Armour Thyroid Medication Shortage

Armour Thyroid medication has been in short supply since early 2009. The original supply problem occurred in the spring of 2009 when Forest Laboratories, the manufacturer of Armour Thyroid had problems with a reformulation of the product. (Note: Armour is a brand name for Natural Desiccated Thyroid, or NDT for short). This reformulation problem resulted in patient complaints for unknown reasons, which led to decreased product availability of in the spring of 2009 as Forest Laboratories attempted to correct the problem. Currently Forest is stating that they are producing a limited supply of 1 grain (60 mg) product, but are currently unable to give a definitive date of when the product will be fully restocked.

The initial solution to the supply problem was for patients, doctors, and pharmacies to turn the other major supplier of NDT, which is RLC Labs, Inc, manufacturers of Westhroid and Nature-throid brand desiccated thyroid. This solution was short-lived however, as RLC Labs has been experienced a substantial increase in demand for their products, resulting in order processing and shipping delays, and depletion of their current stock of product. RLC’s currently states that they are “working diligently to replenish our stock and will resume shipping as soon as possible” (RLC Labs, August 17, 2009).

Unfortunately these problems have caused a great deal of distress and frustration for our patients. Given that this is a problem caused by suppliers we have a limited range of options while we all wait for the problem to be corrected. We will do our best to keep abreast of the situation, work for solutions (please see below), and provide you with updates and information as we receive it. We ask for your patience in this process and as some of you may already know, we are also asking for your involvement in locating sources of thyroid medication to fill your prescription, at your local pharmacies.

Frequently Asked Questions - Armour Thyroid Shortage

Q: Why is there a shortage of Armour Thyroid?  Is it gone for good?

A: Forest Laboratories, the manufacturer of Armour Thyroid, has not been very clear regarding the current shortage of their medication. Early in 2009 they experienced problems with a reformulation of the medication, which is believed to have caused a shortage of their higher dose formulations. This in turn resulted in increased demand and depletion of the smaller size dosages. Currently they are only shipping 60mg tablets. There has been no announcement that Armour is being discontinued, nor would we expect this to happen.

Q: What are my options? Where do I go?  What do I do?

A: You have several options:

1. Locate a source of Armour Thyroid: This will require you call your local pharmacies to see if they have Armour in a dose compatible with your prescription. You may need to call several pharmacies before you locate a supply, since the situation changes hourly as pharmacies receive and dispense their supply of thyroid medications. You can also increase your chances of locating medication by asking the pharmacy if they have any of the acceptable alternative brands (see #2 below).
2. Use an alternative but equivalent brand: Another company, RLC Labs, makes two excellent quality natural thyroid preparations by the names of Westhroid and Nature-throid. We have used these in the past without problems (we are just accustomed to Armour; there is no specific advantage to using it over these others). However, due to the unavailability of Armour Thyroid, these brands are also now in short supply. This also means that you will need to call your local pharmacies to locate a suitable supply. To simplify the process, we can rewrite your prescription using the term “Natural Desiccated Thyroid” which will allow any pharmacy to fill the prescription with whichever brand they have available (including Armour if they have it). These should all be covered equally by your insurance.
3. Use a custom-made thyroid medication: Compounding Pharmacies can custom-make thyroid preparations in any dose you need, from the same raw materials used in the brand names. Using a compounding pharmacy will allow us to write out and fax a prescription for the exact dosage you require, thus saving you time and effort. The compounding pharmacy may require payment prior to filling the prescription; if this is the case you will have to submit these expenses to your insurance company for reimbursement. The average cost is $30- $40 per month. The compounding pharmacies can mail out the prescription when it is ready. You will need to call them with your address and payment information – we will give you their phone number.

Our recommendations: Call about 4 or 5 pharmacies and ask about availability of all three brands (Armour, Westhroid, and Nature-throid) Make sure you mention your exact dose needs. If they have a supply contact us immediately so we can fax or call in your prescription. If you are unable to locate a supply, then it might make sense to pursue a custom-made prescription at a compounding pharmacy. If you would like to pursue this option, please call us and we will fax a prescription to a local compounding pharmacy for you. You will then need to contact them to provide insurance and payment information, and to let them know whether the prescription should be mailed or will be picked up.

Alternately if you don’t have time to call around, or just prefer not to, we can fax a compounding prescription into one of our compounding pharmacies for you now.

NOTE: The doses of thyroid preparations are standardized into a universal measurement called a “grain”. The milligrams will be a little different between the brands. For Armour 1 grain = 60mg, for the others its 62.5mg.

Q: Why can’t I just use Synthroid, Levoxyl or Levothroid?

A: Synthroid, Levoxyl and Levothroid are synthetic versions of thyroid hormone that contain only T4, which is the inactive thyroid hormone. The body must convert T4 into the active thyroid hormone, T3. Many things interfere with this conversion, such as nutritional imbalances, hormone imbalances and stress. We find that 80-90% of our patients do better on natural thyroid preparations which have both T3 & T4 in them. (NOTE: There is a synthetic T3 preparation called Cytomel, but we do not recommend its use because it is very short acting and causes more side effects such as heart rhythm problems (palpitations), nervousness and tremors in our patients.) It is only as a last option that we would put you on a synthetic. And please don’t let your family doctor do it either, unless we have exhausted all other means of locating a natural thyroid medication.

Q: Will my lab values change if I switch to a different form of thyroid medication?

A: We ordinarily check your thyroid labs at every visit. It is possible they will change, but we can adjust the dose easily if they do. And, since Armour Thyroid has been reformulated, it is possible they will change anyway, even if you stay on Armour. (NOTE: Please check lab slip to make sure thyroid labs are on it)

Q: What will happen if I just cut my Armour in half to make it last�or stop it altogether?

A: Your dose has been carefully determined by your laboratory results. If you cut down or stop the medication, you may experience low thyroid symptoms such as fatigue, decreased memory, focus & attention, weight gain, constipation, hair loss, brittle nails, dry skin, depression or anxiety. Thyroid hormone is also in a delicate balance with other hormones. Together they control your metabolism, blood sugar, blood pressure and cholesterol levels. In rare cases, serious consequences can occur such as heart failure or coma if you suddenly stop your medication.

Q: What if the Pharmacy doesn’t have my dose?

A: The pharmacy can use different strengths to make up your dose (i.e. two 30 mg Armour tablets instead of a 60mg, or ½ of a 180 mg instead of a 90mg). The pharmacist knows how to get the correct dose. Please make sure when you pick up your medication that you fully understand the dosage the pharmacist is dispensing, and how many pills are required to meet that dosage.

Q: Why can’t you call around to find out where I can get my prescriptions filled?

A: If we are aware of a pharmacy that recently received a shipment we would certainly let you know so you could check availability. However, the availability of thyroid hormone at the local pharmacies changes on an hourly basis, depending on when they receive their limited shipments and how quickly they exhaust their supply.  Given that we have hundreds of patients on thyroid medication it is unfortunately impossible to contact dozens of pharmacies in any given area to locate an available source.

Q: When will this be over?

A: To be honest, we simply don’t know, as the manufacturers (Forest and RLC) have not been specific, nor has their supplier of the raw material (American Laboratories Incorporated) been forthcoming with information. Realistically, it is likely these problems will continue to varying degrees over the next three to six months.

Please check our website and our newsletter for updates. If you have specific questions regarding your prescription, please call our office. General comments or questions can be posted below and we will respond as soon as possible