A fellow thyroid patient wrote in and asked a GREAT Thyroid Question. Cynthia asked what is the difference between compounded thyroid medication that has T3/T4 in it and tablets of natural desiccated thyroid. Tablets of natural desiccated thyroid would be things like Naturethroid, Armour thyroid, Efra, or the new Generic Thyroid made by Acella.
And the answer to this question is……
It depends! That’s why this is such a great question. I will explain. The active ingredients are the same in either compounded natural thyroid or the tablets that contain natural desiccated thyroid hormone, but there are some differences.
Here are the differences between Natural Desiccated Thyroid Tablets, Versus Getting a compounded thyroid medication from a compounding pharmacy
Compounded Natural Thyroid
* Consists of Natural Desiccated Thyroid Hormone
* A Compounding Pharmacy Makes the tablets according to your thyroid prescription and your health care provider’s instructions
* Has Both T3 and T4 In it
* Your doctor can specify if desired, the amount of T3 or T4 that they want added to the compound. This means that your T3/T4 levels that you would receive in your thyroid medication may be customized to your needs.
* Note: Some doctors however, do not specify a “different’” amount of T3/T4, and simply go with one of the standard formulations of T3/T4 that would come in one of the tablet preparations of natural desiccated thyroid hormone which would be 38 mcgs of T4 and 9 mcgs of T3 for a one grain or 65 mg dose.
* The fillers will vary by compounding pharmacy ** This is important, so ASK your compounding pharmacy if you don’t know what fillers they are using
* If you are paying extra for the compounded natural thyroid please do not get yours compounded using cellulose as a filler (*A much better alternative is either olive oil, or acidophilus) and your compounding pharmacy can use either of these instead of cellulose in the compound. Do not assume your compounding pharmacy will use olive oil or acidophilus—– ASK and write down the answer and then make sure that you get one of the better fillers, like the olive oil or acidophilus in your medication.
* The Cost : Compounded Natural Thyroid Is More Expensive. Because each capsule must be made one by one, there is a labor cost involved, and patients will pay extra for this. When I checked pricing, the cost to fill my own prescription for natural thyroid that was compounded was 10 times the cost compared to what I paid for Naturethroid at the time. So, do take this into consideration as it is important for some people and compounded thyroid medication can be expensive.
* Lack of flexibility to change dosing: The other big drawback, in my opinion, with using compounded natural thyroid medication vs getting a tablet, is that with compounded you don’t have the ability to easily adjust your dose. And since dosing changes are quite common, and can even occur with changes in season. Wintertime, for example, may require that thyroid patients take a larger dose of thyroid hormones, and not having the ability to use a pill splitter to adjust the does with a compounded medication makes a difference as well.
Now, let’s compare Compounded Thyroid to Natural Desiccated Thyroid Tablets.
Natural Desiccated Thyroid Hormone Tablets
For example, Natural Desiccated Thyroid Tablets (Naturethroid, Armour Thyroid, Generic Thyroid and others)
* Also consists of Natural Desiccated Thyroid Hormone
* Is available generally through any pharmacy with a prescription, and is already manufactured, does not have to be custom made
* And Has T3 and T4 in it
* Has a specific amount of T3/T4 in the medication. Some brands vary slightly, but Naturethroid and Armour Thyroid both have 38mgs of T4 and 9 mcgs of T3 per one grain tablet. Naturethroid comes in 65 mg tablets, and Armour’s tablets are 60mg tablets, however, both have the same amount of T3 and T4 in them.
* Less expensive than compounded natural thyroid hormone. Your exact costs may vary per pharmacy and if you have insurance, but generally the tablets are much less expensive than having compounded natural thyroid medication customized for you.
* Perhaps even more important, in my opinion, is that using a tablet gives the patient much more flexibility in terms of working with their doctor with regards to changing one’s dose. Most thyroid patients will have adjustments in their medication strength that is needed, and having the tablet gives the patient the ability to split the tablet into 1/2’s or even 1/4th’s with their doctor’s permission as needed during their treatment if dosing changes are required. Patients may also benefit by having their doctor’s prescribe 2x the dose that they will take per day for example, a 2 grain tablet it they are on a one grain dose, and then splitting the tablet. This can save the patient 1/2 off their costs of their medication and can be a very easy way of reducing medication costs over time. Medications are usually priced per tablet, not per mg, so in theory some tablets will cost the same regardless if you are purchasing a one or a two grain tablet. Thus, sometimes splitting the dose for those patients who can do so and who wish or need to do so to reduce costs can be a way of making thyroid medication much more affordable. Being able to use a tablet splitter when taking thyroid medication also allows the patient and doctor to collaborate on changing or adjusting doses of thyroid medication much more easily than having to have a new prescription compounded.
Note: Very important safety information about tablet splitting.
If anyone ever adjusts their medication with the approval of your physician, and you are taking a different amount than what is listed on your prescription bottle, it is very, very important to carry a medication card with you with the names and doses of all medications including over the counter and prescriptions in your wallet. It is also important to make sure that the person who would be designated as the person making your health care decisions in the event that you become unable to speak for yourself, has a a current list of your medications and dose. Your doctor should also have a list of your medications and the dose you are currently on in your medical chart, but it is always good to have a copy with you at all times for safety reasons. There are some medic-alert bracelets you can get which can be linked to an online record of your medications. This, can also be an important safety feature to make sure that in the event of an emergency, you are not overdosed.
As you can see there are certain situations where having a compounded thyroid medication could be helpful, although other times where using a natural desiccated thyroid tablet may be the best decision for you. Knowing the differences in thyroid medications is important for you to know, so that you can advocate for yourself in discussions with doctors and pharmacists about which thyroid medication is best for you.
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Haven’t been on here for a while so hope everyone is doing well, but new bloodwork has me a bit concerned, so I would appreciate feedback. I should underscore that I’m feeling the best I’ve felt in years: energy levels better, sleep better, little-to-no constipation/dry skin/hair-loss/palps/brain fog…however, my TSH came back at 0.009 (rr: 0.358-3.740 uIU/mL), which was startlingly low as last time it was 0.03. However, I realized that I’d had the test about 8-9 hours after taking 60mg of Armour (I split the 120 mg dose into 2 x’s per day, and on 4 days add another 15mg to the afternoon dose). My Free T4 is mid range, but Free T3 at the top of the normal range. Obviously, I’m concerned about the cardiac risk of supression, so would be grateful to know what you think. Many thanks and Happy Thanksgiving:-)
Armour thryroid was what I had been taking for about 5 years. My TSH is going up even when my doctor increases my dose, so he wants to try compounded. Should I just go along with that suggestion or should I ask to try another natural thyroid medicine?
I agree. Compounded medications are quite expensive, and sometimes the fillers can be problems. I didn’t do well on them, and find that taking Naturethroid, (the natural thyroid tablet) works well for me. It is way, way less expensive also, and when I need to go up by about 1/4 of a grain in the wintertime, I can easily do so by splitting up my thyroid tablet.
RE: Splitting your Tablets to Save Half off Your Medications
To the pharmacist who thinks that pill splitting should not be done. First, let’s be frank about what’s happening in terms of pricing for prescription meds. According to an Article by WebMD, the cost of prescription medications keeps increasing each year. It looks like the stats cited say patients living in the United States have paid 5x more for prescriptions since 1990. And pricing on meds according to the article has gone up 8% each year.
I agree with the person who said good luck convincing your insurance company that any problem exists if the insurer can purchase the same medication at 1/2 the cost. So the insurance company, if someone actually has it these days, will complain that they paid 50% less than they would have paid?
And with many medications these days, doctors must titrate the dose regardless so if the doctor knows that the same tablet costs $20.00 whether you get a 20mg or 40mg pill that is scored anyway and is not a danger to the patient to split, and the patient is going to start out at 20mg and then titrate up, wouldn’t that be best left up to the doctor and patient to think about getting the higher dose from the start and then splitting the tablets? I thought that was why we have doctors so that they can make informed decisions about how best to treat their patients. But some apparently in the US think that every decision a physician makes has to be second guessed or overanalyzed. Guess that’s why our Health Care System in the United States ranks among the lowest in the industrialized world. Managed care was supposed to save costs and improve efficiency. Think we’ve done a good job with that so far?
I can see it now. Requring the doctor to write a lengthy monologue in the chart explaining to the insurance company that most thyroid patients start out on 1/4 or 1/2 a grain with thyroid meds, but because the 1 grain price is the same, and due to the shortage of thyroid medications and the need for patients to not run out, he/she is prescribing the 1 grain tablet and allowing the patient to split it because the patient may soon need a 1 grain tablet which is in the range of a normal starting dose. Good grief do you see where this will lead us? That’s really going to help our escalating health care costs. No wonder as a nation we are broke!
So back to the article. I didn’t see anywhere in the article where the writer said to actually use insurance. They simply stated something that has, as others have also mentioned, is something that savvy consumers have known about for a number of years and that if someone needed to reduce medication costs this was something to discuss with one’s doctor. How many in the US now actually even have insurance? The numbers of ininsured or underinsured keep rising.
Here’s the article in WebMD that talks about this very same issue. So I guess if you’re thinking that this information should not be discussed then I guess it’s far too late to keep patients in the dark about the option of purchasing a medication in whatever dose the doctor deems necessary. Tablet splitting is not new and if the medication costs the same then that is no fault of the patient’s.
Here is the quote from a WebMD article “Some medications cost about the same, per pill, no matter what the dosage. An 80-milligram tablet of a drug might cost no more than a 40-milligram tablet. This quirky pricing gives you a big opportunity to save. Your doctor could write a prescription for double the dosage you actually need. Once you get the pills, you just split them in half with a pill cutter. And, presto, you’ve got two pills for the price of one — more or less.” Full Link to the WebMD Article
Yes, the pharmacy and drug company may make less of a profit this way so there would be an incentive from that angle to not let patients know about options on how to save money on their prescriptions.
Re: Pill Splitting Discussion
No wonder Americans pay more for their health care than any other industrialized society yet rank on the lower echelon when it comes to overall health of the residents.
Geez, talking about whether splitting a pill could get you in hot water with your insurance……
Come on, everyone, why is America losing the edge?
Let’s say for example a 30mg prescription drug costs 140.00 for a 30 day supply
in contrast the same medication 60 mg also costs 140.00 for a 30 day supply
So the patient gets a 30day supply of the 60 mg tablet because it’s the same exact cost, right? And then the patient splits the tablet so instead of 30 days, the patient’s medication will actually last 60 days, instead of 30.
So in essence instead of costing the insurance company 1680.00 per year for the patient’s medication, the insurer only has to pay $840.00.
And the insurance company is going to tell the patient, “no you have to pay more for a lesser supply of medication?”
The US has lost its marbles if that’s the way that things are done. Yes, it benefits the drug companies I guess if you pay more for the same medicine. And maybe the pharmacies that are selling the drugs themselves.
Re: Saving Money on Prescriptions
Don, I’m a nurse case manager and although I did not write the article, I fail to see where the author has said anything about patients using insurance. If a patient has insurance coverage on their medications, then cost of obtaining medication is probably not as prohibitive as for someone who does not have insurance coverage. I know with the population of patients I work with, some seniors are having to make the decision of whether to buy their prescriptions for the month, or have food to eat. So if there are medications that can be split safely, with the doctor’s and pharmacist’s approval, I think that pill splitting provides a great option for patients to be able to have access to prescription medications that they would be unable to afford otherwise.
In terms of safety, yes, you are correct, this can add another level of complexity to the care, but again, many of my patients are on medications where the dose changes frequently anyway, thus the likelihood of the dose exactly matching the prescription is unlikely. The doctor would have the current dose in the chart, and I always encourage patients to carry a wallet card in their wallet with all their current doses of both prescription and non prescription medications so that in the event of an emergency, health care professionals would have access to this information. I also encourage family members to have this information on their person at all times for those whom they may have to make medical decisions for.
Pill splitting in an of itself can be a useful tool. But like everything else, must be done under the guidance of a physician and having safeguards in place to make sure that proper dosing is communicated in the event of an emergency. Not all medications can be split safely, but this article we are discussing is about thyroid meds specifically. For anyone else out there who may be considering pill splitting it is always important to first make sure that the medication is one that is safe to split. Asking a pharmacist if a medication can be safely split is also a good first step. Talk to your doctor and discuss the benefits and risks. And in terms of whether or not this information should be shared. It is something that organizations like AARP have discussed and shared with patients for years, and other websites such as WebMD have openly published articles on the practice of pill splitting as a method of cost savings so I see no reason to keep patients in the dark about the option. Informed patients make better decisions in my view.
I only now came across this website and article, and I it has some good information in the article. The one point that I would like to bring up is the fact that the person writing the article is asking the patient to commit insurance fraud and have the doctor become an accomplice to the situation as well. There should have been more of a review done on this article before it was allowed to be posted. The other thing that should be mentioned is if the person would go the hospital and the health care providers had only the dosing instructions on prescription label to look at and could not communicate to the patient – the patient could possibly be overdosed – how would that help the patient?