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The Desiccated Thyroid Controversy: Why Endocrinologists Don't Like Armour Thyroid

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The Desiccated Thyroid Controversy: Why Endocrinologists Don't Like Armour Thyroid

If you're not familiar with desiccated thyroid, here's a quick rundown. Desiccated (dried) thyroid is a thyroid hormone replacement drug, prepared from the thyroid gland from pigs -- also known as "porcine thyroid." Some of the brand names including Armour Thyroid, Nature-throid, and Westhroid. Desiccated thyroid is a prescription drug, and it's regulated by the FDA. It has been on the market and safely used for more than 100 years. Until synthetic thyroxine (also known generically as levothyroxine, with brand names including Synthroid, Levoxyl, and Levothroid) was introduced in the 50s, desiccated thyroid was the only thyroid hormone replacement medication.

When synthetic thyroxine was introduced, there was a great deal of hoopla about how modern it was, compared to "old-fashioned" desiccated thyroid -- and many doctors switched patients over to the synthetic medication, and never looked back. Meanwhile, synthetic thyroid -- namely Synthroid -- became a hugely profitable mainstay for the various drug companies that have owned the rights to Synthroid over the years, which have included Boots, BASF, and now, Abbott Labs.

All along, Synthroid has been sponsor of medical meetings, golf outings, symposia, research grants, and speakers' fees, and is the chief provider of lunches at medical offices, patient literature, pens, pads, mugs, and other freebies, giveaways, and marketing items for decades.

We now have several generations of doctors who have been trained to believe that synthetic thyroxine -- and specifically Synthroid -- is the only thyroid replacement medication available or worth using. They simply don't know anything else. They don't know that treating and managing patients with hypothyroidism using desiccated thyroid is not especially difficult, because they've never done it, and all they've heard is negative things -- mainly from sales representatives for synthetic drugs. They hear ridiculous rumors on a regular basis -- spread by drug reps for competitive levothyroxine drugs -- that desiccated thyroid is going off the market. And they believe those rumors.

In the 1980s and 1990s, however, Armour started to make a resurgence, as interest in natural medicine was on the rise, and as patients who weren't feeling well on synthetic thyroid medication became more empowered and knowledgeable. Patients learned that there were options -- among them, desiccated thyroid like Armour, and by then, brands including Nature-throid and Westhroid.

Yes, desiccated thyroid drugs have had a resurgence -- but let's be clear: several million prescriptions a year are written for desiccated thyroid, compared to more than 30 million prescriptions a year for levothyroxine. But frustrated patients who don't feel well, coming to sites like this one, reading my books and those of some innovative practitioners, and talking to other patients, are learning that they have options besides Synthroid/levothyroxine -- and namely that some patients feel better on desiccated thyroid medication.

Over at the Endocrine Today blog, endocrinologist and osteopath Thomas Repas, DO, FACP, FACE, CDE, has done a three-part article on "Desiccated thyroid in the management of hypothyroidism," from his perspective as an endocrinologist.

It's an interesting analysis, because it will give you a pretty clear idea of how most endocrinologists view desiccated thyroid drugs like Armour, and why they are so frequently opposed -- often adamantly -- to use of these drugs. (This is in comparison to holistic, integrative MDs, who often prefer use of desiccated thyroid, because they find it works better for some -- or even most -- of their patients.)

Dr. Repas starts out by saying that he, like his peers in endocrinology, doesn't use desiccated thyroid, because "I believe that desiccated thyroid is antiquated therapy and should no longer be used."

He also claims that endocrinologists don't use Armour because of an "unacceptable level of variability batch to batch, often resulting in unacceptable variation in thyroid-stimulating hormone." Noting that levothyroxine also has variability from brand to brand, he states, "if we consider slight variation between various levothyroxine products to be clinically important, then the much larger variation within desiccated thyroid preparations is unacceptable."

In Part III, Dr. Repas climbs high up in his ivory tower to declare that while most people would not dream of "directing a cardiologist how to perform cardiopulmonary resuscitation during a cardiac arrest...otherwise reasonable people have no hesitation trying to 'teach' me about the thyroid." He then argues that the desire to be listened to, interest in natural approaches are driving the interest in natural desiccated thyroid.

Dr. Repas says his opposition to desiccated thyroid is based in science, but he fails to mention that there are no double-blind, peer-reviewed, double-blind studies that compare levothyroxine to desiccated thyroid in terms of effectiveness at resolving patient symptoms. So while he claims to rely on science, the fact is, the science doesn't exist to bolster his arguments that levothyroxine is superior to desiccated thyroid in resolving symptoms.

In fact, Dr. Repas himself admits, in the comments section of Part I:

For the record, my greatest concern with desiccated thyroid (or levothyroxine or T3) is when they prescribed in a manner that results in long-term exogenous hyperthyroidism. If a patient is not hyperthyroid and they are doing better on one product vs. another, it is very hard to argue against that.
He also concludes Part III with a truly ambiguous comment:
Finally, last week I saw a woman who had been on desiccated thyroid for decades. I explained that we now prefer levothyroxine instead of desiccated thyroid. I also quickly pointed out that her thyroid-stimulating hormone has been perfect, between 0.7 mIU/L and 1.0 mIU/L over the last several years. She had no symptoms; it was difficult for me to argue with success. After discussing and asking her what she wanted to do, she left my office still on desiccated thyroid.
It is not difficult to maintain patients on desiccated thyroid without overdosing them into hyperthyroidism. If that is his greatest concern, why would he not be willing to try desiccated thyroid in patients who don't feel well on levothyroxine. He is, after all, a trained endocrinologist with expertise at titrating doses, and keeping a patient "euthyroid" -- in the normal range -- should be simple. Especially when he sees, as he mentions, that some patients are maintained perfectly on desiccated thyroid, for decades.

As you'll see in the three articles, there are a number of comments left by patients who are enraged by Dr. Repas' article, and understandably so. On the one hand, Dr. Repas is trying to explain why he doesn't believe in Armour Thyroid, calling use of it unscientific, and claiming that fans of it are engaging in magical thinking. But without real science to support his claims, and negating the factual experience of hundreds and thousands of thyroid patients, he is showing that he is engaged in magical thinking. After all, where is the evidence that TSH detects all thyroid problems (especially when after six years, they are still arguing over what that normal TSH range is, leaving millions of patients in a non-diagnosis/non-treatment limbo!) and that levothyroxine resolves all thyroid symptoms.

At the same time, Dr. Repas also admits, from a practical standpoint, that his primary concern is overdosing a patient to hyperthyroidism on any thyroid drug -- not just desiccated thyroid. And he also admits that if a patient can be properly managed on desiccated thyroid -- and "properly managed" in his view means maintaining a TSH level in an optimal range -- then he doesn't see a reason to "argue with success."

So he won't start new patients on desiccated thyroid -- even if they ask. If an existing patient who is on levothyroxine but not feeling well asks to switch to desiccated thyroid, he won't do it. But if a patient is already on it and doing well, he won't "argue with success" and will continue to prescribe the desiccated thyroid for him or her? Where is the "science" in that approach?

In some ways, let's admit it -- Dr. Repas is more open-minded than some endocrinologists. There are some who simply will not have as patients anyone on a T3 drug or desiccated thyroid. They will refuse to see -- or fire -- patients who don't follow their direction. But Dr. Repas is also fairly representative of the narrow-minded perspective that we see amongst endocrinologists in general. Their primary concern is the "TSH normal range" -- and their treatment goal is to get patients into the normal range. Symptom resolution appears to be irrelevant, and takes a back seat to numbers management.

Are you a thyroid patient who wants to try Armour? You'll probably need to leave your endocrinologist behind, and find an integrative MD or holistic practitioner who really understands thyroid issues and is versed in use of desiccated thyroid. For more advice, read:

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