May 2003 -- I expect a lot from Worst Pills, Best Pills, a newsletter published by the consumer watchdog group Public Citizen, but unfortunately, they have fallen far short this time. The May, 2003 issue of Worst Pills, Best Pills, has an article titled "Do Not Use! Natural or Desiccated Thyroid (ARMOUR THYROID) For Thyroid Hormone Replacement Therapy."
This article fails the American public by mispresenting a shoddy, poorly researched and misguided
opinion piece as analysis, capped by a panicky headline. They are also veering away from their purported
mission of helping patients educate and protect themselves, instead proposing that patients limit their
options and avoid talking a safe, effective and less costly thyroid drug that may well work better for
What happened? Public Citizen is an organization that usually champions the underdog, and cautions
consumers to be careful of corporate marketing claims. They are usually the first to point up the cozy
relationships between pharmaceutical companies and medical associations. Have they themselves fallen
victim to the marketing spiels of the pharmaceutical manufacturers?
Their condemnation of Armour Thyroid reads like a marketing brochure for Synthroid, and it's clear that
Worst Pills, Best Pills did little or no research on the subject of desiccated thyroid drugs, their
prescription, or their use, as evidenced by the weak and unconvincing arguments they offer in the article.
The first argument the newsletter offers against Armour Thyroid is the following:
The Medical Letter on Drugs and Therapeutics, an independent source of drug information
written for physicians and pharmacists that we frequently cite, concluded that synthetic levothyroxine is
preferred over other forms of thyroid replacement drugs. This recommendation was made in
A 25 year old recommendation is not exactly state-of-the-art research. The newsletter article also fails
to mention that in 1977, synthetic levothyroxine was not even an FDA-approved drug. Synthetic
levothyroxine was introduced in the late 1950s, and at that time, it did not go through an approvals
process with the FDA. Rather, its manufacturers claimed it should be grandfathered in, permitted to be
sold in the same category as Armour Thyroid. Armour had been safely in use as the only thyroid
hormone replacement drug since the early 1900s.
Worst Pills, Best Pills' own editor, Sidney Wolfe, MD, wrote to the FDA in 1996, saying:
In 1978, the last year for which data are available, the FDA estimated that 240 pre-1938
pharmaceuticals were being manufactured. Of these, only 45 had submitted safety and efficacy data in
New Drug Applications, in most instances not for all dosage forms of the medication. FDA's failure to
conduct such a review has permitted these medications, which include Synthroid, the fourth-most
commonly prescribed drug in the United States with annual wholesale sales of $276 million, to remain
The article's next argument against Armour Thyroid is:
...there is no requirement for the potency of these products in regulating metabolism -
the main function of thyroid hormone.
This may be true. But it also applies equally to levothyroxine drugs.
The way that thyroid hormone replacement drugs are measured for effectiveness is in their ability to
restore and maintain a patient to normal thyroid status (euthyroid status) as measured by the highly
sensitive thyroid stimulating hormone (TSH) blood test. If thyroid patients taking Armour thyroid are,
as monitored by their physicians, able to maintain proper TSH levels - then this argument is specious.
If Worst Pills, Best Pills had done its research, they would have first talked to some of the
many thousands of physicians who are legally and ethically prescribing desiccated thyroid products to
determine if they have success with their own patients, and if patients can be properly titrated to optimal
TSH levels. Here at my site, I have articles featuring dozens of nationally known, board-certified MD
practitioners who work with desiccated thyroid when appropriate. My support forums feature thousands
of patients who are successfully treated using Armour and other desiccated thyroid drugs. As the
Worst Pills, Best Pills article itself states, some 2 million prescriptions were dispensed in
2002. There are no studies that indicate that these patients are faring any differently in terms of TSH
management than patients taking levothyroxine.