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Avatar universal

Erfa or Armour?

I had been on thyroxine for ten years when I was prescribed desiccated thyroid hormone in October 2011. At the pharmacy, I asked for both Erfa and Armour to be able to compare the two. I had read so much about the reformulated Armour and all the patients having problems with it, so I was almost afraid to try it...but my doctor wants me to take it, she is on Armour herself and claims it's the best thyroid drug on the market. But after all the stories I've read, I expected Erfa to work wonders for me and Armour to be useless.

But it was the other way around.

In fact, Erfa seems to be acting much faster/absorbed much faster than Armour. Could that be the case? I can take Armour once daily (even such a high dose as the 5 grains I am currently taking) and feel fine, but with Erfa, I need to multi-dose and I find that very inconvenient. If I take 5 grains of Erfa in the morning, I start feeling hyper some time around noon and I stay hyper until the evening. Following my doctor's instructions, I swallow the Armour pills and wait about half an hour before eating.

Has anyone else experienced this, or does anyone know the reasons for this? I have to admit that I am surprised that Armour is working so well for me, after all the negative things I have read about it. And I am equally surprised that Erfa is not so great for me as it seems to be for many others.

Best Answer
798555 tn?1292787551
I've been on both Armour formulations, and currently on Erfa for near 2 yrs. The fillers make them differnt. With both brands I multi dosed per day to spread out the T3. But with Erfa digesting or taken sublingualy seems to make no difference. I need that sublingual option if I dose several times per day, I eat a lot. I'm sure if I tried one big dose in the AM, that would not work so well, and I know I'd get sleepy later.

Really if Armour works for you why change? I see your in Belgium, availabilty could be part of your choice as well.

If Armour worked as well for me, and since its more widley available here (US), I'd be on that.
2 Comments
Yes, Armour is probably more  widely available here in USA but its cost has soared!    At GoodRX.com, 30 Tablets costs $30, and I need three .25 tabs per day.  I find the cost unconscionable, as Armour is the oldest thryroid (porcine) med around.  I feel TERRIBLE on Synthetic thyroid meds (flu like symptoms, muscle aches) and I resent that the Armour has soared, soared, soared in price!
Id like to see ERFA pricing now that its 2018 to compare. Ive used NP thyrtoid for about 4 years now, it was cheap then started to go up too, not nearly as much as the new owners price Armour though. To much greed in America!!!!!!!!!!!!!!
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Avatar universal
I take NP thyroid by Acella pharmaceuticals-------it is very close to what armour was before it was reformulated twice.  It is slightly sweet and I am able to take it sublingually.  I had read that many people taking armour successfully started having symptoms again after the cellulose was increased.

My understanding is that armour should be chewed because the added cellulose makes it harder for your body to absorb.

I was given NP thyroid by a doctor that works closely with the Broda Barnes foundation.  I am also on hydrocortisone---but i was diagnosed with secondary adrenal insufficiency before i saw this doctor---I have central hypothyroidism, so my condition is a bit different than most people that are hypothyroid.

I am also on DHEA, testosterone, progesterone for 10 days a month, and a number of supplements--but only things that I was low on according to blood tests.

My understanding is that approx. 50% of people who are hypothyroid are also low in cortisol---not sure what the connection is.  The reason that barnes doctors put you on cortisol (but only after checking to see if your levels are low) is that as you try to raise your thyroid, your metabolism increases, and if you have low cortisol, it will not be able to keep up with the increased metabolism--so it is supplemented until/if your body is able to catch up and create enough of it's own cortisol.

For me, I will never make enough cortisol, and unless I am supplemented with DHEA and testosterone, i cannot maintain normal levels---i have been on both--then had an endo pull me off---and my levels dropped back down---and I had to go back to supplementing.

I have never heard that too much thyroid can cause water retention, but i have read that if you are on synthetic thyroid only, two things that will never clear up are dry skin and water retention.

I will probably always have to supplement certain hormones and probably some vitamins and minerals because my pituitary just isn't producing everything it is supposed to.

The inactive ingredients of NP thyroid are:
Calcium stearate
Dextrose monohydrate
Maltodextrine
Mineral oil
Helpful - 0
Avatar universal
As far as I've understood it, T3 is about four times as potent as T4, so 40 mcg of T3 would equal +/- 160 mcg of T4. Add to that 120 mcg of T4, and you end up with the equivalent of 280 mcg of T4.

3 grains or 180 mg of NDT is often said to be more or less equal to 300 mcg of T4 (or a little less if you argue that 1 grain of NDT = 75 mcg of T4).

Anyway, you must be seriously underdosed on 125 mg of Erfa, giving you only 73 mcg of T4 and less than half of the T3 you were previously taking...no wonder you feel bad!

3 grains of Erfa will provide 108 mcg of T4 and 25 mcg of T3. I think that its the minimum required to make you feel well. You may even need more. Some patients seem to think Erfa is quite potent, whereas others seem to find it rather weak, so it's all about trial and error.
Helpful - 0
798555 tn?1292787551
You were on a lot of synthetic T3 before. Synthetic T3 is a little more potent compared to T3 in dessicated.

I have never seen a comparison chart that includes synthetic T3 and T4. The chart mostly show just t4 only converted to MG of dessicated and there is one on the ERFA site as well as the Armour PDF on their site..

From my experience I will say that you are on the low side with only 125mg of ERFA.  Its safer to start out a new thyroid med on the low side and be hypo for a while than go hyper as it takes the body time to adjust to dessicated.

Have you been on ERFA for 5 weeks yet........if so did you get your labs checked? FT3 FT4?  That compared to symptoms is how to adjust your dose.

Sorry, cant help you with water issues, maybe start a new post if that continues.
Helpful - 0
Avatar universal
Appreciate if someone might be able to help....

I was on Levothyroxine (T4) 120 micrograms & Liothyronine (T3) 40 micrograms.

A new doctor has suggested I convert to 125 ERFA but I don not have the same energy and definitely more water retention.

Would anyone be able to help me work out how the dosages are converted?

I read a post recently regarding too much medication leading to increased water retention.

Does anyone have any thoughts/ information on this, as this is my main concern.

Appreciate any feedback
Helpful - 0
1139187 tn?1355706647
http://thyroid.about.com/cs/thyroiddrugs/l/blletter.htm
Helpful - 0
1139187 tn?1355706647
by the way - i totally disagree with this statement


" In the meantime, I was diagnosed and asked my Endo about taking Armour. She is not a big fan because she says (in her opinion) because it is made from pig thyroid gland, and the thyroid gland is not always at an exact number, it can not always be consistent in it's dose. "

In fact - synthroid has been proven to have more inconsistency than armour.   There are plenty of studies out there that i would be happy to cite that disagree with the above statement.   I feel like cr@p 24 hours a day, but I am confident that my erfra (or armour) is consistent.
Helpful - 0
1139187 tn?1355706647
i have that hyper crappiness you speak of.  Hits me like a ton of bricks.  day in and day out.  its like ground hog day...
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
The reason your link didn't work, is because the forum referred to, is a competing site and MedHelp, understandably, doesn't allow links.
Helpful - 0
Avatar universal
Do you chew or swallow your pills? I know many are unhappy about not being able to do Armour sublingually anymore and therefore prefer Erfa, but I don't like to take pills that way so that's not a problem for me. I would like to find the best method to take Armour, though; some say the pills should be swallowed, others say they need to be chewed first and then swallowed.
Helpful - 0
Avatar universal
After their prior painful experience with changing Armour, I doubt that Forest will risk any further changes.  

I can't really tell any difference in its effect on me.  I'm happy with it.
Helpful - 0
Avatar universal
There is also a thread on this forum, entitled Anyone found Armour was reformulated AGAIN in 2011? (don't think it will work to copy and paste link but hope you can find it anyway)
Helpful - 0
Avatar universal
It seems impossible to copy and paste the link here.

The site I mentioned is called Health Boards (in one word but I write it like this to make it seem less like a name that could be deleted) and the number of the post is 739276.

Hopes this helps.
Helpful - 0
Avatar universal
www.************.com/.../739276-armour-refor

It was on ************ where someone claimed his/her doctor said that Armour had been reformulated a second time in 2010/11 and was working much better since.

Does anyone know WHY Forest chose to reformulate a product that has been working so well for so many for years?
Helpful - 0
798555 tn?1292787551
"I've read that it was reformulated a second time in 2010 and the amount of cellulose slightly decreased "

- hmm. That would be a good thing. Can you recall where you read this? Would be good to see, since its apparent the the micro crystalline cellulose is to blame for the newer Armour working different for some people. I really dont understand how a company cannot understand communication - I tried that with them, got nowhere.
Helpful - 0
Avatar universal
Another question: do you swallow or chew Armour?

This is a really nice site with a lot of useful info! I have read a lot on the STTM website and found it very informative but, unfortunately, I feel like I'm the enemy when I try to say that maybe Armour isn't all bad and Erfa isn't the saving grace for everyone...it's like you HAVE to hate Armour and love Erfa on that site. Very helpful info in many ways, but slightly one-sided...here, I feel it's much easier to ask questions and discuss various treatment options.
Helpful - 0
Avatar universal
One more question: did you have to raise the dose on the new Armour compared to the old one? It seems the new one is slightly weaker and that many need to raise the dose to feel the same.
Helpful - 0
Avatar universal
It's nice to read about someone doing fine on the new Armour! I've read that it was reformulated a second time in 2010 and the amount of cellulose slightly decreased and that many have been doing OK on it since.

The problem is likely that Forest refuses to communicate with patients and therefore nobody really knows what is going on with Armour. I'm just afraid that it will be reformulated again and cellulose increased. It seems that after the first reformulation (in 2009) it was really bad and not working for anyone. So something must have changed if some are now doing OK on Armour!
Helpful - 0
Avatar universal
Your thyroid test results are pretty typical of patients taking large doses of T4 meds, except that your FT4 was still only around the middle of the range.  Your Free T3 was very low in the range (frequently associated with hypothyroidism) due to inadequate conversion of the T4 med to T3.

I went through that same scenario for well over 25 years, 200 mcg of T4, high Free T4, TSH around .05, and lingering hypo symptoms, until learning about the importance of Free T3 here on this Forum.  Got mine tested and confirmed low in the range.  Doctor switched me to Armour Thyroid.  Now I am on the new Armour Thyroid and after some tweaking of the dose (now 3 grains), my Free T3 is 3.9 (range of 2.3 - 4.2) and Free T4 is .84 (range of .60 - 1.50), and I feel best ever.  The only change being considered is adding some T4 to increase my free T4 level to the middle of the range.
















Helpful - 0
Avatar universal
OK, the only lab results are those I had done BEFORE I started on NTH; at the time (Sept '11), I was on 200 mcg of thyroxine (lab's ranges):

BLOOD:

TSH 0.3 (0.4-4.0)
free T4 1.2 (0.8-1.8)
free T3 2.2 (2.1-4.2)
S-cortisol 8 am 5.5 (10-30)
estradiol 27 (100-210) day 21 of cycle
progesterone 1.4 (5-20) day 21 of cycle
anti-TPO >60 (2000 according to doc
T4  1100 (550-3160) should be > 2500 according to doc
cortisol 30 (10-100) should be >50 according to doc


The reason my doctor decided to start my on all those meds was that I had been on thyroxine for 10 years with considerable weight gain and water retention and many other hormone deficiencies as a result. She decided I should not waste any more time.

Helpful - 0
Avatar universal
Ok back to basics.

Could you please post your lab results including their reference ranges.  And if you had them the previous results prior to starting Dissected Thyroid.

Your Dr has you on a lot of hormones in addition to Thyroid.  These all interact in very complex ways.  So there must be some specific reason for this.  Otherwise it seems wise to start off and stabilize Thyroid hormones and THEN start on other hormones.  Thyroid is so dramatic in the results on metabolism and how fast things are absorbed and operate that is the reason to start with Thyroid.  I'm not saying the others don't need adjusting, just trying to fix one problem at a time.  Otherwise they are so interconnected changing one of them affecting all the others it is hard to know what move to make next.
Helpful - 0
Avatar universal
The reason the doctor switched me from thyroxine to NTH was that my free T3 levels were suboptimal and I had symptoms of hypo such as weight gain, brittle nails, fatigue and muscle and joint pain. My doctor is a so called Barnes doc who prefers natural hormones to synthetic ones. She also put me on hydrocortison, estrogen and progesterone.
Helpful - 0
Avatar universal
I was diagnosed with Graves disease and Hashimoto's in the past year (had radioactive Iodine this past August.) I am taking Synthroid and still trying to get regulated which I understand could take me a year or so :/

My Mom was given Armour by her doctor (who at one time had to actually sell to her in the office because she couldn't get it here in the US.) the doctor is very passionate about it and takes it herself.

The weird thing was that my Mom took it for a few years and then started having these strange dizzy, throwing up, rash episodes. We couldn't figure out what they were and of course she went to doctor after doctor.

In the meantime, I was diagnosed and asked my Endo about taking Armour. She is not a big fan because she says (in her opinion) because it is made from pig thyroid gland, and the thyroid gland is not always at an exact number, it can not always be consistent in it's dose.

So there you have both opinions and there is so much written about the use of Armour on the web it's mind boggling!

The bottom line with my Mom was, she wasn't able to get back to the 'Armour prescribing doctor' right away so switched back to her left over back up meds. She's never had another problem with the dizzy sick episodes and has learned that she can no longer eat Pork!! She is now allergic to Pork! She can't eat bacon, ham - nothing!

Now that's weird!
Helpful - 0
Avatar universal
If it is an absorption issue.  Maybe a smaller dose of Erfa would work fine.

But also my recommendation would be to not fixed what is not broken. If Armour is working stick with it!

Just one question purely out of curiosity.  What changed to cause the Dr to switch from a T4 med to dissected thyroid?
Helpful - 0
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