After hearing the rumors, I was waiting for official notice that Armour Thyroid was being dropped from the Medicare formulary. The confirmation came by way of a form letter telling me that one of my patient’s prescriptions for Armour would no longer be covered by Medicare and asked if I want to switch them to levothyroxine. With that letter I understood that the only viable alternative to traditional t4 therapy for hypothyroidism is now officially shoved to the outer fringes of medical care in the United States.
Not to be naive about the role of Armour in this country, I already know that the use of this medication is considered “off beat” if not worse, by many of my colleagues. For years I also was skeptical of its viability as a treatment for low thyroid (hypothyroidism) conditions. What changed my mind was the realization that so little is truly understood about what constitues ideal thyroid hormone replacement. The endocrinologists who taught me that Synthroid (t4) was the gold standard of thyroid hormone replacement were speaking more from the unexamined prejudices of their generation, than from true understanding of the needs of their patients.
I have treated many patients with traditional t4 therapy who are doing fine. There is no reason for them to think about another type of thyroid hormone replacement. But for the portion of older hypothyroid individuals who fail to return to feeling normal on t4 alone and who have happily switched to Armour, there is now financial disadvantage if they want to continue using this medicine. Is this fair? Is it proper medical care to switch them back to what appears to be an inferior treatment? These are questions the community of thyroid patients and their doctors must now begin to address.
Comments welcome.
