Underactive thyroid: diagnosed.
Now: the medication.

Unless you’ve discussed this with your doctor beforehand, he or she will undoubtedly first offer you a prescription for a synthetic T4-only medication, most likely Synthroid or its generic equivalent, Levothyroxine. While it will technically keep you alive, you will not feel as if you are. I was on synthetic T4 alone for about 7 years, during which time I accumulated more and more “illnesses” that required more and more prescriptions. However, it wasn’t until I gained 20% of my body weight within six months that I finally wised up.

There is a synthetic T4/T3 combination by the name of Thyrolar, which is much better than T4 alone, as well as a synthetic T3-only medication by the name of Cytomel, which is useful if you are on T4 alone, but it is best to skip the synthetics of you can. Unsavory foreign elements are likely what damaged your thyroid in the first place; try not to add to the problem by adding synthetic elements that your body is not amenable to.

The most widely prescribed natural desiccated thyroid is Armour. Most people did very well on it, until spring 2009, when Forest Laboratories made an unannounced reformulation, which caused a resurgence of hypothyroid symptoms in many patients. To compound the problem, due to a reported lack of powdered Thyroid gland, Armour has become widely unavailable, with some pharmacies only able to obtain a limited supply of 1 grain (60 mg) tablets. The newly formulated tablets are not scored and shatter when cut, even with a pill cutter, so getting the correct dose is near impossible. Armour’s lack of availability, as well as unsuccessful reformulation, make it an unsuitable option as is; however, another option is taking your Armour prescription to your local compounding pharmacy. They will contact your doctor to approve the compounding, then make your specific dosage according to your specifications (hypoallergenic, sublingual, etc). It costs more than a monthly supply of Armour, but is very precise and is available during the shortage. A man I know said his bald spot started filling in after switching to compounded medication, which gives hope to all of us who have experienced hair loss. Just be sure to ask the right questions before getting your prescription compounded. In asking three different compounding pharmacies how they compound a prescription for Armour, I received three different answers. One used the natural dessicated thyroid, one used synthetic (Boo!), and the other would not compound a prescription for Armour; rather, the scrip must specify “Natural dessicated porcine thyroid”.

Many who have had problems with the new Armour formlation have switched to Westhroid or its hypoallergenic counterpart Nature-Throid, manufactured by RLC Labs. Unfortunately, many conventional doctors refuse to prescribe it, so you may have to find a Naturopath (ND) to prescribe it for you. In addition, these two formulations are also backordered, making them difficult to obtain.

A product called Thyroid from Canadian manufacturer Erfa has been gaining ground, due to the current US natural desiccated thyroid shortage. Patients have reported doing quite well on this formulation, though some have reported that it is not as strong as Armour, so you may have to increase your dosage. Prices per bottle of 100 tablets are as follows: 30mg/$18, 60mg/$39, 125mg/$50. Shipping to the US is $20/order, which still makes this a cost-effective option. Have your doctor or nurse practitioner prescribe Thyroid in the same dosage as Armour, then follow these instructions.

Technically, Raw Thyroid is an over-the-counter supplement; however, I want to be as free of the US health care system as possible, so am listing it here as full-fledged medication, not just a supplement. Its reviews are outstanding. I was told by the supplier that each capsule contains 50mgs of raw thyroid, but by law he could not say that it was equivalent to 50mgs of any of the prescription drugs mentioned here. I ordered a bottle and took it in lieu of Armour but using my regular dosage. Was it as good as Armour Thyroid without a prescription? I can’t say for sure – perhaps my correct dosage has gone up in the midst of all this switching and experimenting, but I would say to start with twice the Raw Thyroid as your usual Armour dosage and see how you feel.

I have found joining the Coalition for Desiccated Thyroid Yahoo Group to be a very valuable resource. Patients share experiences with symptoms, medications, and how they are dealing with the Armour shortage. Many of the contributors are very proactive about their conditions and can answer questions and share information that is not widely known or available.  Chances are that someone else is experiencing the same bodily malfunctions as you are!