." Subpotent batches of Synthroid and Levoxyl have often been recalled by the FDA. And over the years, an  occasional patient of ours has found that the Armour, Cytomel, Cynomel, or other brand of thyroid hormone she was taking was subpotent.

In our experience, only a small percentage of prescription products are subpotent, and a higher percentage of OTC products are subpotent. Unfortunately, we don't know exactly what percentage of OTC products are subpotent.

We find that prescription thyroid hormone products generally—but certainly not always—provide more predictable clinical results. Still, though, we’ve found that most patients who use OTC thyroid hormone have had satisfactory results. Many patients we know have fully relieved their hypothyroid symptoms with OTC products after doctor-regulated therapy with prescription products failed to do so.

July 8, 2003
Question: I read your new book Your Guide to Metabolic Health, and I’m truly impressed. I learned many things to try to get into a healthy routine. But I bought the book for my mother. She’s hypothyroid and has fibromyalgia symptoms. I was so glad that in the book, you support every issue I’ve brought up to Mom, especially that she should be using a thyroid hormone product that contains both T4 and T3. She’s taken Synthroid for many years and it hasn’t helped her. I explained that Synthroid has only T4 in it, and now she’s willing to ask her family doctor for a product that contains T4 and T3.

Family doctors are oblivious to how to correctly treat hypothyroidism, but maybe hers will listen if she tells him what to prescribe instead of Synthroid. Can you give me the name of some prescription products that contain T4 and T3? Knowing what to ask for is a step in the right direction. Hopefully he’ll cooperate, and then my prayers may be answered and she’ll finally get well.

Dr. Lowe: Thanks for your kind estimate of Your Guide to Metabolic Health. It sounds like you plan to improve your own metabolic health with the methods we describe in the book, and perhaps your mother will, too.

Doctors have a choice of prescribing any of several brands of thyroid hormone that contain T4 and T3. Armour Thyroid is the most commonly prescribed brand. (Erfa Thyroid from Canada is competing well with Armour now) Armour is desiccated (dried) thyroid taken from pigs. Thyrolar is a synthetic brand that contains the same ratio of T4 to T3 as Armour.

Many of our hypothyroid patients use Armour. Most of them fully recover from their hypothyroid symptoms when they reach a high enough daily dose. It's noteworthy that the patients recover with Armour after having failed to improve enough—if at all!—with the use of Synthroid, Levoxyl, or other brands that contain only T4. A small percentage of patients do well with brands that contain only T4. But many years of clinical experience have compelled us to a firm conclusion: Brands containing T4 alone provide most hypothyroid patients with distinctly inferior treatment results. Because of this, none of our patients use such brands anymore.

I hope your mother’s doctor will cooperate and switch her to a more effective thyroid hormone product than Synthroid. If he does, you’re likely to see her undergo a rapid and full recovery—assuming, of course, that she uses the other metabolism-regulating therapies and lifestyle practices I describe in Your Guide to Metabolic Health. Please give your mother my best wishes.

 

Our Educational Consulting Service We provide educational consulting to both patients and clinicians. Phone us at 603-391-6061, or preferably, write to us at  Tammy@drlowe.com. Our fax number is 303-496-6200. —Tammy Lowe

February 15, 1998
Question: Four years ago I was diagnosed with fibromyalgia. I have had my thyroid level tested and my doctor tells me it comes back "normal". She has, at my request, prescribed Armour Natural Thyroid at 60 mg daily. Is this enough?

Dr. Lowe: Whether 60 mg of Armour is enough for you must be determined by you and your physician. In general, however, 60 mg is not enough for improvement or recovery from fibromyalgia. It should help to put this dosage of Armour (desiccated thyroid) into proper perspective. To do so, I'll convert your dosage of Armour into the equivalent dosage of T4 (thyroxine) required for most hypothyroid fibromyalgia patients to improve or recover.

Most hypothyroid fibromyalgia patients respond only to 200-to-400 micrograms of T4 (0.2-to-0.4 milligrams). Few patients benefit from the 100-to-200 micrograms of T4 that most clinicians unjustifiably restrict them to. Some writers state that your dosage, one grain (65 mg), of desiccated thyroid provides the equivalent of 80 micrograms of T4. [Actually, desiccated thyroid contains both T4 and T3]. For example, one grain of Johnson's desiccated thyroid contains 38 micrograms of T4 and 9 micrograms of T3. T3 is often reported to be four times more potent than T4. Thus, in terms of potency, the 9 micrograms of T3 is roughly equivalent to 36 micrograms of T4 (9 x 4=36). So it could be argued that the total potency of the thyroid hormone in one grain of Johnson's desiccated thyroid is equivalent to about 74 micrograms of T4 (38 micrograms from T4 + 36 micrograms from T3 = the potency equivalent of 74 micrograms of T4).]

From this consideration, one might assume that to benefit from Armour thyroid, a patient must take enough to equal the potency of 200-to-400 micrograms of T4. If this were true, it would be necessary to take between 2½ to 5 tablets of Armour per day. (2½ tablets would have a potency roughly equivalent to 200 micrograms of T4; 5 tablets would have a potency roughly equivalent to 400 micrograms of T4.) But this assumption would be incorrect. Most hypothyroid fibromyalgia patients improve on lower dosages of Armour than this. The likely explanation is that the potency of the T3 in the Amour is actually equivalent to more than four times the potency of T4. Some recent publications suggest that T3 may be 10 times more potent than T4.

The bottom line is this: While mathematical conversions can be fun, they don't help us determine how much Armour a patient will need to improve. A patient's effective dosage must be determined on an individual basis, with the patient and physician closely cooperating. To find that dosage, the patient's fibromyalgia status should be objectively measured repeatedly (as with the five fibromyalgia measures we use in our research studies). So should certain physical measures, such as the Achilles reflex and pulse rate. A comparison of the repeated measures as time passes will show whether the patient is benefiting from a particular dosage. If not, the physician may need to gradually increase the dosage until the repeated measures indicate improvement or recovery. In most cases, the patient's subjective assessment of his or her improvement corresponds closely with the changes in the objective measures. And it's important to remember that the patient's TSH level is of no value in determining the proper dosage.

The response to desiccated thyroid is difficult to predict simply through mathematical conversions. However, many patients benefit from it after they've failed to benefit from T4 alone.