We had a great Thyroid Patient Community Call Friday night on TalkShoe with John Voliva, RPh, the President of Hooks Apothecary in Evansville, Indiana. Hooks Apothecary is a compounding-only pharmacy that has been in existence for ten years and is a small and high quality family-owned business.
And with our current shortage of desiccated thyroid via the tablets we were used to, compounding pharmacies are a good alternative in the meantime. Here’s what we learned from Mr. Voliva:
1) Different compounding pharmacies will use different fillers. Hooks Apothecary, for example, uses powdered acidophiles, the “active culture” which helps replace the good flora in your gut and improves digestion.
2) Compounded desiccated thyroid can be more expensive for two reasons: they acquire smaller amounts of the powder as compared to the huge amounts obtained by a pharmaceutical like Forest, and it takes time to compound it.
3) A good compounding pharmacy will give you the Certificate of Analysis right when you ask for it, and you should ask for it. This Certificate will tell you how much T4 and T3 is in one grain..and it’s not always simply 38/9 mcg. It could be 35/8.6 or 39/8.5 per grain…for example. Find out because there are allowed deviations of 10 mcg +-. A really good pharmacy will shoot for an even better deviation and will also produce that Certificate right when you ask for it, not a day later. To not receive that documentation right when you ask implies they really weren’t paying much attention to the deviation.
4) A compounding pharmacy will get better deviations when they create a 65 mg grain of compounded desiccated thyroid than when they create a 60 mg grain.
5) Top notch Compounding Pharmacies will be accredited by, or be close to completing the steps towards, the Pharmacy Compounding Accreditation Board.
6) Compounding pharmacies can’t make a desiccated thyroid trouche because of the problems with heat in the processing of the trouche.
7) Mr. Voliva feels it would be too easy to overdose with transdermal (on the skin) desiccated thyroid.
8 ) Compounding pharmacies, via their 5 – 6 distributors, get the powder from American Laboratories. But not all compounding pharmacies will be as diligent as others to make sure the deviation is closer to 5%.
9) If the compounding pharmacy is getting their powder via the distributor PCCA (Professional Compounding Centers of America), you can be assured you are getting a good product. Ask the pharmacist where they are getting it.
10) Compounding pharmacies generally have plenty of desiccated thyroid powder.
My apologies to a group of callers whose chat questions I wasn’t able to see. I have sent a question about that to Talk Shoe’s Customer Support to find an answer before the next Community Call. But on the good side, the audio worked on everyone’s computer.
This entry was posted on Saturday, September 19th, 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.
Siobhan said:
Sep 19, 09 at 7:41 amIs there any chance these calls will ever be recorded so that those of us unable to attend can listen to them later?
(Hi Siobhan. Yes! We finally worked out the bugs and it was being recorded. Yet, for some reason, there is nothing to listen to when you click on LISTEN for the Episode on Compounding Pharmacy. So I’ll go back to TalkShoe and work this out before episode 4. Sorry about that. You’ll hear Diane typing in the background on this one, plus her saying Test, Test and Can you hear me. lol. Then it stops. Weird since it clearly shows that the call was 1 1/2 hours. We’ll get this all smoothed out with each future episode. http://www.talkshoe.com/talkshoe/web/talkCast.jsp?masterId=62603&cmd=tc ALSO NOTE THAT FUTURE THYROID PATIENT COMMUNITY CALLS will be held on THURSDAYS and one hour earlier.)
John S R.Ph. said:
Sep 19, 09 at 7:34 pmIf you switch to a compounded formulation of Thyroid, I’d be ready to have the dose tweaked. If absorption is a little different from Armour, you may not have the same effect, even though the C of A show the correct level. This shouldn’t concern you though as all thyroid therapy should be individualized. between lab tests that include free t3, free t4 and TSH for cya and MOST IMPORTANTLY how you feel should be the most important factors.
Michelle said:
Sep 20, 09 at 12:06 pmThanks for this information. I’m having severe palpitations and insomnia on Nature-Throid — I’ve been on it a month and a half. My heart rate goes to 90 the second I put it in my mouth. I’m taking it sublingually. Is anyone else having this problem?
Dave said:
Sep 23, 09 at 8:34 amAfter having been on Armour for at least four year successfully (I thought-60mgs.), things got weird at the beginning of year (palpitations at night, had to get a new blood pressure med to counteract palps). Through this site I learned about reformulation of Armour (my cause?). I couldn’t get Armour (maybe luckily) and started Naturethroid today (65mgs.) What do I do now about taking
(sublingual or swallowing), monitoring for proper dosage, etc. Any help very much appereciated
(From Janie: Here are patient groups where you can get feedback from other patients: http://www.stopthethyroidmadness.com/talk-to-others)
Cat Dromont said:
Sep 23, 09 at 11:40 amAge: 52
Sex: Female
Health problems: Thyroiditis or Hashimoto’s; a form of hypothyroid.
I knew that my health problems started from my thyroid condition way before I was “professionally” diagnosed hypothyroid in 1997. I was always active — in work and in play. I walked everywhere, yet I gained 80 pounds in six months and this was 10 years previous to the hypothyroid diagnosis! I knew my symptoms were all related to my disease and that I needed help. I will not list my symptoms here, as they are too numerous. I can include them at a later date if anyone is interested or it is helpful.
I went to MCPN/CICP for indigent care offered thru the Colorado Health Dept. after I had to give up Kaiser. I was paying $8880.00 a year for a “condition” where symptoms were so many that I was given tests every 30 – 60 days. Yet I was told I wasn’t that sick. I had exhausted every clinic and doctor in the MCPN network and finally was referred to an endocrinologist at the main hospital in Denver. I was allowed only levothyroxine. L-thyroxine or T4, a storage hormone in theory is supposed to convert into the active T3 in the liver. T3 is what the cells of the body need to create enough energy while keeping the cells from oxidizing.
Hypothyroidism is a doubled edged sword because if undertreated or mistreated, it creates myriad manifestations that develop into other diseases; i.e. heart disease, kidney and liver problems, diabetes, rheumatoid arthritis, lupus and many, many others.
Many of my visits with doctors left me depressed and I was given antidepressants by them and was told I had “too many symptoms” and while they could NOT be related to Hashimoto’s, the anti-depressants will remove pain and “other things”. Their drug insistence only increased my symptoms. I have been told that taking Armour Thyroid causes osteoporosis and high lipid panel ‘readings’, yet when I asked for substantiation of these claims I received none.
More advice came from an associate professor of endocrinology – and a thyroid specialist. This specialist, as do others, refused to allow me the bio-identical meds I knew would help me, based on my own research and findings. I was becoming sicker, and again the doc gave me other drugs for high lipids and hypertension, but these were signs that my thyroid condition was not changing for the better. She said in one of our visits, that if I didn’t take enough Levothroid, it [my lack of health] was really my own fault because, she said, “I am trying to help you”. My options were limited at that time and I continued with her for two years. It wasn’t working. I was feeling worse.
After searching every clinic, taking the uninsured, I found someone whom I thought would help and allowed me to have Armour. She took my labs, took the research I found and discovered that my antibodies were in quadruple digits and treated me for about 6 months until I needed an increased dosage of Armour. She told me twice that she “did not know how to dose Armour”. While she said she would prescribe it, she now claimed that the FDA has a limit on the amount a person can take; “no more than 180mg. and you are at that limit”, said she. I assumed she did not know about the shortage, since she didn’t get dosing instructions from Forest Labs. If I could get this vital information, I knew SHE could. Her claims are not factual, and unsubstantiated because the FDA has no connection to Armour Thyroid. It is a ‘grand fathered’ pill that has been used for over 100 years. However, the formulation has changed a few times and it is not as potent as it once was and Forest Labs has said they are behind on production.
Now, I am taking a lesser amount of Armour, firstly because it is so difficult to get and secondly because the “health-care pro’s” I have seen DO NOT KNOW how to dose it, even if I could find a pharmacy that has enough of it! After calling in all the prescription refills that I have coming, the pharmacy must call around to see what dosages are on hand, so it takes about a week to get this medication [I am running out of options]. Winter will be here and without a dosage that is a little higher than 180mgs, I will continue to have worse symptoms; especially since I have had to decrease the amount from 180mgs. And the circle continues, causing more illness, more stress and the need for more Armour.
Every time I suffer this decrease in my meds, it harms me exponentially. I have been battling doctors’ lack of knowledge and compassion for years and I am tired.
My Letter to Consumer’s Report on Health Care
Wednesday, September 23, 2009
loran thompson said:
Sep 28, 09 at 9:31 amI have been researching this for awhile now and have found that Erfa pharmaceuticals in Canada has Armour Thyroid. Google ERFA thyroid and you’ll find it. I haven’t tried it yet, but I’m going to order it today. Hope that helps.
Pat said:
Oct 26, 09 at 11:38 amI switched to Canada’s ERFA Thyroid when my town ran out of Armour, and for me it DID NOT WORK AT ALL !! I am so so sick now, that my doctor (a DO, BTW — much more useful than an MD IMHO) had to double my dose of Armour to make up for the months that I have been without !