On my August 26th blog post below, I reported good information about US patients being able to use their doctor’s prescription to order the Canadian version of natural desiccated thyroid called simply “Thyroid” by Erfa.
And here’s more:
In each Erfa 30 mg tablet embossed “ECI 30”, there is 18 mcg. of T4 and 4 mcg. of T3;
In each Erfa 60 mg tablet embossed “ECI 60”, there is 35 mcg. of T4 and 8 mcg. of T3;
In each Erfa 125 mg tablet embossed “ECI 125”, there is 73 mcg. of T4 and 17 mcg. of T3.
Erfa’s very friendly and helpful Medical Director, Henri Knafo, MD, states that they follow the USP (United States Pharmacopoeia) specifications. But I do see some slight differences. The USP specifications ratio for one grain that we are used to in the US is 38 mcg. T4 and 9 mcg T3, i.e 38/9. The above ratio is 35/8.
Likewise, US patients are used to 2 grains of 120 mgs having 76 mcg of T4 and 18 mcg of T3, i.e. 76/18. In Erfa’s medication of 125 mg, you will get a ratio of 73/17. I don’t know if this will make much of a difference but want you to be aware as you work to adjust Erfa’s desiccated thyroid to the treatment you were used to.
Knapo happily states that most all “Thyroid” is making it across the border to the states without issue. You will need your doctor’s prescription. And by the way, Erfa’s Thyroid is manufactured in Belgium, plus they have a huge supply of desiccated powder.
Erfa is also working with IDIS to get Thyroid to others. You can read about them here.
Need a doctor to work with who will provide a prescription for your needed desiccated thyroid? There are a growing body of good doctors out there. We also have a good list of Canadian pharmacies you can consider using during the current shortages.
I have also received word from a gal that the FDA document 1572, a federal form that FDA requires for over-the-border movement, has not always been used, and Erfa’s medication is arriving fine. i.e. the FDA may be tolerating it.
This entry was posted on Wednesday, September 2nd, 2009 and is filed under hypothyroidism. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
Jay said:
Sep 02, 09 at 6:29 pm“they have a huge supply of desiccated powder.”
I don’t agree with this statement at all.
The ERFA website has a forum, and Dr. Knafo stated that they had a 1 year supply because they anticipated the shortage in the USA.
A 1 year supply could easily run out prematurely and cause a shortage if the demand gets too great.….……just like the RUN on the supply of Naturethroid in the last couple of months.
I have spoken to Dr. Knafo also. He told me that the Canadian Patients are the first priority. If supplies did run out, then Canadians would be helped first.
(From Janie: quote comes from Knafo. I can understand the last comment he made on your post about Canadians. Understandable. )
tina budde said:
Sep 05, 09 at 5:26 pmAlot of my members/patients have hypothyroidism, we are located at various places in the world, we are lymphedema patients and hypothyroidism goes hand in hand. I have many who currently take Armour thyroid, and now that is going to be reformatted and not available to us. I take 60mg of Armour, would this be a good choice as a substitute?
Tina
Hashi's Paul said:
Sep 08, 09 at 12:18 pmI had the Dr. office FAX a script for #500, 125mcg ERFA Thyroid on monday Aug 31st and it arrived in south Florida Sept 8th. I used CROSSBORDERPHARMACY.COM. Canada still has ERFA available, as of a week ago.
Janie.… I have looked, but cannot find any source that states “How many NDT patients or scripts are there in the USA or world???” “Does anyone have any idea how many of us there are??”
Strenght in numbers!!!!!
(From Janie: there have been estimates made, but they are just that. So the real number is unknown, I’m thinking, until we have something solidly factual)
Rose H. said:
Sep 14, 09 at 8:26 pmIs it safe to assume that if I’m taking 90 mg. of armour at this time~~ if I switch to Thyroid by Efra I take the exact same amount? Please– an answer from someone!! I plan to order from Canada this week… whole thing makes me nervous.
(From Janie: some have stated they need more; some less. You’ll have to figure it out by symptoms, I figure.)
Jen said:
Sep 24, 09 at 7:40 amI just ordered ERFA’s Thyroid from Canada. The pharmacy I went through was only able to send me 100 tablets because they are starting to experience shortages.
This is making me more than a little nervous. If we can’t get it from Canada, are there any other options?
(From Janie: go here: http://www.stopthethyroidmadness.com/options-for-thyroid-treatment)
Sandy said:
Sep 25, 09 at 5:46 amDo I need an RX to order from a Canadian pharmacy?? Also, I now take .125 mcg of Synthroid, what would my dose be with Erfa? Thanks!
(From Janie: yes, you need a prescription. And there’s no definitive equivalent. You figure that out as you raise it bit by bit. Read this page: http://www.stopthethyroidmadness.com/things-we-have-learned or Chapter 3 in the book with more detail which you can also share with your doc. Here are patient groups so you can get more feedback: http://www.stopthethyroidmadness.com/talk-to-others )
Monika said:
Sep 27, 09 at 6:38 pmIn July, I had started taking 90 mg of Armour for about 1 month when the shortage occurred. I have been able to get 100 pills of the 60 mg & 30 mg of Erfa Thyroid. I don’t know if my body needs a higher dose or if Erfa is not as potent as Armour, either case my hypo symptoms have returned with a vengeance. Has anyone experienced this being on Erfa? Janie I know you have posted there is a slight variance in the T4/T3 ratio.…..not sure if that might be playing a roll. Either case, asking Dr. to do some bloodwork this week.
Steve said:
Oct 31, 09 at 5:32 pmI recently received and started taking the 30mg ERFA Thyroid tablets as a substitute for Armour 30 mg. It doesn’t have the same effect on me either. First, a single 30 left me feeling extremely hypo. So I increased it by 25% with slightly better results. Second, for some reason, it wears off by mid-afternoon. A pharmacist at CanadaMeds.com assured me that it was the equivalent, but doesn’t seem to be having the same effect as the old Armour.
Steve said:
Nov 02, 09 at 11:13 pmI spoke too soon (see my comment on 10/31/09). I didn’t realize/know that there might be a “ramp up” period when switching from the reformulated Armour tablets that weren’t working at all to the Erfa tablets. Although I was still feeling extremely hypo yesterday (after about 8 – 10 days on Erfa), I feel pretty decent today. Thus, unless my hypothyroidism magically cured itself in the last 24 hours, I assume that the Erfa is doing its job.
Stac said:
Nov 03, 09 at 5:20 pmMonika,
I have experienced the same thing. I was on Armour, then Natur-thyroid. After the shortage hit, I ordered Thyroid (Erfa) from Canada. My hypo symptoms have also returned. MOstly hair falling out, stubborn weight, dry skin bumps on legs, rump, arms. I’m now attempting to increase the dosage by 1 grain (from 3 that worked well on Nature thyroid. Hopefully symptoms will improve (will also check with the Dr. in about 1 month).
How did your test come out?
Sonja said:
Nov 09, 09 at 2:09 pmTo Monika — I thought I got Armour about 6 weeks ago with no problem at canadadrug.com. It says Armour on the bottle, but the pill was different, so I knew it was a substitution. But it seemed to work the same or better, so I didn’t worry about it. However last week, my symptoms have returned too — fatigue, brain fog, weight gain — so I called them and they said it was a straight across deal with the Erfa dosing. Obviously not, so I started to increase my dose today. I hope you can get yours figured out. It’s nice to know I’m not the only one with problems and hopefully this is an easy fix!
Amy said:
Dec 09, 09 at 2:06 pmI am having the same problem with ERFA. I am glad to know it is not just me. I have had to increase my dosage twice already. I thought that maybe ERFA doesn’t work for me but maybe it is because of the slight ratio differences listed above? I hope so.….
Melinda said:
Jan 14, 10 at 9:32 amAbout a week and a half ago I started Thyroid. I had been on Armour and then went back to Levoxyl (YUCK). My NP’s MA said she finally found a way to get the meds from Canada so I went with that. While waiting for the Thyroid delivery I went back to the Armour I had saved. I immediately felt better!
I went from the Armour to the Thyroid when that arrived and my headaches are back. I went from 60 Armour to 1 grain Thyroid and am beginning to wonder if I need to adjust a little bit since the headaches had almost disappeared with the Armour.
Cheryl said:
Jan 23, 10 at 10:32 amI switched from nature-throid 75mg (1.25 gr) to ERFA about 2 weeks ago and definitely noticed hypo symptoms almost immediately: fatigue, muscle aches, brain fog, depression, and carpal tunnel pain. i have upped the dosage to 90mg ERFA and feel a bit better…we’ll see how it goes in a few more weeks…
n.b. the ERFA pills are quite sweet…(like the old armour) and they crumble easily when cut. i got 100 of the 60s and 100 of the 30s.…i had no problems getting my shipment from canada.
nica lina said:
Jan 25, 10 at 7:41 pmSteve…and Amy…wondering how your doing on Erfa now, still on it..did your hypo symptoms stay away?
Cheryl said:
Jan 26, 10 at 7:39 amGiving up on ERFA… a miserable 2 weeks with no signs of improvement even with increasing the dosage. In fact, I started to feel both hyper and hypo at the same time. Thankfully I was able to get some Nature-throid from Clarke’s Pharmacy in AZ. I took one pill and immediately started to feel my hypo symptoms retreating…Disappointed as I really wanted to be able to get stable on ERFA…Everyone’s system is different… It may work for some…but unfortunately not me…
Leyna said:
Feb 03, 10 at 11:56 amHow are other folks doing with Erfa Thyroid? I am on day 7, having switched from a Synthroid & Cytomel combo. Used to be on Armour, which was the best of all for me, like many others. It’s Day 7 and I’m more tired and down than I was on synthroid & cytomel. Has anyone found Erfa to get better after a few weeks, despite a rocky start? Or have the folks who found success with Erfa Thyroid felt good immediately? I’m so grateful for this chat, keeps me hanging on when I feel like giving up! Thanks, everyone.
(from Janie: I think you just need to raise it.)
Leyna said:
Feb 04, 10 at 3:31 pmJanie, thanks for your suggestion to raise my Erfa Thyroid. My doc switched me from 50 mcg Synthroid and 5 mcg Cytomel together once daily (am), to a split dose of Erfa Thyroid 30 mg in am and 30 mg in afternoon (as I used to do, successfully, with Armour). It’s only been one week, but i’m noticeably more tired and cranky — and hugely brain-fogged. I’ve seen conflicting reports on whether or not Erfa should be split into two doses. Wondering if perhaps I should try a return to a single am dose of 60 Erfa, or a raise on the split dose? Will of course check in with my doc, who is very kind and open-minded, but not familiar with Erfa (I’m her first patient trying it). Any/all thoughts greatly appreciated. Thank you!
Rich said:
Feb 05, 10 at 12:45 amI’m a recent transfer to Erfa, was on 3x1g a day (30yo Male, big guy) of Armour, was stable for 8yrs (initial diagnosis of ht). First thing I noticed when switching is I immediately went hypo, but only slightly, no brain fog, decent energy, but cold hands/feet and the carpal tunnel is the most noticeable. I am 5 days in now, and have noticed the achey hands come 4-5hrs after a dose, so it seems i need a lil more, and will be bumping up a 1/4 grain for a few days and see how I react. I am just putting this here since I have been searching for others responses on their switch to erfa from armour, and not finding much of experience stories of if they had to increase dosing or reduce etc. General comments like it works for me, or it doesnt work for me is all I have seen.
So that’s my concensus, I can tell it’s a little weaker than my Armour was, and I’ll have to adjust the dose. No choice since I can’t get Armour or NatureThroid in the Los Angeles area it seems!
Toni said:
Feb 07, 10 at 4:56 pmMay ’09 I switched to Armour since I took various synthetics (thyroidless) for 30 years. I had no change in symptoms at all. Two and a half weeks after my switch to Erfa I woke up one morning and I was shocked because it was the first time I felt well in years. I did not know that the reason I felt bad all day every day was my thyroid med. A week later though I became hyper (was on 1 1/2 60mg), so I cut it back to one 60mg and the hyper stopped, but my carpal tunnel is back. Today I started 1 1/4, I’m trying to get it right but I’m not sure how this will affect my upcoming blood work to check my levels. I have been on Erfa for 25 days now.
Leyna said:
Feb 16, 10 at 8:04 pmJust wanted to post an update. I’ve been 2.5 weeks on Erfa and after a slow start, I am feeling well again! I take 30 mg in am and 30 mg around 2:30 pm. Still having occasional afternoon dips, but they are minor and improving. My brain is back! No fog, and energy is wonderful. Erfa Thyroid was very much worth waiting for! Patience paid off for me. Hang in there for a few weeks if you can to see if it works for you.
David said:
Mar 12, 10 at 4:33 pmI have to agree with those who have moved over to Erfa having been on Nature Thyroid which was severely restricted late last year. Started off on replacement 3 grains to match Nature Thyroid but boy after 10 days on it I am going through my working day like a zombie ! I have never suffered brain fog ever until now ! Have been on Armour(the Best),then Nature, o.k as a compromise. works well.….….….….…but Erfa …does not work for me. Have know re-ordered Nature as my job demands that I am there and the last 10 days have been as bad as when if not worse than when on Synthetic T4 (The pits !!) never to return. Maybe it is the Iodine within the Erfa that maybe disagrees with my Auto Immune thyroid ? Don’t know.…but it it is not for me.
Miranda said:
Mar 16, 10 at 5:56 amI started taking ERFA a couple months ago due to not being able to get ARMOUR anywhere. My Dr prescribed me 60 of ERFA, which was the same dosage as I was on ARMOUR. I went and had my levels checked last week and my TSH is all the way up to 18. We found out that more ARMOUR had been supplied at my local pharmacy so we changed back to that at the same 60 dose. Since I switched back on Sunday I am having a choking feeling in my neck/chest, feeling like I can’t get enough air…I feel horrible. What do I do? Someone help, I am so afraid my Dr is going to use this as an excuse as to why natural thyroid is so unreliable or something. I do not want Synthroid.…
(From Janie: Erfa was not your problem; the amount was, and still is. You are here: http://www.stopthethyroidmadness.com/mistakes-patients-make For more feedback, here are patient groups: http://www.stopthethyroidmadness.com/talk-to-others )
Lisa said:
Aug 06, 10 at 7:21 pmI’ve been on 30 mg ERFA for two weeks, after switching from Synthroid (and previously Armour). I felt better immediately for a few days and then I started to notice a real dip around lunchtime accompanied by hot flashes. So I started to add a 1/2 of 30 mg before lunch and it seemed to have a calming effect. Unfortunately after about a week of the extra 1/2 tablet I started to feel hyper — lots of hot flashes all night and poor sleep. One day I took nothing and felt so much better! I’m so confused! I can’t seem to find the right dose. Without the extra 1/2 tablet I can’t even make it to 8 PM without feeling worn out.
(From Janie: you have either adrenal fatigue and/or low ferritin. http://www.stopthethyroidmadness.com/adrenal-info and http://www.stopthethyroidmadness.com/ferritin There are two chapters on adrenal fatigue in the STTM book if you have it with even more details, and more about ferritin as well. )