There have been supply issues with Forest Pharmaceuticals (makers of Armour and Thyrolar/Liotrix which is the synthetic T4/T3 blend) off and on for several years now. They release a batch every so often, just to keep us on our toes. Basically every month I have to call every pharmacy in the phone book to find out if they've got any in stock either at the store or the warehouse, and the minute I find some I race to the store with my bottle to score some. I've tried to buy more than one months' worth at a time but no one will let me because there are other patients who need it too. I think I've transferred my script just about every month in the last year. Major Pharmaceuticals has stopped manufacturing their generic version of Armour entirely.

Westhroid and Naturethroid are very hard to find even when things are normal (usually must be specially ordered) but are also dessicated porcine thyroid products like Armour. Unfortunately, the pharmacist cannot just substitute them for Armour because they are measured in "grains" rather than milligrams - for instance, Westhroid 1 grain is roughly equivalent to 65 mg of Armour, but the Armour is 60mg. Here's a good website about various things you can do to get Armour or Armour-analogues, including having it compounded. I'm willing to go the compounding route if I have to, even though my insurance won't cover it. I couldn't get an appt with my endocrinologist for earlier than January, although I'm on a cancellation list with about 50 other people.

The last time we had a major supply issue with Armour, where it simply was not available for love nor money for several months a few years ago, my endocrinologist (different one from the one I have now) first tried to put me back on plain generic Synthroid, but I cannot properly convert T4 to T3 so my hypo symptoms all came back with a vengeance. So, she added Cytomel (synthetic T3) which had pretty nasty side-effects for me, like heart rhythm changes after each dose - pounding heart, skipped beats, erratic rate (fast then slow then fast again), along with quite a few hypERthyroid symptoms, although my hypo ones didn't let up. I ended up having to take tiny doses every 2-3 hours so that I didn't feel like my heart was trying to leap out of my chest, and I was feeling both hypo and hyper symptoms at the same time even though my labs looked all right. It was a pretty miserable several months - I was calling pharmacies every couple of weeks to see if they'd gotten Armour back yet.

I'm on the hyPER side of thyroid issues so don't take Armour, but I've heard of folks having some luck finding stashes at big-box pharmacies, so call places you might not expect would have any left.

JM - it sounds like you find tiny doses effective? I'm asking because I take an anti-thyroid drug and am down to 2.5 grams per day so I stopped dividing it, thinking it wouldn't make a difference. I know it's a different drug than you're taking, but I'm curious what you think about splitting doses.

oops, make the 2.5 mgs, not grams!

goldgirl, I take 120mg of Armour per day (2 60mgs, because 60s are pretty much all that's available). I would like to knock it up to 150mg because I prefer to run my TSH under 1.0 - 120 gets me to between 1.5 and 2, which my endo thinks is fine, but he's not the one living in my body. At 2 I'm still dropping hair, unable to budge a pound, scratching like I've got fleas (dry skin itch), etc. etc. That's a middlin' dose, from what I can tell. I've actually had the best luck finding it at the little independent pharmacies, oddly enough, but I just pull out the yellow pages and start with "A" and keep going down the line until I find some.

Armour doesn't often split well IME - it has a tendency to crumble. (I've been on some odd "tinkering" dosages that required dividing pills.) My feelings on splitting pills in general vary with the medication. Purchasing a higher-dose pill and dividing it can definitely be a cost-saving measure; my Lamictal (mood stabilizer) dose is 300mg, but for some silly reason 1 1/2 200mg tablets is cheaper than 2 150mg ones. They're scored, so they're clearly considered divisible (I think that's the right word, brainfogged this morning). Enteric tablets (those that are coated to dissolve in the intestines) and sustained/extended-release pills should NEVER be cut. Capsules can actually be divided but it's a pain - if you're going for a half dose, you measure out something like 1/4 cup of applesauce or baby food, thoroughly mix in the contents of the capsule, and eat half the applesauce. Refrigerate the remainder and use it up at your next dosing time.

Or do you mean dividing doses as in "take X amount 3 times a day" vs. "chuck it all down at once"? Depends on the medication and is something to go over with the prescribing practitioner. With some meds the half-life is so short that you do need to dose more frequently to keep a consistent level in the body, or perhaps the side effects are problematic if you take the whole day's dose at once but aren't if you divvy it up (I've had that happen). With the Armour I never noticed a difference whether I take it all at once or divided it AM/PM, so I just toss it down with the rest of my morning meds/(appropriate) supplements. (Anyone who takes thyroid medication should know that you should never take iron or calcium within 4 hours as it interferes with absorption, so I take my vitamins at night.)

Are you on Tapazole or PTU? DH has Graves' (in remission for about 12 years now, thank heavens, but we watch him carefully) but was terrifyingly allergic to Tapazole. It wasn't discovered until he had a thyroid storm (T3 toxicosis) that nearly killed him. Some time on PTU and symptoms went away, all numbers are fine. I am glad we refused the surgery and RAI we were pushed toward that would have sent him into hypo. Hypo sucks.

Johnmari-are your saying that you can take your empty pill bottle to a different pharmacy than where the last prescription was filled and have the new pharmacy fill your prescription? I called numerous pharmacies to find the Armour, then went to that new pharmacy with my bottle. That pharmacy said they had to get the prescription transferred from the previous pharmacy. They couldn't "hold" the Armour for me and by the time they had the prescription the Armour supply had been sold. Any secrets on how to succeed?

Yes, Vickij, that's what I do, just bring my empty bottle to the new pharmacy. Luckily, I'm in the computer at just about every pharmacy in three towns. LOL I have them do the transfer while I wait - it's not a complex procedure and they generally don't push it off until it's convenient (as sometimes happens with transfers) if you're standing there - and thus far every pharmacy I've been to has been ethical enough not to sell their supply of any medication out from under me when they have a valid rx bottle or box sitting on the counter to be processed and they've told me they had it in stock.

Your other option is when you have your doctor's appointment, have him/her write a separate paper prescription for each month's supply, no refills, to cover you until your next appointment. Hardcopy prescriptions for non-controlled substances are good for 12 months. They'll moan and whine but if you explain the situation they're usually more cooperative. Then when you call around and find some Armour, you can run over with a fresh paper prescription to fill rather than wasting time with transfers. That's what my previous endo did during one of the past Armour shortages. I plan on doing a combination of this and having my prescriptions written differently so they can be filled with any dessicated thyroid product rather than just Armour, if I don't go the compounding route. The way the script should be written is "Natural desiccated thyroid" and the amount in grains rather than milligrams. I may also have him write the scripts so they can be filled with either 2 pills of 1-grain (equivalent to 65mg) or 1 pill of 2-grain (130mg) in order to get maximum flexibility.

If I could get to my doctor's office now, I'd have him set me up for a several-months' supply of Armour 240mg and to heck with the crumbling problem when splitting them, since drugstore.com does have 240mg and 300mg in stock, and just pay for it myself. 180 tablets of 240mg (which would be a year's worth for me) is about $140.

People have been reporting problems importing natural porcine thyroid from Canadian pharmacies, including confiscation of the meds by US Customs, but if you're interested in going that route here's a list of supposedly reputable online pharmacies.

See, problem is that natural dessicated thyroid was never actually approved by the FDA under modern standards - it was "grandfathered" in as legally prescribable because it had been in use for many years when the FDA was established. Unfortunately, the FDA is seeking to rescind that and force the manufacturers to go through the entire FDA approval from scratch. This is not likely to be profitable for the manufacturers. There is also pressure on the FDA from groups like American Association of Clinical Endocrinologists and the American Thyroid Association, both of which advocate removing natural thyroid from the market entirely, claiming it's "dangerous" and "unreliable" compared to levothyroxine (Synthroid, etc.). However, both groups and their members do accept grants and other financial support from the manufacturers of levothyroxine drugs, which creates a major ethical issue.

Okay, just when I thought the problem was getting better, I read all this. My head wants to explode. I found a supply of 60s last month and grabbed some. Had assumed that by the time I ran out, the supplies would be more consistent.

What bugs me the most is how Forrest is not forthcoming about what the problem is. I keep hearing September....October....and so on. Yet, still the problem has not been resolved.

Thanks for the tip on drugstore.com and the 300s, Mari. I agree that splitting has its drawbacks, but I am on 150 and it's better than carving up the 90s like I did this Fall.