bears repeating: Dear Doctor

[Guest guest]

(We have new members joining all the time, so I thought the

following deserves to be posted, even if you Armour-experts have

also read it before! grin. This was written by a gal whose doc

refused to treat her with Armour thyroid, even though she was

already on it. URL is below the letter:)

Dear Doctor ______________:

I would like for you to clarify several points which came up during

our recent discussion. You said Armour Natural Thyroid, my thyroid

replacement preference, was impure, not predictably the same

strength and old fashioned. I am concerned about this information

because I have uncovered some research which indicates flaws in this

reasoning.

Would you clarify your statements on Armour Natural Thyroid product?

If you feel those statements were valid, can you provide

documentation to confirm your opinion that Armour Thyroid is an

inferior product to Synthroid? Is Synthroid really a " new " product

or was it " grandfathered-in " around 1930? I would like to know, why,

when I changed to Armour Natural Thyroid, you didn't consider the

definite improvement in my health important? I would like to know

why you felt I was unqualified to say how my own body felt? Why

would you insist upon prescribing a drug that I have tried and does

not work well with my body?

Why do you prescribe one drug for all patients? According to Dr.

E. Langer's book Solved, The Riddle of Illness, " It is

possible, because of the liver's role in the T-4 and T-3 conversion,

to have an over-or under-conversion as a result of liver function. "

For some patients, Armour Thyroid, because it contains both T-3 and

T-4, may provide the extra energy they need to stay employed,

continue relationships, or feel good. Synthroid does not contain

both, Synthroid has to convert to T3 from T4. Furthermore, author

Dr. Ray Peat states, " Unfortunately, our physicians often fail to

understand or explain the benefits of natural (marketed under the

name 'Armour') over synthetic thyroid medication. " Though the

formula has changed somewhat in recent years, Dr. Peat calls the

natural {thyroid} " the most generally effective, " since " many people

whose thyroids are suppressed by stress cannot respond to synthetic

thyroxine, T4. " Finally, is it possible that those impurities or

unknowns you mentioned might possibly be as yet undiscovered

substances which assist thyroid function, a substance or substances

which cannot possibly exist in a synthetic product?

Your first statement during my consultation as a new patient was

that the Armour Natural Thyroid should be discarded, it was full of

impurities, it was of inconsistent strength and it " went out in the

70s. " Synthroid was the drug of choice. Armour was clearly inferior.

I explained that I felt better on the Armour Thyroid. You ordered me

to throw the Armour Natural Thyroid away and take the Synthroid

dosage you prescribed. You said that a TSH test would not be valid

if taken while on Armour Natural Thyroid. Can you document this last

statement? I understand the TSH is considered one objective

measurement for thyroid supplementation; however, I question the

inference that a patient's subjective opinion is unimportant. You

seem to disregard how your patients feel. Have there been any major

published studies indicating which product the health consumer

preferred? Customers have apparently had no choice in thyroid

medication in most instances. Therefore, sales volume is not

indicative of customer preference. Also, does the Synthroid company

fund or in any way contribute to organizations which you belong or

to the university, itself? If so, does this influence your decision

to singularly prescribe Synthroid?

At the end of my appointment, when you began to write my

prescription for Synthroid, I indicated that would not be necessary.

You asked, " Why? " I said I was continuing with the Armour Thyroid at

the dosage my family physician had prescribed. Your response

was, " You don't need to return do you? " I said, " No, I don't. " You

further explained you did not use the Armour Natural Thyroid, and

you would not treat me if I continued taking it.

Do you refuse to treat thyroid cancer patients who refuse to take

Synthroid? Should I develop thyroid cancer at some point in the

future, would you refuse treatment to me on the basis that I chose

not to take Synthroid? Can you legally refuse to treat a patient who

has thyroid cancer because the patient takes Armour Natural Thyroid?

Why should I or any patient be intimidated into taking what they

feel is an inferior product. Why should I or any patient suffer a

lesser quality of life because of physician bias for a particular

brand name?

I called Forest Pharmaceuticals, Inc. the manufacturer's of Armour

Natural Thyroid, and spoke to Neal Sailer, the Product Manager,

Thyroid Products. He is sending a packet of documentation supporting

the consistency of Armour Natural Thyroid.

He took exception that Armour Natural Thyroid is of " unpredictable

variability. " He explained that desiccated Thyroid powder is a

U.S.P. product which means potency content is consistent and he

added that the active drug product is constantly assayed during the

entire manufacturing process, the FDA insists on this for all

products. In addition, Mr. Sailer explained that samples from every

batch are retained and periodically assayed for potency. I

understand that the limit for T3 and T4 for U.S.P. Thyroid powder is

90% to 110% and natural thyroid is a more stable product than the

synthetics. Mr. Sailer would like to know how you came to a

determination of Armour being an " impure " or sub-potent drug

substance, and would like to see your data. Are you suggesting that

Armour Natural Thyroid be recalled?

Additionally, Mr. Sailer informed me of a study recently published

in the Journal of the American Medical Association (JAMA), entitled

Bioequivalence of Generic and Brand-name Levothyroxine Products in

the Treatment of Hypothyroidism, by Betty J. Dong, PharmD; et. al.

Are you familiar with the study? Why are you prescribing a product

that is 50% more expensive than Levoxyl and Levothroid? Are you

assured of the potency of Synthroid? I also understand that

Synthroid was reformulated in 1982 because the potency of Synthroid

was not near its stated content. In fact, in a letter from Dr. Betty

Dong, to the editor of The Journal of Clinical Pharmacy, Dr. Dong

assayed several 200 mg tablets of levothyroxine from several brands

and generic and found Levothroid had 99% of it s stated potency

content and Synthroid had only 78%. I understand that it was this

information that prompted the reformulation of Synthroid. I also

understand that patients were not informed of this change in

formulation, which was clearly dangerous. Which now leads me back to

the U.S.P. standard and something else I have learned about

Synthroid.

Mr. Sailer informed me that Synthroid is failing the original U.S.P.

standard for dissolution for levothyroxine preparations. It is also

my understanding that they requested and were given a separate

standard for dissolution by the U.S.P. which Mr. Sailer said was

most unusual. If this separate dissolution standard for Synthroid is

successfully challenged, Synthroid may have to once again

reformulate. Will you or the public be informed if this happens? I

understand also that there are several class action lawsuits pending

against the makers of Synthroid probably initiated as a result of

the several articles that appeared in the Wall Street Journal and

news stories that were carried on NBC Nightly News. After all of the

above, why did you insist on prescribing Synthroid? Could _________

University provide me with any information regarding support from

the makers of Synthroid, whether it is Knoll or Boots or Flint?

I would sincerely appreciate an answer with documentation, in

writing about the statements you have made about Synthroid and

Armour Thyroid. I feel these are important questions, not only for

me, but for the future physicians _______________ University

educates. These future doctors, including the student who took my

thyroid history, have not been given complete information which

would allow them and their patients to make educated decisions about

their health and their lives.

Sincerely,

Shirley E. Grose

http://thyroid.about.com/blletter.htm