ERFA management, advice please: Hi, I used to... - Thyroid UK

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ERFA management, advice please

lorien profile image


I used to take Eltroxin & swopped to 75 mcg Wockhardt levothyroxine due to negative reactions taking Amco's generic levothyroxine which took the place of Eltroxin.

Alongside the 75 mcg T4 I also took the equivalent of 6 mcg synthetic T3 (Cynomel from Mexico). I didn't like the spiking and severe irritability that I experienced with it. Also I didn't know the quality of this T3.

Am now trying to take Erfa. The doctor who prescribed it (privately) suggested I drop to 50 mcg T4 and replace the T3 with half a grain of Erfa (30 mcg = equivalent to 18 mcg T4 and 4 mcg T3).

I've stopped the Cynomel completely, but still taking 75 mcg Wockhardt T4 as afraid of becoming hypo.

I am extremely medication sensitive. I've started Erfa on a quarter of half a grain which is equivalent to approx. 4.5 mcg T4 and 1 mcg T3.

I take it sublingually.

The very moment I've taken it I immediately feel the need to eat and immediately very spaced out. My brain goes into shut down mode (like brain fog) and I can't think clearly anymore. Not possible to use PC, phone, or any other left brain stuff. Anxiety goes up. When it wears of some hours later I have a headache and feel hung over.

I'm not sure how I should manage the change over. I'm used to taking levothyroxine early morning an hour at least before food.

Does it matter whether Erfa is taken before or after food? Would absorption be affected by eating? Maybe I would tolerate it better if I ate first and my blood sugar was up. (I have low blood sugar issues).

It would be very useful to hear what others of you do please. Any feedback would be appreciated! I am about to think that I have to come to terms with using levothyroxine only.

Thank you!

11 Replies

I get very hungry on erfa. I put on 2 stone when I first started using it, which was great for me as I was very underweight, just been put back on it recently after buying my own armour for 2 years, first thing I noticed was my increased appetite. dont know of any ways round it, though, I like my wieght now, not sure I want to be putting on much more.

I also get a little spaced out when I take my morning dose, only lasts about 30-45 mins, then its gone, dont get any lasting effects and it doesnt happen with the afternoon dose. Not much help to you

lorien profile image
lorien in reply to susymac

Thanks ~ this is useful to hear about!

shaws profile image
shawsAdministrator in reply to lorien

If you have a sensitivity to meds, both Naturethroid and WP thyroid are hypoallergenic.

Until last week I thought 1 grain NDT was equivalent to approx 60 -65mcg levo but I now find 1/2 grain Armour is equal to 50mcg levo.

lorien profile image
lorien in reply to shaws


Sorry I haven't replied sooner to thank you for your input. This is useful to know and I'll look into to it.

Next I have to attend to my adrenals so putting NDT to one side for the moment!

Try NDT been around for 80 years with no adverse effects as evidenced by those who take it in their droves

Erfa is ndt. :-)

As far as I'm aware all ndt (Armour, etc) needs to be taken on an empty stomach, a minimum of two hours after food (or non-water drinks) and an hour before.

Do you know if your antibodies are high? I don't take ndt myself because my doc says that high antibodies mean that you'll go hypo on ndt. I don't have evidence at hand to support this so take it with a grain of salt, but it does make some sense to me that if antibodies are destroying your thyroid that perhaps ndt is being destroyed as well. So either you may 1) find it unsuitable, 2) have to take more, 3) need to take hydrocortisone with it or 4) wait until your antibodies have improved before you try it again.

Just some ideas. :-)


Thank you very much for this information which is very helpful in answering my query.

My antibodies were in the normal range when checked a few years ago, but I may do a home test.

I've just received my saliva adrenal tests and they show very low morning cortisol, and only just in the normal range at other times except the eve when it rises.

I'm waiting results of iron and ferritin tests this week.

I've stopped Erfa because I just couldn't function, and we're in the middle of house renovations so timing not good!

Back on 6mcg T3 and dropped to 50 mcg T4.

Looks to me like I need to attend to my adrenals before trying again with an NDT. Sigh!!!!!!!

Oh bless you - the worst of both worlds! I found house renovations very stressful when I wasn't well. I think I have a reputation as a terrible harridan among the people who worked here. :-(

I hope you see some improvement soon. Keep chipping away at it and it will get better. :-)

Thanks for this too!!! The workmen tend to keep a distance from me as I watch them like a hawk and my mood isn't always too brilliant!!!

Thanks so much for your understanding and encouragement!

Strength in numbers! We had a bloke who liked to come 10 minutes earlier every day regardless of what had been arranged. Monday he came at 8, Tues at 7:50, Wed at 7:40 etc until one day I hadn't even finished my first wee of the morning when he rang the bell. It drove me insane.

Bon courage!

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