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Thyroid UK
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NDT and adrenal fatigue

I would love to hear from people on Armour or Erfa how you are doing, especially since STTM has been claiming lately that Armour was reformulated again (and has been working even LESS well than it did after the 2009 reformulation...) and, apparently, that Erfa, too, has changed, although the company denies this...I read that even the founder of STTM has now switched to a different brand, after doing well on Erfa for years.

This does not bide well for thyroid patients in Europe, with even less NDT drugs to choose from than in the US...

I have been on "reformulated" Erfa in the past year and doing OK, even fine sometimes, but I never feel stable...sometimes I feel borderline hypo on 6 grains daily, then hyper, decrease it slightly, only to end up feeling borderline hyper on 5 grains...so really confusing.

I have all the signs of adrenal fatigue - puffy face, dark circles under eyes, salt and sweet cravings, water retention, fatigue temporarily "cured" by caffeine or alcohol...you name it. I was diagnosed with AF a few years ago, and put on Medrol (4-6 mg daily) by my doctor (a Hertoghe doctor). I felt great at first, but Medrol no longer seems effective. I was told I could not take HC because of my tendency to retain fluid. The other day, I had a facial treatment, and the esthetician commented on my puffy face and dark circles under eyes...she asked if I am overworked and don't not sleep enough:-(

I am currently on 5.5 grains of Erfa, and 4 mg of Medrol daily.

I don't know if that has to do with Medrol, or Erfa, or both...or something completely different...?!

Any input and advice would be greatly appreciated. Thanks,


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STTM seem obsessed with reformulation. I don't know whether to buy into it or not. What does seem to happen to everyone over time though is that what once worked no longer works so well. Our bodies change all the time; we get older, we develop other ailments, we change what we eat, increase/decrease exercise. Yet somehow, through all that, it's always a reformulation problem?

5.5 grains is a lot by UK standards. There aren't many here in the UK on that amount. I've noticed recently that those who are on high doses are often advised to consider taking T3 only. It makes sense if you think about it. If all that T4 isn't being converted, why take a pill with it in at all?

Re the adrenal fatigue, do you take vitamin c?

Yes I agree about what you say in that so much changes in our lives.

Have you tried dropping back on the thyroid meds? I have found that going backwards with the dose can have beneficial effects. Sometimes we are well past optimum dosage and just don't realise. Things just don't feel right and we think we are under medicated.

do you have any ft4 and 3 blood readings on your current meds

True, I think I will try that. I vaguely remember feeling OK on 5 grains daily. Anyway, I somehow doubt I am currently under medicated...the question to me, is more: why do I not seem to be using all that thyroid hormone effectively?! Is it because of my adrenal fatigue...???

Why don't u use the hormones?

Yes it probably will be to do with cortisol. It could be to high or to low. Your blood results would help in working out what is happening. Is ft3 very high ?

High esterogen sort of wraps up the thyroid hormones. This is the main reason why women have this condition more than men. So look into esterogen and progesterone balance.

Low iron is a problem as well.

I am a man and progesterone was the answer for me. I have blood data which shows after using prog for a few weeks my tsh raised. This shows that the t3 was now being taken into the cells more efficiently. All due to more cortisol via the progesterone.

Try messing about with the timings of the thyroid meds. Bedtime dosing is much more effective. Check my post about how bed time dosing fits in with our natural cycle

Yes, I take a multivitamin pill for women daily (Biovea brand) which contains vit C among many other things.

I have not tried T3 only. However, I am seeing another doctor (a Hertoghe doctor) in a few weeks, and this doctor comes highly recommended. I don't know if hydrocortisone could now that Medrol seems to be working less well, but I have been asking to go to the lab for both blood and 24 h urine testing...so I guess I'll have to take it from there.

The Belgian so called top doctors do not seem to work with T3 only at all...

That won't be enough vitamin c. See: stopthethyroidmadness.com/2...

OK, thanks! There is so much to learn, isn't there?! Every time I think I know something, I realise I don't know enough...

I was on Erfa for years and years after the Armour fiasco a while back. If any of you remember, it wasn't just the reformulation of Armour at the time. It was also that there was a shortage of any thyroid extract meds and none to be had at any price in the US.

I found out about Erfa and was a happy camper using Erfa, obtained with script, thru UniversalDrugstore in Canada. I think it was last year??? I had stocked up on Erfa and had taken a few tabs out of a new bottle and within a few days, I was dizzy, light-headed and feeling generally crummy. I had noticed that the Erfa tabs looked a little different but thought nothing about it. I went on the STTM site to see if anything was going on and read about the new mfg facilities for Erfa. It used to be mfg in Brussels (if I remember right) and was now mfg in Spain. It was now spotty looking and had a harder outer casing than before. Well.. sure enough .. that was what I had, the spotty, hard ones.

Thus began my search (again) for an NDT. I tried thiroyd, thyroid S, Naturethroid, WP and NP by Acella. No.... didn't try Armour. I still don't trust it. I am now on WP and doing just fine, same dosage and stable labs.

anna, a poster on the STTM site said that he used the 'new' Erfa as directed and had hypo symptoms. When he thoroughly crushed the Erfa between two tablespoons to a fine powder and ingested it, all his hypo symptoms resolved. So... maybe something in the way the Erfa is pressed/formulated that effects absorbability? I am going to give it a go with all the stores of Erfa that I have. lol.. I would love to be able to use them up.

You might google/search STTM pooling and/or STTM high Rt3. It may be that something is keeping the t3 from getting into your cells so ... no matter how much NDT you take, it isn't doing you any good? It can be a myriad of conditions from low iron, low B 12 to estrogen dominance, struggling adrenals and even 'pooling'.

ps. I am grateful for the STTM site. That is where I learned about Erfa so long ago. It sure made my life easier at the time. STTM doesn't go out looking for problems with NDT. They just report what users are telling them and follow up. They are careful to state that many users of Erfa and Armour are doing well, even tho both products are having their problems according to some users.

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OK, thank you. I will have to look into other options, and see if I could get NP or WP Thyroid for instance. It's true that "old" and "new" Erfa pills (I compared pills from a batch expiring in early 2013 to one expiring two years later) look different.

Do you get NP prescribed by a doctor or do have you found a way to order it anyway?

It's interesting what you say about crushing the pills before swallowing them.

I have no labs on current dosage, but will post them here as soon as I've had labs done (in the next couple of weeks).

Hi, anna. I think I gave you some links to vendors for other NDTs a while back. Maybe ck your messages? If not, just send me a message and I will repost privately.

I get my meds with a prescription but have purchased without in order to build up my 'stash'.

Don't forget, adrenals run on salt. Having an adrenal 'cocktail' a few times per day might be helpful and is supportive of the adrenals. No strenuous exercising, try to be as stress free a possible. Here is a copy of an adrenal 'cocktail' just posted by a moderator on the US thyroid group I belong to advising someone with adrenal fatigue:

"Here is the one I use:

I use a glass of filtered water (or carbonated water) along with a pinch of the gray unprocessed celtic sea salt (usually 1/4 - 1/2 tsp of salt), 1/4 tsp. cream of tartar or some coconut water (for potassium), some ionic trace minerals, a few squeezes of fresh lemon juice, some flavoring, and a little bit of liquid stevia." Deb

Here are others: gotmag.org/the- adrenal-cocktail/

http://thenourishedcaveman. com/keto-electrolyte-drink/

Maybe try crushing your Erfa and see what happens? It wouldn't hurt to track your daily blood pressure and body temp while you are testing out crushing the Erfa tabs in case you are absorbing the Erfa better that way and need to drop back your dosage a bit if your bp and body temp rises.

Years ago, before the invention of the cursed TSH test, the only way doctors could and did prescribe and optimize dosage of NDT (no synthroid back then either) was by symptoms, blood pressure and body temp.

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Anna... For some reason I wasn't able to edit my post on the adrenal cocktail. I was going to note that some find the addition of cream of tartar controversial so... you can substitute something like black strap molasses and/or orange juice for the extra potassium.

The addition of cream of tartar helps to lower cortisol from what I hear so it may not be suitable for those with low cortisol. I take COT in the evening when my cortisol is highest. In the daytime I just take sea salt with Vit B.

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Absolutely !! Change from Erfa -am sure it'll be the cause. I was on Erfa happily for two years but once they moved their factories to a different country, changed their pill press machinery I went dramatically downhill. Didn't realise it was the Erfa for eight months and then happened to look online and low and behold . I had the same symptoms as you! It took me over three months to recover on a different NDT -I switched to WP Thyroid and am fine now. It was nothing to do with my body getting used to the meds but is definately to do with Erfa changing its manufacturing process. A pharmacist told me that a change in pill presses can affect the uptake of the medication into your body.


In this context, I wonder if being on NDT with Hashimoto's can be a contributing factor...?


At the time of initial diagnosis, my anti-TPO levels were +6000. The first years, I was on enough T4 drugs to keep my TSH within range. My anti-TPO levels only dropped marginally during that time. Then I went to see a doctor who believed in a suppressed (below 0.1) TSH for Hashimoto's patients, while using T4 drugs only, the reason being that NDT can perpetuate the autoimmune attack. This doctor was of the opinion that a suppressed TSH while on T4 drugs would calm it down. And, once my TSH dropped below 0, the antibody levels normalised.

I have been on NDT since November 2011, and my anti-TPO levels haven't risen in all that time. Should I interpret that to mean that NDT is not worsening the autoimmune attack?

It would be interesting to know how many Hashimoto's patients here take NDT without any problems. If anyone had to switch from NDT to synthetics meds, what were your symptoms of a worsened autoimmune attack?

I also found this article very interesting:


The doctor who put me on NDT four years ago told me to take it once daily (in the morning), and I have been doing it since, for one reason and one reason only: it's convenient. But maybe it should actually be taken at least twice, preferably three times daily? I know that it what most practitioners and patients recommend...

I did well on Armour until it was reformulated in 2009, then I switched to Naturethroid, read that was about to be reformulated (not as drastically as Armour as it turned out) so switched again and did very well on ERFA until a new batch in November 2013. These looked like the usual ones, were apparently made in the old Belgian factory not the new Spanish one, but they had a different label and although I always chew them for best absorbency, they upset my stomach within half an hour and after three days I became lightheaded and dizzy, so stopped them. I've found four other people ranging from Canada to Finland with the same batch as mine who also had problems, but others thought them fine - an odd thing is that one person got hers from a pharmacy in Canada two years after I got mine online! I had a long email correspondence with various people at ERFA and all denied any change to the formula, so I don't know what happened to them but enough others had similar problems for me to no longer trust their standardisation. This was discussed on various forums but it seems only STTM is still talking about the problem, with some people still trying to get on with them. I know people doing fine on them, others who've had a really up and down time and have had to switch - not easy for those I know in Canada! I think the best alternative seems to be WP as they have so few fillers and, being specifically made like that, they're less likely to be altered in the future.

Interesting! It's true that WP Thyroid contains very few inactive ingredients, and no talk...so it might be worth a try.

I said to myself the other day that maybe Erfa is not so bad after all, as I have not been reading as many critical posts lately...or maybe I just have not been visiting the right forums?!

Those of you on Erfa, do you still feel it's working less well than before?

I am currently on Erfa (combining 30 and 60 mg pills), and I feel fine. The batch numbers are: LF04142A and LF04265A respectively.

I know the STTM has been very critical of Erfa in the past year or so, but I have been wondering if that has anything to do with them preferring to take the pills sublingually, and maybe that is now more difficult for some reason? I have always chewed Erfa up before swallowing it, and the pills are hard, crunchy, and taste very sweet. This causes me to believe that they have not been reformulated, so any change in the pills must come from a change in the mfg process (as mentioned in a previous post).

Erfa said they have not reformulated their tablets. i have no reason to not believe them as i doubt they would say this if it wasn't the case due to litigation. BUT they have admitted to changing factories, moving to a hot country and changing their pill presses. All/ or one of these factors could make a difference to the tablets and our ability to absorb them. It might also account for the variability in uptake with people feeling high or low on the same dose.

I felt extremely ill and all my hypothyroid symptoms reappeared on Erfa having before they moved factories etc..felt fine for two years. I had to take time off work!!! i had a number of emails from them being in correspondence and never got a resolution -infact they stopped replying to my emails. Their official line to me was that i had become intolerant of that particular brand! hmmmm

Personally i want a medication that is stable and reliable. And I don't want to deal with a company that stops trying to resolve a problem that i and many others have reported to them. Erfa if your still reading our emails then note that have been on WP for nearly two years and am fine, no ups and downs like on Erfa AND because of WP's fillers my uptake is miles better so have had to reduce my daily dose by 1/2 a grain.

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Someone else on Medrol - or I was I am on HC now - and disagree that they say that you retain more water - may I ask why you were put on Medrol and by whom?

When you see a user name of Hidden, it means that the person is no longer a member of this forum.

We often close posts that were originated by people who have left - there is no point in wasting our time making replies. Occasionally, the thread might still be active and popular and will be left. More often, it is simply a case of none of the admins noticing!

This thread is almost all over three years old. It would be better to write a new post.

I shall now be closing this post to replies.

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