Erfa’s Canadian “Thyroid” — more details

erfathyroidOn my August 26th blog post below, I reported good information about US patients being able to use their doctor’s prescription to order the Canadian version of natural desiccated thyroid called simply “Thyroid” by Erfa.

And here’s more:

In each Erfa 30 mg tablet embossed “ECI 30”, there is 18 mcg. of T4 and 4 mcg. of T3;

In each Erfa 60 mg tablet embossed “ECI 60”, there is 35 mcg. of T4 and 8 mcg. of T3;

In each Erfa 125 mg tablet embossed “ECI 125”, there is 73 mcg. of T4 and 17 mcg. of T3.

Erfa’s very friendly and helpful Medical Director, Henri Knafo, MD, states that they follow the USP (United States Pharmacopoeia) specifications. But I do see some slight differences. The USP specifications ratio for one grain that we are used to in the US is 38 mcg. T4 and 9 mcg T3, i.e 38/9. The above ratio is 35/8.

Likewise, US patients are used to 2 grains of 120 mgs having 76 mcg of T4 and 18 mcg of T3, i.e. 76/18. In Erfa’s medication of 125 mg, you will get a ratio of 73/17. I don’t know if this will make much of a difference but want you to be aware as you work to adjust Erfa’s desiccated thyroid to the treatment you were used to.

Knapo happily states that most all “Thyroid” is making it across the border to the states without issue. You will need your doctor’s prescription. And by the way, Erfa’s Thyroid is manufactured in Belgium, plus they have a huge supply of desiccated powder.

Erfa is also working with IDIS to get Thyroid to others. You can read about them here.

Need a doctor to work with who will provide a prescription for your needed desiccated thyroid? There are a growing body of good doctors out there. We also have a good list of Canadian pharmacies you can consider using during the current shortages.

I have also received word from a gal that the FDA document 1572, a federal form that FDA requires for over-the-border movement, has not always been used, and Erfa’s medication is arriving fine. i.e. the FDA may be tolerating it.

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67 Responses to “Erfa’s Canadian “Thyroid” — more details”

  1. Fabs

    Hi Janie,
    You write that “Erfa’s Thyroid is manufactured in Belgium”. How do you know that, where did you find this info ??? I’m living in Belgium and they say over here that Erfa comes from Canada. Which is only a detail, except that from time to time, there is no Erfa available in the drugstores here, because – they say – Canada is not sending enough …. If it is really manufactured here, I could go directly to the manufacture.

    • Janie Bowthorpe

      They may have changed their location of manufacturer since I wrote that. But it was known. Different NDT pharms are known to have it made up elsewhere, then they sell it. But there can be changes to that fact.

  2. Kara

    Do you know if Erfa Thyroid still contains these amounts of T4 and T3 since they changed their formula a few years ago? Thanks.

    • Janie Bowthorpe

      We hope so…

      • Debra

        Hi there, according to the product monograph on Erfa’s website, 60 mg table of Erfa contains .1 mg (=100 mcg) T4 and 25 mcg T3:

        “Note: Desiccated thyroid 60 mg is usually considered equivalent to thyroglobulin 60 mg, levothyroxine sodium (T4) 0.1 mg or liothyronine sodium (T3) 25 μg.”

        So it is a much higher dose of T4 and T3 than Armour or other NDTs. (More than double.) My environmental doctor has posted a sign in her office about the T4 and T3 content of Erfa as set out above and tells me the change was made a few years ago. Doc is of the view that Erfa isn’t as “good” as it used to be for this reason. Perhaps Janie could change the notes about Erfa “Thyroid” in “Addendum A – Ingredients for Desiccated Thyroid Products” in the next edition of Stop the Thyroid Madness book and on the website. (See p. 224 of revised edition of STTM book.)

        • Janie Bowthorpe

          Debra, you misunderstood. What you are reading is about ug, not mcg. What is in the STTM book is correct as it’s about mcg.

          • Janie Bowthorpe

            Also, what you were seeing is a conversion chart, not what is in 60 mg. It’s what they claim is a conversion if you take synthetic T4 and synthetic T3 in place of 60 mg Erfa. And those conversion charts are awful.

          • Debra

            Janie, I understand. To make matters worse, my doctor has posted a conversion chart on her office wall and claims that mcg are the same as ug and that the STTM book is incorrect. I could scan and upload it if you like

          • Janie Bowthorpe

            I think they are. But it appears the chart is more about their opinion that “one grain” of Erfa is equivalent to “this much T4″ and this much T3” if you take both of the latter.

          • Debra

            Janie, can you give me a reference for your numbers for Erfa (i.e. In each Erfa 60 mg tablet embossed �ECI 60�, there is 35 mcg. of T4 and 8 mcg. of T3m etc.) Doc doesn’t believe it, says the Erfa conversion chart is correct, that the STTM book is not authoritative (!) etc. and would like proof. I thought that these numbers came from Erfa/Dr. Knafo, but do you have something that I could show the doctor?

          • Janie Bowthorpe

            It’s been known for years and in many places. Your doctor doesn’t understand that a “conversion” between Erfa and taking T4/T3 has nothing to do with what’s in the pills.

            1), under What doses of ERFA Thyroid are available.
            2) under “Further information….” and is Sept 2018 info

            And you can also do a search for more. 🙂

          • Debra

            Janie, thank you so much! I agree, doc doesn’t understand. Unfortunately, this physician is the only one I can find who will prescribe NDT. Thanks again.

          • Giugi

            ug and mcg are the same thing!

  3. SNT

    Is ERFA Gluten-free? and ARMOUR?, please with many thanks. I am not happy withNature-throid and I am looking for an alternative.

  4. Anna

    Janie, after everything that has been said and written about the possible reformulation of Erfa in 2013, what is your impression? Is Erfa working less well than it used to? Are you still on Erfa, or have you switched to another brand?

    I’d like to hear from other users of Erfa as well!

  5. Irena

    I just returned from my pharmacy where I went to fill out my ERFA Thyroid prescription. I’ve been told that ERFA stopped manufacturing it. Did anyone heard anything about it? I’m panicking, because it’s the only thing that works.

    • Anna


      I just refilled a script for Erfa, and I got several bottles (30, 60, and 125 mg pills) expiring in mid-2016.

  6. Valerie

    Hi I had a total thyroidectomy 5 months ago. Synthroid did absolutely nothing to reduce my hypothyroid symptoms (extreme body pain, swelling fatigue). Then tried Cytomel. Still had the hypo symptoms though not as bad but strangely I also had hyper symptoms- rapid pulse, heart palpitations. So I did some research and decided I would try the natural route which in Canada is Thyroid by Erfa. My GP knew nothing about it but was experienced enough to know that blood tests do not tell the story, the patient does. She gave me 30 mg tablets. I started with 30mg in the morning and 30 mg in the afternoon. After a week, I increased the morning dose to 60 mg but left the afternoon dose at 30 mg. I started to feel ALOT better for a few days. Now I am back to feeling totally hypo – body pain, swelling, fatigue. So, my question is should I increase the dose now or wait for a few weeks? It is quite possible I have an adrenal problem having been on prednisone for 18 months a few years ago. So I guess I should be taking something to boost the adrenals – but what and how much?? It is so hard to find answers and since I seem to be the one who is educating my GP, I have no access to a professional who could guide me with this. The endocrinologist I saw last month told me the only thing I should be taking was synthroid. I told her I refused to go back on it because I had never felt worse in my life than when I was on it. This annoyed her quite a bit. She refuses to follow me ( what a blessing!!) and intended on writing a very long letter to my GP. PLEASE DOES SOMEONE KNOW HOW MUCH I SHOULD INCREASE THE THYROID BY ERFA?? I have looked everywhere and there us no clear cut instructions about when to increase if you start feeling hypo again. Thanks for reading!!

  7. Steven

    Man problem with Thyroid ERFA (Erectile Dysfunction)


    I am a 32 year old male and after 2 years with Synthroid (0.137 mg), I asked my doctor to change for Thyroid (ERFA) because I was still tired and I had mood problems (normal tsh , t4 , t3). I have started with with Thyroid 60 mg (2 weeks) and increase to 90 mg (recommanded by pharmacist and physician).

    The first few days that I have used Thyroid, I have started having erectile dysfunction (weak erection, difficulty to maintain erection). I never had problems like this in my life, (with or without Synthroid). I have not changed anything else in my life, except Thyroid.

    I feel better on Thyroid (happiest, more energy) but erectile dysfunction is a major problem. I have talked to my physician and I am back on Synthroid. I have used Thyroid for 4 weeks and I had erectile dysfunction all the time. 1 week on Synthroid and my erection is normal again.

    Does someone has already had erectile dysfunction with Thyroid (ERFA) or another desiccated thyroid?

    Thank you

    • Janie Bowthorpe

      Steven, you are probably on too low a dose, thus making yourself even more hypo, which can affect sex hormones. 60 mgs is a starting dose from which we raise from. 90 mg is also pretty low. See

    • Frank

      Steve, I was taking Synthroid 150 / 175 mcg alternate days and was still experiencing hypo symptoms. I finally found an MD that would prescribe NDT and started with 60 mg then went to 90 mg and the results have been remarkable with the one exception, the ED. My physician did a TSH test and it was high so upped it to 90, the ED is a little better but still not good. I will be going back in two weeks so I hope he will up it again.

      • Steven

        Hello Frank,

        I just re-read an old comment that I wrote on this forum and I saw that you had answered … in 2015;)

        Have you seen an improvement with your erectile problems? I have been using ERFA Thyroid for 2 years, and I have seen no improvement.

  8. TC

    I was diagnosed with Hashimodos’ Thyroiditis (auto-immune disease) in my mid-twenties and I’m in my mid-fifties now.
    I just lost 29 pounds (elimination carbs, add b-vitamins, many cleanses, especially parasite cleanses following Hulda Clark’s protocol).

    After 25 years of study I’ve learned the following: 1) thyroid medication is one of the most commonly prescribed types of medication in the U.S. It is an epidemic. 2) Like any epidemic there are likely widespread causes. My personal belief is that much of the epidemic has to do with our ignorance of the impact on the thyroid and other glands from the many sources of pollution now rampant in our foodstuffs, our dentistry (mercury), and our radiation exposure (you name it).
    3) I have used the website, which lists all ingredients that are cancer causing, to clean out my home of personal and cleaning items that are harmful. I can’t control the environment outside my home but I can control my home purity. I buy organic food. I make green drinks via the nutri-bullet. I make sure my cookware and tableware is lead-free (not made in China). I read all labels, question all ingredients no matter how “organic” an item is supposedly labelled. As a U.S. citizen, I recognize that we have the lowest standards of organic foodstuffs in the world. When possible and affordable, I buy my homeopathic and other medicines from Europe, Australia and other overseas sources.
    4) I have removed the mercury from my mouth.
    5) I have installed a reverse osmosis water purification system (made in Europe – Aquasana).
    6) I continually scour the websites for more information on health and alternatives. I look at Edgar Cayce protocols (be careful many of the manufacturers do not follow his recipes faithfully – but if you can swing a direct visit to the clinic in Virginia Beach, it is literally a life saver. Try the “Cayce Cleanse” – a full afternoon – amazingly powerful).
    7) Finally, some of my most recent finds have been HAMPL for my pets (wonderfullly powerful homeopathics for our furry friends), Native Remedies (they use herbs from ancient Ukrainian forests – very powerful). I am looking into essential oils.
    Don’t give up and whatever you do, do not put blind faith in any physician.
    I have been on ERFA now for about 4 years and I am stabilized but looking to continue to heal and lessen my dependency. As such a long-term user, this will not be overnight. But I know I will lick this.
    I know we all can!! Do your research, be educated, and be a discerning advocate for your own health.
    Oh – almost forgot – those of us on thyroid medicine tend to have low B vitamin. Sublingual B has been a great boost for me.
    Good luck and don’t give up!!

    • TC

      Sorry – correction – the website is or

      • pep

        hi dear, i’m agree with your opinion. you have to watch the label even for the food that says is organic , i found by myself that any company in NJ, that makes organic milk is not organic 100% because they add syntetic vit.A and you pay triple more price for organic milk. the frustraiting part is that nobody stop this companies of doing this or at list to control them what the organic items should have. all food drugs /vitamins , food suplement /consist ceculose and silica. do you know how harmfull is the silica for your body?who control this. i have a fealling that the idea is to make you get sick and make money from your sicknessi’m trying to get thyroid from canada. Forest is doing whatever they want, change the formula and make thyroid patients more uncomfortable with armour thyroid and who control this lab the answer is you take thyroid erfa from a pharmacy or from belgium have any webside or phone will be helpfull. thank you

    • Kiwijack

      TD, How do you recommend ramping up the dose of ERFA desiccated thyroid? It’s suggested I do 90 mg for 6 months, starting at 30 mg, any issues with ramping up quickly? Don’t want to waste time with a low dose, but don’t want to be on tilt either and set myself back. Any opinion? Thanks …

    • Patricia


  9. Brenda

    I just started on ERFA a few months back and had been feeling terrible for a few months beforehand. Shivering, fatigue, brainfog, no motivation, vertigo, etc.

    Started on 30 mg for a month and that didn’t work a whole lot. It was increased to 60 mg and it helped but I wasn’t near where I wanted to be. After another month my naturopath increased it to 90 mg. A whole lot better but not there yet. My naturopath was hesitant to increase it anymore. At 60 mg I had started some raw adrenal. It wasn’t the type I had taken before but it helped a bit. Finally the last increase was 90 mg of ERFA with my usual adrenal supplement which is Adreno-Lyph Plus. I should have taken it from the start but I wanted to try a different one, which obviously didn’t work. The Adreno-Lyph Plus has excellent reviews too!

    At first I was taking 4 a day but I am now down to 1 a day with the same results as when I took 4. You really should take adrenal and the other supplements listed on this site as it really helps to build you back up. It will take time. Some say up to a year so give it a try along with your ERFA and don’t give up.

  10. Anna

    It would be nice to get an update from others! I find Armour not to be so bad now, so maybe there is some truth to it the rumour that it was reformulated a second time some time in 2010/11? It’s softer, can easily be crushed and left in the mouth to dissolve, and it no longer turns into a chalky paste. It seems to be more effective also. I’d be very interested to know if anyone else has noticed any difference.

    Also, on some of my Armour bottles it says “ver 2” on the labels, on others this is not to be found, but the label looks slightly different…I hope Forest is not in the process of going back to the bad formula from 2009…!

  11. Donna

    Still looking for a doctor who prescribes Erfa in the Toronto, Ontario area. Had a thyroidectomy 5 years ago and have not felt well on T4 only. Please help.

  12. Leeann wen

    Can someone please contact me ….I need help I am so fed up, I live in Canada in St.Thomas Ontario. Its been years since I have lived, I have begged for help and seen many Drs……Please Help Me

    (From Janie: use patient groups to find a doctor: and this:

    • Mindy

      Hello, did you ever find a good doctor to help figure out your thyroid issues? I’m in London and am pretty desperate myself. Just switched over from Synthroid to Desiccated Thryoid a few days ago.

  13. Monica

    I have been alternating between Armour and Erfa for the past year. I have felt great on both and not so great on both. I’ve really had no way of telling why that is. All of a sudden, I realized that maybe my adrenals have started to heal. Along with NTH, I’ve also been on HC, estrogen, progesterone and DHEA, as well as a dozen of vitamins and mineral supplements. Maybe the fact that BOTH Armour and Erfa seem to be working just fine for me now (temps up, hands and feet warm, fatigue gone) means that my adrenals have healed enough to make my body use that thyroid hormone in a way that it was unable to do before? I just wanted to mention this alternative, as I sometimes feel that it’s just black or white; you either hate Armour and love Erfa or (less common) the other way around. When I started NTH, before I had my adrenals checked and corrected, neither Erfa nor Armour completely relieved my symptoms. Now, my doctor think it’s time for me to slowly wean off the HC, and suddenly both Armour and Erfa seem to work just fine.

    (Good post. And for those who are reading this and have adrenal issues, you don’t have to be on HC anymore. Read this:

  14. DM

    I recently switched from 75mcg Synthroid/ 12.5mcg Cytomel combo to 60mg Erfa. Initially my doctor didn’t know how to calculate dosage so she relied on the pharmacy, who recommended 60mg. I immediately went very hypo – gained 8 pounds in 3 weeks, sluggish, brain fog, depression, low height rate, and period came 2 weeks late. The amount of T4 & T3 listed on the Erfa website is not consistent with some of the other articles I’ve read. I have recently increased to 120mg Erfa with no results. I’ll try it for a week to see if I feel better. The Erfa website states that the amount of T4 absorbed depends on your digestive system. Perhaps thats the reason for inconsistent dosages? I just want you all to know that you’re not the only ones. In hindsight I would have stayed on synthetics.

    (From Janie: This has nothing to do with being inconsistent, and no, staying on synthetics was not the answer. The reason you went hypo is because 60 mg is a “starting dose”, not a dose you should have stayed on much longer than two weeks. When you stay on starting doses too long, hypo does come back with a vengeance due to the feedback loop. Going up was the right thing to do, and it may need to be done again. Read this carefully: and the STTM book has even more details. You also need to check the status of your adrenals (not via blood, but via a 24 hour saliva test–very important) and iron levels (four labs). Desiccated thyroid works! 🙂 You just need to learn from patients)

  15. Christine

    I used to be on 5 grains of Armour and switched to Erfa two weeks ago (same dosage). I have no specific hyper symptoms, but these last few days I have noticed an enormous increase in appetite. No matter how much I eat at each meal, I am still hungry after less than two hours, and I need to snack constantly. Should I interpret this as a sign of hyper and cut back? It’s funny because Erfa contains slightly less hormones per grain than Armour, but it seems much more effective. If anything, I was expecting to raise the dose and not lower it. Has anyone else had the same experience? How much Armour did you take and how much Erfa did you end up taking?

  16. steeno

    been on Erfa for a month. At first it was great then return to hypo symptoms so keep gradually upping the dose but it seems like my body gets used to it and back to hypo symptoms…….

    (From Janie: there’s a reason which has nothing to do with Erfa. Join patient groups for feedback: )

  17. Anna

    So, those of you who have found your optimal dose of Erfa, what did it turn out to be compared to your previous dose of Armour? I am curious as I am still trying to find the right dose for me.

  18. Catherine

    Henri Knafo is indeed a wonderful man! He sent me the names and addresses of pharmacies in Belgium carrying Erfa, and one of them offered to send me Erfa although my prescription said “Armour” (the pharmacist said the products are considered bioidentical so no problem there). Within three days, I had received the shipment. I can’t believe how kind and helpful Henri Knafo is, and it seems he takes the time to answer every single message.

  19. Lisa

    I’ve been on 30 mg ERFA for two weeks, after switching from Synthroid (and previously Armour). I felt better immediately for a few days and then I started to notice a real dip around lunchtime accompanied by hot flashes. So I started to add a 1/2 of 30 mg before lunch and it seemed to have a calming effect. Unfortunately after about a week of the extra 1/2 tablet I started to feel hyper – lots of hot flashes all night and poor sleep. One day I took nothing and felt so much better! I’m so confused! I can’t seem to find the right dose. Without the extra 1/2 tablet I can’t even make it to 8 PM without feeling worn out.

    (From Janie: you have either adrenal fatigue and/or low ferritin. and There are two chapters on adrenal fatigue in the STTM book if you have it with even more details, and more about ferritin as well. )

  20. Miranda

    I started taking ERFA a couple months ago due to not being able to get ARMOUR anywhere. My Dr prescribed me 60 of ERFA, which was the same dosage as I was on ARMOUR. I went and had my levels checked last week and my TSH is all the way up to 18. We found out that more ARMOUR had been supplied at my local pharmacy so we changed back to that at the same 60 dose. Since I switched back on Sunday I am having a choking feeling in my neck/chest, feeling like I can’t get enough air…I feel horrible. What do I do? Someone help, I am so afraid my Dr is going to use this as an excuse as to why natural thyroid is so unreliable or something. I do not want Synthroid….

    (From Janie: Erfa was not your problem; the amount was, and still is. You are here: For more feedback, here are patient groups: )

  21. David

    I have to agree with those who have moved over to Erfa having been on Nature Thyroid which was severely restricted late last year. Started off on replacement 3 grains to match Nature Thyroid but boy after 10 days on it I am going through my working day like a zombie ! I have never suffered brain fog ever until now ! Have been on Armour(the Best),then Nature, o.k as a compromise. works well………………..but Erfa …does not work for me. Have know re-ordered Nature as my job demands that I am there and the last 10 days have been as bad as when if not worse than when on Synthetic T4 (The pits !!) never to return. Maybe it is the Iodine within the Erfa that maybe disagrees with my Auto Immune thyroid ? Don’t know….but it it is not for me.

  22. Leyna

    Just wanted to post an update. I’ve been 2.5 weeks on Erfa and after a slow start, I am feeling well again! I take 30 mg in am and 30 mg around 2:30 pm. Still having occasional afternoon dips, but they are minor and improving. My brain is back! No fog, and energy is wonderful. Erfa Thyroid was very much worth waiting for! Patience paid off for me. Hang in there for a few weeks if you can to see if it works for you.

  23. Toni

    May ’09 I switched to Armour since I took various synthetics (thyroidless) for 30 years. I had no change in symptoms at all. Two and a half weeks after my switch to Erfa I woke up one morning and I was shocked because it was the first time I felt well in years. I did not know that the reason I felt bad all day every day was my thyroid med. A week later though I became hyper (was on 1 1/2 60mg), so I cut it back to one 60mg and the hyper stopped, but my carpal tunnel is back. Today I started 1 1/4, I’m trying to get it right but I’m not sure how this will affect my upcoming blood work to check my levels. I have been on Erfa for 25 days now.

  24. Rich

    I’m a recent transfer to Erfa, was on 3x1g a day (30yo Male, big guy) of Armour, was stable for 8yrs (initial diagnosis of ht). First thing I noticed when switching is I immediately went hypo, but only slightly, no brain fog, decent energy, but cold hands/feet and the carpal tunnel is the most noticeable. I am 5 days in now, and have noticed the achey hands come 4-5hrs after a dose, so it seems i need a lil more, and will be bumping up a 1/4 grain for a few days and see how I react. I am just putting this here since I have been searching for others responses on their switch to erfa from armour, and not finding much of experience stories of if they had to increase dosing or reduce etc. General comments like it works for me, or it doesnt work for me is all I have seen.

    So that’s my concensus, I can tell it’s a little weaker than my Armour was, and I’ll have to adjust the dose. No choice since I can’t get Armour or NatureThroid in the Los Angeles area it seems!

  25. Leyna

    Janie, thanks for your suggestion to raise my Erfa Thyroid. My doc switched me from 50 mcg Synthroid and 5 mcg Cytomel together once daily (am), to a split dose of Erfa Thyroid 30 mg in am and 30 mg in afternoon (as I used to do, successfully, with Armour). It’s only been one week, but i’m noticeably more tired and cranky – and hugely brain-fogged. I’ve seen conflicting reports on whether or not Erfa should be split into two doses. Wondering if perhaps I should try a return to a single am dose of 60 Erfa, or a raise on the split dose? Will of course check in with my doc, who is very kind and open-minded, but not familiar with Erfa (I’m her first patient trying it). Any/all thoughts greatly appreciated. Thank you!

  26. Leyna

    How are other folks doing with Erfa Thyroid? I am on day 7, having switched from a Synthroid & Cytomel combo. Used to be on Armour, which was the best of all for me, like many others. It’s Day 7 and I’m more tired and down than I was on synthroid & cytomel. Has anyone found Erfa to get better after a few weeks, despite a rocky start? Or have the folks who found success with Erfa Thyroid felt good immediately? I’m so grateful for this chat, keeps me hanging on when I feel like giving up! Thanks, everyone.

    (from Janie: I think you just need to raise it.)

  27. Cheryl

    Giving up on ERFA… a miserable 2 weeks with no signs of improvement even with increasing the dosage. In fact, I started to feel both hyper and hypo at the same time. Thankfully I was able to get some Nature-throid from Clarke’s Pharmacy in AZ. I took one pill and immediately started to feel my hypo symptoms retreating…Disappointed as I really wanted to be able to get stable on ERFA…Everyone’s system is different… It may work for some…but unfortunately not me…

  28. nica lina

    Steve…and Amy…wondering how your doing on Erfa now, still on it..did your hypo symptoms stay away?

  29. Cheryl

    I switched from nature-throid 75mg (1.25 gr) to ERFA about 2 weeks ago and definitely noticed hypo symptoms almost immediately: fatigue, muscle aches, brain fog, depression, and carpal tunnel pain. i have upped the dosage to 90mg ERFA and feel a bit better…we’ll see how it goes in a few more weeks…

    n.b. the ERFA pills are quite sweet…(like the old armour) and they crumble easily when cut. i got 100 of the 60s and 100 of the 30s….i had no problems getting my shipment from canada.

  30. Melinda

    About a week and a half ago I started Thyroid. I had been on Armour and then went back to Levoxyl (YUCK). My NP’s MA said she finally found a way to get the meds from Canada so I went with that. While waiting for the Thyroid delivery I went back to the Armour I had saved. I immediately felt better!

    I went from the Armour to the Thyroid when that arrived and my headaches are back. I went from 60 Armour to 1 grain Thyroid and am beginning to wonder if I need to adjust a little bit since the headaches had almost disappeared with the Armour.

  31. Amy

    I am having the same problem with ERFA. I am glad to know it is not just me. I have had to increase my dosage twice already. I thought that maybe ERFA doesn’t work for me but maybe it is because of the slight ratio differences listed above? I hope so…..

  32. Sonja

    To Monika – I thought I got Armour about 6 weeks ago with no problem at It says Armour on the bottle, but the pill was different, so I knew it was a substitution. But it seemed to work the same or better, so I didn’t worry about it. However last week, my symptoms have returned too – fatigue, brain fog, weight gain – so I called them and they said it was a straight across deal with the Erfa dosing. Obviously not, so I started to increase my dose today. I hope you can get yours figured out. It’s nice to know I’m not the only one with problems and hopefully this is an easy fix!

  33. Stac

    I have experienced the same thing. I was on Armour, then Natur-thyroid. After the shortage hit, I ordered Thyroid (Erfa) from Canada. My hypo symptoms have also returned. MOstly hair falling out, stubborn weight, dry skin bumps on legs, rump, arms. I’m now attempting to increase the dosage by 1 grain (from 3 that worked well on Nature thyroid. Hopefully symptoms will improve (will also check with the Dr. in about 1 month).
    How did your test come out?

  34. Steve

    I spoke too soon (see my comment on 10/31/09). I didn’t realize/know that there might be a “ramp up” period when switching from the reformulated Armour tablets that weren’t working at all to the Erfa tablets. Although I was still feeling extremely hypo yesterday (after about 8-10 days on Erfa), I feel pretty decent today. Thus, unless my hypothyroidism magically cured itself in the last 24 hours, I assume that the Erfa is doing its job.

  35. Steve

    I recently received and started taking the 30mg ERFA Thyroid tablets as a substitute for Armour 30 mg. It doesn’t have the same effect on me either. First, a single 30 left me feeling extremely hypo. So I increased it by 25% with slightly better results. Second, for some reason, it wears off by mid-afternoon. A pharmacist at assured me that it was the equivalent, but doesn’t seem to be having the same effect as the old Armour.

  36. Monika

    In July, I had started taking 90 mg of Armour for about 1 month when the shortage occurred. I have been able to get 100 pills of the 60 mg & 30 mg of Erfa Thyroid. I don’t know if my body needs a higher dose or if Erfa is not as potent as Armour, either case my hypo symptoms have returned with a vengeance. Has anyone experienced this being on Erfa? Janie I know you have posted there is a slight variance in the T4/T3 ratio……not sure if that might be playing a roll. Either case, asking Dr. to do some bloodwork this week.

  37. Sandy

    Do I need an RX to order from a Canadian pharmacy?? Also, I now take .125 mcg of Synthroid, what would my dose be with Erfa? Thanks!

    (From Janie: yes, you need a prescription. And there’s no definitive equivalent. You figure that out as you raise it bit by bit. Read this page: or Chapter 3 in the book with more detail which you can also share with your doc. Here are patient groups so you can get more feedback: )

  38. Jen

    I just ordered ERFA’s Thyroid from Canada. The pharmacy I went through was only able to send me 100 tablets because they are starting to experience shortages.

    This is making me more than a little nervous. If we can’t get it from Canada, are there any other options?

    (From Janie: go here:

  39. Rose H.

    Is it safe to assume that if I’m taking 90 mg. of armour at this time~~ if I switch to Thyroid by Efra I take the exact same amount? Please– an answer from someone!! I plan to order from Canada this week… whole thing makes me nervous.

    (From Janie: some have stated they need more; some less. You’ll have to figure it out by symptoms, I figure.)

  40. Hashi's Paul

    I had the Dr. office FAX a script for #500, 125mcg ERFA Thyroid on monday Aug 31st and it arrived in south Florida Sept 8th. I used CROSSBORDERPHARMACY.COM. Canada still has ERFA available, as of a week ago.

    Janie…. I have looked, but cannot find any source that states “How many NDT patients or scripts are there in the USA or world???” “Does anyone have any idea how many of us there are??”

    Strenght in numbers!!!!!

    (From Janie: there have been estimates made, but they are just that. So the real number is unknown, I’m thinking, until we have something solidly factual)

  41. tina budde

    Alot of my members/patients have hypothyroidism, we are located at various places in the world, we are lymphedema patients and hypothyroidism goes hand in hand. I have many who currently take Armour thyroid, and now that is going to be reformatted and not available to us. I take 60mg of Armour, would this be a good choice as a substitute?


  42. Jay

    “they have a huge supply of desiccated powder.”

    I don’t agree with this statement at all.

    The ERFA website has a forum, and Dr. Knafo stated that they had a 1 year supply because they anticipated the shortage in the USA.

    A 1 year supply could easily run out prematurely and cause a shortage if the demand gets too great………..just like the RUN on the supply of Naturethroid in the last couple of months.

    I have spoken to Dr. Knafo also. He told me that the Canadian Patients are the first priority. If supplies did run out, then Canadians would be helped first.

    (From Janie: quote comes from Knafo. I can understand the last comment he made on your post about Canadians. Understandable. )


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