Thyroid (armour) 4gr (240mg) Tabs
WARNING: Do not use this drug for weight loss. Severe and sometimes deadly side effects may happen with this drug if it is taken in large doses or with other drugs for weight loss. If you have questions, talk with the doctor. @ COMMON USES: It is used to add thyroid hormone to the body.It is used to treat or prevent an enlarged thyroid.It is used to manage thyroid cancer.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Thyroid hormone replacement
Pharmacologic Class
Thyroid hormones
Pregnancy Category
Category A
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
This medication is a natural thyroid hormone replacement that contains both T4 and T3 hormones. It is used to treat an underactive thyroid gland (hypothyroidism) by replacing the hormones your body isn't making enough of. It helps regulate your body's metabolism, energy levels, and overall function.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. It's best to take this medication on an empty stomach.
Important Notes About Different Brands and Forms
There are various brands and forms of this medication available. Do not switch between different brands or forms without consulting your doctor first.
Interactions with Other Medications and Foods
Do not take colesevelam, colestipol, or cholestyramine within 4 hours before or 4 hours after taking this medication. Additionally, some foods like soybean flour (found in infant formula) may affect how this medication works in your body. Discuss this with your doctor.
Establishing a Routine
Take your medication at the same time every day. Continue taking your medication as directed by your doctor or healthcare provider, even if you're feeling well.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding the bathroom. Keep all medications in a safe location, out of reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you're unsure about the best way to dispose of your medication, consult your pharmacist. You may also have access to drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next dose, skip the missed dose and resume your regular schedule. Do not take two doses at the same time or take extra doses.
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. It's best to take this medication on an empty stomach.
Important Notes About Different Brands and Forms
There are various brands and forms of this medication available. Do not switch between different brands or forms without consulting your doctor first.
Interactions with Other Medications and Foods
Do not take colesevelam, colestipol, or cholestyramine within 4 hours before or 4 hours after taking this medication. Additionally, some foods like soybean flour (found in infant formula) may affect how this medication works in your body. Discuss this with your doctor.
Establishing a Routine
Take your medication at the same time every day. Continue taking your medication as directed by your doctor or healthcare provider, even if you're feeling well.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding the bathroom. Keep all medications in a safe location, out of reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you're unsure about the best way to dispose of your medication, consult your pharmacist. You may also have access to drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next dose, skip the missed dose and resume your regular schedule. Do not take two doses at the same time or take extra doses.
Lifestyle & Tips
- Take this medication exactly as prescribed by your doctor, usually once daily on an empty stomach, at least 30-60 minutes before breakfast or at bedtime (3-4 hours after the last meal).
- Avoid taking this medication at the same time as calcium, iron, antacids, or fiber supplements. Separate doses by at least 4 hours.
- Do not stop taking this medication without consulting your doctor, even if you feel better.
- Inform your doctor about all other medications, supplements, and herbal products you are taking, as they can interact with thyroid hormones.
- Regular blood tests (TSH, Free T4, Free T3) are essential to ensure you are on the correct dose.
Available Forms & Alternatives
Available Strengths:
- Thyroid (armour) 2gr (120mg) Tabs
- Thyroid (armour) 0.25gr (15mg) Tabs
- Thyroid (armour) 3gr (180mg) Tabs
- Thyroid (armour) 4gr (240mg) Tabs
- Thyroid (armour) 5gr (300mg) Tabs
- Thyroid (armour) 0.5gr (30mg) Tabs
- Thyroid (armour) 1gr (60mg) Tabs
- Thyroid (armour) 1.5gr (90mg) Tabs
- Thyroid 1.5gr (90mg) Tablets
- Thyroid 0.5gr (30mg) Tablets
- Thyroid 0.25gr (15mg)tablets
- Thyroid 2gr (120mg) Tablets
- Thyroid 1gr (60mg) Tablets
Dosing & Administration
Adult Dosing
Standard Dose:
Initial: 30 mg (0.5 grain) orally once daily, titrated in 15 mg (0.25 grain) increments every 2-3 weeks based on clinical response and laboratory parameters (TSH, Free T4, Free T3). Maintenance: 60-120 mg (1-2 grains) once daily. The specified dose of 240 mg (4 grains) is a high maintenance dose, typically reserved for severe or resistant hypothyroidism.
Dose Range:
15 - 300 mg
Condition-Specific Dosing:
hypothyroidism:
Individualized based on patient response and laboratory values. The 240mg (4gr) dose is a high maintenance dose.
Pediatric Dosing
Neonatal:
Initial: 4.8-6 mg/kg/day (0.08-0.1 grain/kg/day) orally once daily, adjusted based on TSH and T4 levels. Not established for this specific high dose.
Infant:
Initial: 3.6-4.8 mg/kg/day (0.06-0.08 grain/kg/day) orally once daily, adjusted based on TSH and T4 levels. Not established for this specific high dose.
Child:
Initial: 2.4-3.6 mg/kg/day (0.04-0.06 grain/kg/day) orally once daily, adjusted based on TSH and T4 levels. Not established for this specific high dose.
Adolescent:
Initial: 1.2-1.8 mg/kg/day (0.02-0.03 grain/kg/day) orally once daily, adjusted based on TSH and T4 levels. Not established for this specific high dose.
Dose Adjustments
Renal Impairment:
Mild:
No specific dose adjustment generally required.
Moderate:
No specific dose adjustment generally required.
Severe:
No specific dose adjustment generally required, but monitor closely for signs of over- or under-treatment.
Dialysis:
No specific dose adjustment generally required, but monitor closely.
Hepatic Impairment:
Mild:
No specific dose adjustment generally required.
Moderate:
No specific dose adjustment generally required, but monitor closely.
Severe:
No specific dose adjustment generally required, but monitor closely due to hepatic metabolism of thyroid hormones.
Pharmacology
Mechanism of Action
Desiccated thyroid contains both levothyroxine (T4) and liothyronine (T3), which are synthetic forms of endogenous thyroid hormones. These hormones exert their physiologic actions through control of DNA transcription and protein synthesis. They regulate metabolism, growth, and development by binding to thyroid hormone receptors in the cell nucleus, leading to gene expression modulation.
Pharmacokinetics
Absorption:
Bioavailability:
Variable; T4 approximately 48-80%, T3 approximately 95%.
Tmax:
T4: 2-4 hours; T3: 1-2 hours.
FoodEffect:
Decreased absorption when taken with food, certain medications (e.g., calcium, iron, antacids, proton pump inhibitors), or dietary fiber.
Distribution:
Vd:
T4: 10-12 L; T3: 0.46 L/kg.
ProteinBinding:
T4: >99% (primarily to thyroxine-binding globulin, transthyretin, and albumin); T3: ~80% (less tightly bound than T4).
CnssPenetration:
Limited for T4; better for T3.
Elimination:
HalfLife:
T4: Approximately 6-7 days (euthyroid); T3: Approximately 1 day.
Clearance:
T4: 1.1 L/day; T3: 2.3 L/day.
ExcretionRoute:
Primarily renal (conjugated metabolites), with some fecal excretion.
Unchanged:
Not applicable (metabolized).
Pharmacodynamics
OnsetOfAction:
Days to weeks (due to T4 component's half-life and need for T4 to T3 conversion).
PeakEffect:
Weeks (for full therapeutic effect and TSH stabilization).
DurationOfAction:
Weeks (due to T4 component).
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high blood pressure, including:
+ Severe headache or dizziness
+ Passing out
+ Changes in eyesight
Chest pain or pressure
Fast or abnormal heartbeat
Shortness of breath
Sudden weight gain or swelling in the arms or legs
Headache
Feeling tired or weak
Shakiness
Trouble sleeping
Sensitivity to heat
Excessive sweating
Changes in appetite
Unintentional weight changes
Diarrhea
Stomach cramps
Vomiting
Irritability, nervousness, excitability, anxiety, or other mood changes
Fever
Muscle cramps
Muscle weakness
Flushing
Bone pain
Changes in menstrual periods
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild ones. If you are bothered by any of the following side effects or if they do not go away, contact your doctor:
* Hair loss (usually temporary and resolves on its own within the first few months of treatment)
Reporting Side Effects
This is not an exhaustive list of all possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high blood pressure, including:
+ Severe headache or dizziness
+ Passing out
+ Changes in eyesight
Chest pain or pressure
Fast or abnormal heartbeat
Shortness of breath
Sudden weight gain or swelling in the arms or legs
Headache
Feeling tired or weak
Shakiness
Trouble sleeping
Sensitivity to heat
Excessive sweating
Changes in appetite
Unintentional weight changes
Diarrhea
Stomach cramps
Vomiting
Irritability, nervousness, excitability, anxiety, or other mood changes
Fever
Muscle cramps
Muscle weakness
Flushing
Bone pain
Changes in menstrual periods
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild ones. If you are bothered by any of the following side effects or if they do not go away, contact your doctor:
* Hair loss (usually temporary and resolves on its own within the first few months of treatment)
Reporting Side Effects
This is not an exhaustive list of all possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Symptoms of too much thyroid hormone (hyperthyroidism): rapid heart rate, palpitations, chest pain, nervousness, irritability, tremor, excessive sweating, heat intolerance, weight loss, diarrhea, insomnia.
- Symptoms of too little thyroid hormone (hypothyroidism): extreme fatigue, weight gain, constipation, dry skin, hair loss, cold intolerance, depression, slow heart rate.
- Seek immediate medical attention if you experience severe chest pain, shortness of breath, or signs of an allergic reaction (rash, itching, swelling, severe dizziness, trouble breathing).
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain health conditions, including:
+ An overactive thyroid gland
+ A weak adrenal gland
This list is not exhaustive, and it is crucial to discuss all your health problems and medications with your doctor.
To ensure your safety, provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
* Your health problems
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe to do so. This will help prevent potential interactions and ensure the safe use of this medication.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain health conditions, including:
+ An overactive thyroid gland
+ A weak adrenal gland
This list is not exhaustive, and it is crucial to discuss all your health problems and medications with your doctor.
To ensure your safety, provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
* Your health problems
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe to do so. This will help prevent potential interactions and ensure the safe use of this medication.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. To ensure continuous treatment, do not allow your supply of this drug to run out. Please note that it may take several weeks for the full effects of this medication to become apparent.
If you have diabetes (high blood sugar), consult with your doctor, as this drug may occasionally affect blood sugar control. As a result, your diabetes medications may need to be adjusted. Adhere to your doctor's instructions for monitoring your blood sugar levels and undergo blood work and other laboratory tests as directed.
If you are taking biotin or any products containing biotin, discontinue use at least 2 days prior to having your thyroid levels checked. This medication is derived from pork (pig) thyroid tissue, which carries a minimal risk of transmitting a viral disease. Although no cases have been reported, if you have concerns, discuss them with your doctor.
If you are 65 years or older, exercise caution when using this drug, as you may be more susceptible to side effects. If you are pregnant, planning to become pregnant, or breastfeeding, consult with your doctor to weigh the benefits and risks of this medication to both you and your baby.
If you have diabetes (high blood sugar), consult with your doctor, as this drug may occasionally affect blood sugar control. As a result, your diabetes medications may need to be adjusted. Adhere to your doctor's instructions for monitoring your blood sugar levels and undergo blood work and other laboratory tests as directed.
If you are taking biotin or any products containing biotin, discontinue use at least 2 days prior to having your thyroid levels checked. This medication is derived from pork (pig) thyroid tissue, which carries a minimal risk of transmitting a viral disease. Although no cases have been reported, if you have concerns, discuss them with your doctor.
If you are 65 years or older, exercise caution when using this drug, as you may be more susceptible to side effects. If you are pregnant, planning to become pregnant, or breastfeeding, consult with your doctor to weigh the benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Signs and symptoms of hyperthyroidism (thyrotoxicosis): headache, irritability, nervousness, sweating, tachycardia, arrhythmias, increased bowel motility, menstrual irregularities, heat intolerance, fever, tremor, insomnia, weight loss, chest pain, palpitations.
What to Do:
In case of suspected overdose, contact a poison control center immediately (e.g., 1-800-222-1222 in the US) or seek emergency medical attention. Management typically involves supportive care, reduction or temporary discontinuation of the drug, and symptomatic treatment (e.g., beta-blockers for cardiac effects).
Drug Interactions
Contraindicated Interactions
- Uncorrected adrenal insufficiency
- Acute myocardial infarction
- Untreated thyrotoxicosis
Major Interactions
- Oral anticoagulants (e.g., warfarin): May increase anticoagulant effect, requiring dose reduction of anticoagulant.
- Antidiabetic agents (e.g., insulin, metformin): May increase requirements for antidiabetic agents.
- Bile acid sequestrants (e.g., cholestyramine, colestipol): May decrease thyroid hormone absorption; separate administration by 4-5 hours.
- Ion exchange resins (e.g., sevelamer, patiromer): May decrease thyroid hormone absorption; separate administration by 4-5 hours.
- Iron supplements, calcium carbonate, aluminum/magnesium-containing antacids, sucralfate, proton pump inhibitors (PPIs): May decrease thyroid hormone absorption; separate administration by at least 4 hours.
- Phenytoin, carbamazepine, rifampin, phenobarbital: May increase thyroid hormone metabolism, requiring increased thyroid hormone dose.
- Amiodarone: Can cause hypo- or hyperthyroidism; monitor thyroid function closely.
- Beta-blockers: May decrease conversion of T4 to T3.
Moderate Interactions
- SSRIs (e.g., sertraline): May increase thyroid hormone requirements.
- Estrogens (oral): May increase thyroid-binding globulin (TBG), increasing thyroid hormone requirements.
- Androgens: May decrease TBG, decreasing thyroid hormone requirements.
- Corticosteroids: May inhibit T4 to T3 conversion.
- Iodine-containing products: May alter thyroid function.
- Dietary fiber: May decrease absorption; separate administration.
Minor Interactions
- Not available
Monitoring
Baseline Monitoring
Thyroid Stimulating Hormone (TSH)
Rationale: Primary indicator of thyroid function and adequacy of replacement therapy.
Timing: Prior to initiation of therapy.
Free Thyroxine (Free T4)
Rationale: Measures unbound T4, which is metabolically active.
Timing: Prior to initiation of therapy.
Free Triiodothyronine (Free T3)
Rationale: Measures unbound T3, which is the most active thyroid hormone. Particularly relevant for desiccated thyroid.
Timing: Prior to initiation of therapy.
Clinical assessment of symptoms
Rationale: To establish baseline symptoms of hypothyroidism.
Timing: Prior to initiation of therapy.
Routine Monitoring
Thyroid Stimulating Hormone (TSH)
Frequency: Every 4-6 weeks until stable, then every 6-12 months or as clinically indicated.
Target: Typically 0.4-4.0 mIU/L (may be individualized based on patient age, comorbidities, and etiology of hypothyroidism).
Action Threshold: Values outside target range indicate need for dose adjustment.
Free Thyroxine (Free T4)
Frequency: Every 4-6 weeks until stable, then every 6-12 months or as clinically indicated.
Target: Typically 0.8-1.8 ng/dL (may be individualized).
Action Threshold: Values outside target range indicate need for dose adjustment.
Free Triiodothyronine (Free T3)
Frequency: Every 4-6 weeks until stable, then every 6-12 months or as clinically indicated.
Target: Typically 2.3-4.2 pg/mL (may be individualized).
Action Threshold: Values outside target range indicate need for dose adjustment.
Clinical assessment of symptoms (e.g., fatigue, weight, mood, heart rate)
Frequency: At each visit, or as needed.
Target: Resolution or improvement of hypothyroid symptoms without development of hyperthyroid symptoms.
Action Threshold: Persistent or worsening symptoms, or development of hyperthyroid symptoms, indicate need for dose adjustment or further investigation.
Symptom Monitoring
- Fatigue
- Weight changes (gain or loss)
- Cold intolerance
- Constipation
- Dry skin
- Hair loss
- Bradycardia or tachycardia
- Palpitations
- Nervousness or irritability
- Tremor
- Heat intolerance
- Diarrhea
- Insomnia
Special Patient Groups
Pregnancy
Thyroid hormone requirements often increase during pregnancy. Desiccated thyroid is considered safe and essential for fetal neurological development. Close monitoring of thyroid function (TSH, Free T4) is crucial throughout pregnancy, and dose adjustments are frequently needed.
Trimester-Specific Risks:
First Trimester:
Untreated maternal hypothyroidism in the first trimester is associated with adverse fetal outcomes (e.g., impaired neurocognitive development, increased risk of miscarriage, preterm birth).
Second Trimester:
Continued need for adequate thyroid hormone levels for fetal development.
Third Trimester:
Continued need for adequate thyroid hormone levels for fetal development.
Lactation
Thyroid hormones are excreted in breast milk in small amounts, but are generally considered compatible with breastfeeding. No adverse effects on the nursing infant have been reported with maternal therapeutic doses.
Infant Risk:
Low risk to infant.
Pediatric Use
Dosing is weight-based and requires careful titration. Regular monitoring of TSH and Free T4 is essential to ensure proper growth and development. Overtreatment can lead to craniosynostosis in infants and accelerated bone maturation in children.
Geriatric Use
Lower starting doses are often recommended due to increased sensitivity to thyroid hormones and a higher prevalence of cardiovascular disease. Dose titration should be gradual and based on clinical response and laboratory parameters. Monitor for cardiac side effects.
Clinical Information
Clinical Pearls
- Desiccated thyroid contains both T4 (levothyroxine) and T3 (liothyronine), unlike synthetic levothyroxine which contains only T4.
- Dosing is not directly interchangeable with levothyroxine; 1 grain (60 mg) of desiccated thyroid is roughly equivalent to 100 mcg of levothyroxine, but individual conversion varies.
- Patients transitioning from levothyroxine to desiccated thyroid, or vice versa, require careful monitoring and dose titration.
- Always take on an empty stomach, consistently at the same time each day, and separate from interacting medications/supplements.
- Monitor TSH, Free T4, and Free T3 to guide therapy, as TSH alone may not be sufficient for patients on T3-containing preparations.
Alternative Therapies
- Levothyroxine (synthetic T4, e.g., Synthroid, Levoxyl)
- Liothyronine (synthetic T3, e.g., Cytomel)
- Combination therapy with synthetic levothyroxine and liothyronine
Cost & Coverage
Average Cost:
Varies widely by strength, quantity, and pharmacy. For 240mg (4gr), it would be at the higher end of the range. per 30 tablets
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (preferred generic/brand)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication, including the amount taken and the time it happened, to facilitate prompt and effective care.