NP Thyroid by Acella has once again been recalled!

Yup. It’s happened again. The following lots of NP Thyroid by Acella Pharmaceuticals LLC have been recalled due to sub-potency! 15-mg, 30-mg, 60-mg, 90-mg and 120-mg NP Thyroid®

And as the creator of Stop the Thyroid Madness (STTM) patient-to-patient movement, I’m not surprised.

Since Acella brought NP Thyroid back after the recall(s) in 2019, there have STILL been complaints by some hypothyoid or Hashimoto’s patients!! No, not all. But enough to cause concern. The complaints have occurred in thyroid groups directly associated with STTM…and even in groups that are not directly associated with STTM. I was hearing those complaints in STTM coaching calls. I was hearing about them from many patient volunteers who contact me!

What were the continued complaints? They revolved around not being able to fully get out of one’s hypothyroid state.

And this is the second time for a recall of NP Thyroid

The first recall(s) happened in 2019. And you can read my blog post about it here. You will read that in some patients, their newly obtained NP Thyroid prescription was causing problems in the Summer of 2019. Then by Fall of 2019, there were obvious changes along with a return of hypothyroid symptoms, like a “cat piss” or “ammonia-type: smell. Patients reported back then:

  1. It now smells and tastes horribleworse than before.
  2. The tablets look different from previous ones
  3. I’m feeling much worse now on the same dose that made me feel great. Symptoms are back.

Then in the same blog post, you will read about the recall due to sub-potency, then later “super potency”. Either way, it was clear that too many patients were NOT feeling well on it anymore. Even those who said they still did feel well, didn’t have labs to prove it would last.

So what do you do now if you had returned to using NP Thyroid since it came back out again?

Still to this day for what appears to be the majority of hypothyroid patients, Armour desiccated thyroid is working (even though there have been periods in the past where it had problems, but they seem to have been corrected a few years ago). So is using synthetic T4 with synthetic T3. Examples of the two synthetics are Tirosint for T4, with Cytomel or Sigma Pharm for T3. Honestly, all the brands have worked.

BUT….we as patient learned that to make either work correctly, we have to have the following:

1) The right amount of cortisol, otherwise we get hyper-like symptoms when raising. You can read this page to see clues that you might not have the right amount of cortisol. i.e. some levels being too low, others too high. All can cause hyperlike symptoms when raising a product with T3 in it. It’s the results of pooling.
2) The right amount of iron levels, otherwise we get rising RT3 (reverse T3), an inactive hormone which can block us from achieving the right amount of T3.
3) Optimal free T4 and optimal free T3. Optimal is NOT midrange. Optimal is not below midrange. Optimal is not just slightly above midrange. Read the page on optimal.

So let’s talk. Use the Comment feature below.

NOTE: If you reading this via an email because you signed up to receive notifications, the links will NOT work. You have to come straight to the blog post by clicking on the title of this post.


Here are links about the recall:–

I will be adding more links to this blog post as they come out.

Important notes: All the information on this website is copyrighted. STTM is an information-only site based on what many patients worldwide have reported in their treatment and wisdom over the years. This is not to be taken as personal medical advice, nor to replace a relationship with your doctor. By reading this information-only website, you take full responsibility for what you choose to do with this website's information or outcomes. See the Disclaimer and Terms of Use.

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119 Responses to “NP Thyroid by Acella has once again been recalled!”

  1. Jenny

    Having not taken any NP during summer this year and felt tolerably well, (I’d started getting ocular migraines once again),I then started feeling not so good so restarted on a v low dose again gradually building until taking a little over 1 grain and felt fine. Just began a new bottle and notice the tabs are significantly harder and shiny compared to the last lot, plus they smell quite disgusting… and am feeling decidedly weird, headache, jumpy, anxious…so am assuming I might’ve got some of the hyper potent ones previously mentioned in the above piece. Not sure whether to drop the amount I’m taking or abandon them entirely. The cost to have more shipped is now horrendous via the pharmacy I’ve traditionally used so I dont want to waste what I have already spent or risk buying more that may be faulty also.
    Wondering if I ought to buy Armour this time though I’ve not tried it before….are you hearing reports of any problems with Armour ? Can anybody help please ? I’m in the UK and trying to obtain a script for NDT is hopeless so I have no choice but to purchase overseas. Thankyou….

    • Janie Bowthorpe

      One thing we’ve learned over 20 years is that we can’t go by how we feel. We simply have to look at the labs free T3 first and foremost, plus RT3 second. Because feeling fine can backfire, believe it or not. What doesn’t backfire is an optimal free T3, which is a free T3 in the upper part of the range with no lingering hypo symptoms.

      It’s normal for NDT to smell weird though. That’s the pig. If you are feeling weird, headache, jumpy, anxious, that can be that the thyroid med is revealing this: And if you have an adrenal problem as suspected, you will still have issues with Armour revealing the same thing.

      • Jenny

        Sorry for delay in replying….I haven’t been here for a while….I know it’s the pig causing the smell, this however is something else entirely !…I’ve been taking NDT for ages so quite familiar with the whiff. I have to disagree a little….I absolutely know when what I am taking is good because I feel normal….I dont trust blood tests and in any case cant get any useful tests done on the NHS and my miniscule retirement income means I cant buy them privately, so I have no choice but to go by how I feel in any case…both ERFA and good NP batches do not make me feel jumpy or headachey as happened this NP stuff. I was however actually asking if anyone taking Armour has experienced any problems and still dont know. I will just have to shell out the hideous amount of money to buy some and take a risk I suppose.

        • Janie Bowthorpe

          You can’t go by what any random person says about having problems with Armour. Too many people can say they have problems, yet the cause is not directly the Armour. Problems can happen by never reading what it means to be optimal, thus experiencing the backfire/return of symptoms from never being optimal, yet they blame Armour. People can blame Armour due to the problems of low iron. People can have problems due to heavy metals or toxin, yet blame Armour. On and on.

  2. Mary

    Hello – I was switched to np thyroid in 2019 & started having hypo symptoms & later discovered levels had worsened. This was during a time of extreme stress also & my menstrual cycle abruptly became sporadic. My FSH had been very good for my age had been about 3 & then over 5 years went to about 7, but still very good for my age. Then during the time of extreme stress & trouble with np thyroid my FSH abruptly raised quite a bit. My DHEA & progesterone also tested very low & cortisol very high during this time. After thyroid medication changed & cytomel added & supplementing DHEA i started having increasingly regular menstrual cycles, but still not regular. It all happened so abruptly during a time of extreme stress & thyroid medication not working & wondering if this could have caused me to go into abrupt perimenopause/menopause, & if possibly it could be corrected if stress were lowered & thyroid levels restored? From what I’ve read perimenopause/menopause usually occurs over a period of several years & this was so abrupt that it seems as if the stress & thyroid issues may be a factor? If anyone has experience or knowledge of a situation like this I would appreciate any information. Thank you!

  3. Gianluca

    Hi Guys

    I’m wondering if anyone has any recent complain about the 60mg NP thyroid.

    I went from 30mg, then 30mg 15mg, ultimately to 60mg which I found is working less than the 45mg combined, within 3 days I had more cold hands. I picked up this RX 10 days ago

    I called the company and the pharmacy, according to them no recalls or issues with it, and no differences between the different strengths. I’m curios to try 2 of the 30mg for a few days, which 3/4 weeks ago, I couldn’t even tolerate

    • Janie Bowthorpe

      Gianluca, the more we raise low doses like that, the more it will suppress our own thyroid hormone release, thus why were raise every two weeks or slightly less until this is achieved: 60 mg is what we start on before raising! We don’t start lower than that.

      Also, anytime we feel hyper-like symptoms upon raising, we have learned that those symptoms are pointing to this

      • Gianluca

        Janie, I then tried to use the two half grains instead of the 1 grain, and in two days my before rising am temperature increased from 97 to 97.6 again. So it is either a coincidence or the 1grain doesn’t work, or the half grains are overdosed. I’m thinking to switch to Armour perhaps.

  4. Gianluca

    HI Jamie, I have a bottle of NP Thyroid that is sitting in the cabinet for about a year, the bottle says it is good until 10/22. Do you think it may have lost some strength and I’m better off getting a new RX?


  5. Gianluca

    HI Janie. i apologize if I’m bombarding the blog with comments, but I need so help here. I see both NP and Armour have some problems, and I still not fully understanding if that is because the FT4 and FT3 levels are not optimal, or some reactions to the NDT itself.

    I’m currently off any Thyroid, but need to resume taking it. I always used NP Thyroid, and I still have at home a bunch of half grains and 1/4’s as well, still within the expired date. If those pills I have at home, were able in the past to raise levels to optimal, then I should be fine with the NP, or you would recommend anyway to restart everything with the Armour this time?

    I had some side effects few months months ago, like a resting HR in the mid 80’s, nervous at the time. but I understood it may have been my Testosterone dose too high, and getting off the NP made things worse with my adrenals.


    • Janie Bowthorpe

      NP had major problems starting around 2019. But some are saying it’s working again today. Armour seems to be working for many today, as well. But for either, understanding this is crucial:

      • Samantha

        I find that NP is working fine for me. I feel warm as soon as I take it. Actually Armour has crazy sub-potent batches that have almost no potency at all and the reason I know is that I never finish a bottle that is working, before I open a new one, just in case, and the last three bottles I bought from the UK were crazy weak in comparison to the working batch and made me totally hypo, cold, carpel tunnel feeling in hands, stiffness in joints, crashing in the evenings. Blood tests confirmed T3 actually lower than when on T4 monotherapy. I switched to NP as a last resort as I cannot tolerate Erfa because of racing thoughts and it has been good. Though not as good as a working potent Armour. But it’s too expensive to play dodgeball with pill potency so I will stick with NP until Armour gets its act together.

  6. Gianluca

    Hi guys. i see on the website that NP thyroid has been recalled twice, and most people are not doing well with it, overall the articles and blogs goes in favor of Armour. But if the NP is increasing FT3 and FT4 level at the optimal range, then I think it is working and ok to take it? or despite obtaining an optimal level people are still experiencing some thyroid related issues with it?
    i was told by my doc years ago, NP would actually be better than armour due to less fillers in it

  7. Jennifer

    Hello Janie,

    I have been taking compounded thyroid and about a month ago, I started not feeling as well with my thyroid.  Then yesterday I looked at my capsules in a brighter light and noticed that the powder had turned a dingy yellow and there were yellow specks in it.  I called the pharmacist and he said that it sounded like the acidophilus filler was oxidizing and that they had gotten a new lot of the acidophilus after filling this prescription.  He also said that the oxidizing acidophilus would not affect the thyroid med.  However, I have to wonder if that is the reason I’ve been having trouble with the med for the past 3 weeks.  (By the way, the porcine powder was still the same lot as before when I didn’t have an issue with the capsules so we didn’t suspect the porcine.)

    I will also add that the tops of my feet and my ankles have been swollen for the past week (which is not a usual thing for me at all). In addition, my knee joints are starting to get stiff feeling.  Last night I didn’t take the oxidized capsule and the swelling in my feet/ankles was down a little this morning.  So my question is:  do you think the oxidizing acidophilus can be affecting me and should it even be in contact with the porcine powder?

    I would like to have a tolerable filler that is not subject to oxidation.  I have never seen my capsules do this before (not even old ones that expired and were left sitting around for months).  I have a lot of trouble tolerating fillers (can’t do Avicel at all).  Are there any other fillers you might recommend as a possibility?  What about  dextrose monohydrate as it is used in Acella’s NP Thyroid and I seemed to tolerate the NP really well before they went south.

    Thank you so much. -Jen

  8. Susan

    Have there been any new reports of problems with NP? I recently started on a new refill and have noticed my pulse rate has been erratic, sometimes swinging from mid 50s, with lots of irregular beats, to a high of 115. I skipped my NP this morning to see what happened and the rate has been running at about 75 to 85 all day. I wondered if it was a new problem with the ratio of T3 to T4.

    • Ryan

      YES! 100% is the issue. I had a new refill recently as well and I’m seeing spiking heartrates, dizzy spells, blurred vision, brain fog, and poor absorption (I say that due to cold hands and feet and feeling fatigued). They changed the damn formula again, and I’ve been begging my doc to switch me over to Cytomel and Levo so that I can ditch this garbage behind.

      • Janie Bowthorpe

        But also check to see where your last free T3, free T4 and RT3 was. We need to be sure whether it’s the actual product going downhill again, or whether you are experiencing the backfire around the same time as the refill due to never having had “optimal” frees. Optimal free T3 is not midrange. Optimal free T3 is not just above midrange. Etc.

      • Gianluca

        wow that is scary. Basically, even if the NP is bringing the FT3 and FT4 to an optimal range, it can still produce this type of side effects compared to Armour for example? I had stooped my NP about 3 months ago and debating if i should switch to Armour this time. Have you checked your levels when you were experiencing the side effects?

  9. Jody Joy

    Just wondering if there is any update as to the NP Thyroid recall. Been out of the country and just about to call in a refill, but checking to see if there is news first. Have they corrected issues-is this known at all?

  10. Hugo

    Hello Janie, thank you for your hard work! excuse my english is not very good. I live in Canada, Hashimoto since 2009. I’m not good with Syntroid only, I convert not well. Now I take Syntroid and Cytomel and I’m not that bad but not much energy. I would like to get better and would like to try Erfa Thyroid, the only NDT available in Canada. what is your opinion as of today on Erfa. it might be a good idea to give it a try, even with Erfa? Thanks again for your wonderful work!

    • Janie Bowthorpe

      Hi Hugo. It sounds like you haven’t achieved this on T4 and T3:

      • Hugues

        Hi Janie, thanks for your reply, Oh yes I read your post which I liked and all the others. In the past I did the cortisol test, it was in the low normal range and a little high in the evening. I had high RT3’s so I was on Cytomel only for 1 year, with 75mcg and I was fine. I was taking 5 doses a day.  I am comfortable with a T3 just over the range. My doctor has asked me to try again to get back on the Synthroid with Cytomel. I have been trying to find the right T4/T3 for last 7 months. Now i’m on Synthroid 77mcg and Cytomel 30mcg.My T4 is in the low middle and my T3 is in the high but I don’t feel well, fatigue, brain fog, extrasystoles. I think Synthroid is not good for me, or I haven’t found the right fit yet. I think I’m only coming back with T3. But I wonder if the T1, T2 and Calcitonin of NDT could be an advantage for me.  I would try NDT with Cytomel.But I don’t know if ERFA is good or if the doses always change. Is it possible to be fine with ERFA? Here in Canada we can’t have Amour. Sorry again about my english and thx for your help!

        • Janie Bowthorpe

          Do you understand that lab results are about “where” in the range they call, not just falling anywhere in range? By how you worded your reply, I can’t tell that you get that. See what’s on this page:

          We learned repeatedly that taking that many small doses of T3 (you mentioned 5 doses a day) doesn’t give us the punch that moving the same total amount down to 3 doses a day does. With three doses, you get more T3 each time.

          It never works to get back on T4 if you have had high RT3, but never treated the cause, we have found out the hard way. Read this: And no, we don’t need T4 in our treatment the way your doctor is implying. It’s great to have T4 IF we aren’t converting to RT3. But if it still is, it’s perfectly fine to be on just T3. Remember: Doctors are ONLY trained about T4. So they tend to freak out if we aren’t on it.

          High free T3 and not feeling well = pooling due to a cortisol problem. You will see the saliva cortisol test you need to order. It’s never about blood testing for cortisol.

          You need to be reading STTM or the STTM book. 🙂

          • Hugo

            Thank you so much for your time and your help Jenie!

  11. Ryan

    Finally got around to doing some labs. Not exactly what I asked my doc to submit to the lab testing agency to pull but good enough.

    =>TSH| 4.28 | 0.40-4.50 mIU/L MI
    T4, FREE |1.0 | 0.8-1.8 ng/dL MI
    T3, TOTAL | 112 | 76-181 ng/dL MI

    Certainly not optimal by any means with that high end TSH and middling T3. I’m still on NP Thyroid for what it’s worth but I plan to make the jump to synthroid/cytomel combo. At least I know why I feel like garbage so often. Doesn’t help that I try to space out dosing so I don’t get headaches/migraines as much either, but I’ve been sucking it up for a month or so to try and get the most accurate level readings. Shame to hear there’s no real NDT meeting expectations for everyone. Hate to go to synthetics but I guess there’s not much of a choice. At least it’ll be cheaper every month than the near $50 price tag I’m paying now for NP.

    Edit: I also did a full lipid panel and my bad cholesterol and triglycerides are elevated. I looked into it and apparently being suboptimal hypothyroid has a direct effect/causation for this condition. I’m a 36 year old male with a slight gut and work out often. I suppose I could diet a bit more but I have a feeling it’s fleeting until I get my thyroid levels under control.

    • Janie Bowthorpe

      Ryan, your T3 is the useless total lab. That doesn’t help us as it’s measuring mostly bound UNusable T3. We always need the free T3, which measures unbound, useable T3.

      And your labs reveal why you feel so awful. When we get optimal, we see the free T3 (which you need) at the top numbers spread of the range. We see free T4 around midrange–yours is far lower. And with both the latter, the TSH goes below range. No wonder you feel awful.

      You also didn’t measure your RT3. IF that’s going up, that can explain your feels bads, too. Healthy people have a results in the bottom two numbers of any range, or below. (European ranges can be broader, so the bottom area or below.)

      So just moving to T4 and T3 requires the same attention to this: and this

      And to the contrary, Armour has been working for what seems the majority who report back IF THEY GET OPTIMAL on it with those frees. That’s even be true for those who have just picked up their Prescription, use it, and do labs several weeks later. Can there be batches that are bad? Yes. But we aren’t see that often.

      • Ryan

        Yeah I mentioned to them that I wanted a full thyroid panel so T1-T4 both free and totals and TSH. I end up getting a standard panel. Is synthroid and cytomel still a viable, reliable option here? Would you recommend it? I honestly would love a cheap NDT like Naturthroid used to be pre-2017 where I spent $8 a month for a fill, but I think those days are gone. Since I have health insurance and no job prospects due to covid closing my business down, I’ll take what I can get on a the lower side. I figure cytomel and synthroid are the cheapest, reliable option here and the FDA actually quality checks it unlike their hands-off approach to NDT.
        After switching over, assuming that’s my best option here, I’ll have them do another check for everything I’ve asked for. Can’t be wasting $200 on labs that lead to nothing.

        Thanks for the info!

        • Janie Bowthorpe

          Most any T4, plus a lot of the T3’s (Cytomel, Sigma Pharm, etc etc), are viable options, yes. Sadly, T3 is not cheap. But if you are in the US, you can use cards/card numbers like GoodRX, etc, if you don’t have a prescription discount insurance. And remember to fully read the optimal page.

          And for others reading this, Armour has still been working for many, many people if they have a low RT3, and if they get optimal frees. STTM will keep on listening to patients, because STTM is not afraid of noticing and reporting what is consistent in reports (and it’s still consistent for a large body that Armour is working if they get optimal and aren’t seeing RT3 go up), as STTM is not into ego, the need to look oh-so-powerful, nor empty opinions. 🙂 And be wary of any group that is still exclaiming that “none” of the NDT’s are working at any time, ever. That is patently false.

          • Janie Bowthorpe

            And the totals are a waste of our blood and money.

          • Ryan

            Good info and thanks Janie!

            Finally got a call back from my doctor’s ARNP today after trying to get her to read my results and go over them with me for weeks. Doc doesn’t make calls, so this is the best I can do with that office. As predicted she told me that “everything looks good” and that I just need to diet and cut carbs to get my high bad cholesterol and triglycerides down…

            I tried to explain to her, since she’s likely not an expert, that undermedicated thyroid issues can cause higher cholesterol and that no diet and exercise routines will bring it down till the thyroid is treated adequately. I also tried to explain that “4.28 is on the high side of normal for TSH” and her response was “everyone is different this might just be your genetics.” Gonna start looking for a new doctor, ’cause I can’t be dealing with these inept ARNPs who try to gatekeep medical care in favor of doing repeat visits and labs so they can bump their numbers and not actually fix the problem. Sucks, since I’ve been with that Doc for over 15 years now, since he’s usually really good about patient concerns and bedside manner, and he doesn’t realize his staff is gonna start costing him.

    • Jay

      How much NP do you take per day?

      • Janie Bowthorpe

        To anyone reading this: just want to clarify that it’s all about getting optimal with a working NDT. And the amount that does that can be very diffeent among individuals. A working NDT means we are still seeing a good percentage of people able to get truly optimal with a removal of symptoms. And they have the right amount of cortisol to do so, which is key. Without the right amount of cortisol, raising to get optimal causes hyper-like symptoms and is called pooling.

        And that will be different amounts among different people. If on a straight NDT that is known to still be working (by the amount of people who report with evidence as still doing well on it), this page explains:

        And above is true if just using T4/T3.

        And if using less of an observed working NDT with T3 added (a common method of treating rising RT3), we then just pay attention to the free T3 being optimal, as the free T4 will be lower than optimal and that’s okay if free T3 is truly optimal.

        If on nothing but T3 and multi-dosed, just the free T3 is watched to get it optimal. Some on nothing but T3 can go a tad higher than the top of the range.

        And all the above will greatly lower the TSH below range if optimal. We have to stand firm against poor understand by doctors who think we’re on too much if that occurs, which is totally false. They are confusing our low TSH with that of Graves disease, and not paying attention to our frees.

        Can there be batches of certain NDT’s where it’s not working? Sure. But we also still see a lot of people, who think it’s not working, actually be underdosed and not optimal, or having a rising RT3 (which is treatable), or having a cortisol problem (which causes pooling). All are treatable. So though someone might have picked up a bad batch, others need to be more careful in discerning any of the latter.

      • Ryan

        I take 1 grain and 1/4 currently, so it’s a combined dosage of 60mg and 15mg.

  12. Aaron

    Like other people have mentioned on your website, I got really bad gastritis, stomach burning and tinnitus from NP Thyroid. I started taking it in December 2020. Started burning stomach and tinnitus in January 2021. I’ve spent THOUSANDS trying to figure out what was causing this and seen multiple doctors including Neurologists, general practitioners, Urgent care, multiple gastrointerologists and very expensive out of pocket functional medical doctors. Everyone was baffled as to why I had erosive gastritis and tinnitus. I stopped taking the medication in July 2021 due to being over medicated, the Endocrin. put me back on levothyroxine. At about the 3 month mark I noticed a significant improvement in my gastritis, it was still there but had improved. After another month (so 4 total) I decided to go back on NP Thyroid due to excessive hair loss and feeling hypo all the time. On the day I took the NP Thyroid again I noticed my stomach burning more, I wanted to make sure it wasn’t in my head and not just a coincidence so I stayed on the medication. Less than a week later I was getting intense burning and bloating again. It was awful! So i stopped and went back to the left over Levothyroxine I had. Literally the day I stopped NP Thyroid the burning and bloating went down a notch. So it seems pretty clear its been the NP Thyroid causing this the WHOLE TIME. I can’t believe I didn’t connect the dots initially, instead i was on this damaging medication for 7 months! NEVER would have thought it was the thyroid medication. I’m either allergic to a filler, which is weird because i’m not allergic to anything else on the planet that im aware of, or there is a bad chemical in this causing poisoning. The weird thing was the medication worked as far as labs and hair growth. But came with a debilitating side effect.

    So now that I have lingering gut issues from this medication, which I never had before taking it, what kind of doctor/specialist should I go see to help assess the damage and help with the repair process? Some kind of poison specialists maybe? Hopefully this damage isn’t permanent.

    I’m going to try Armour when I see my Endo next. Hopefully that doesn’t do the same thing

    • Janie Bowthorpe

      Hi Aaron. Sorry you went through that. Do know that there seem to be a significant amount of people who are finding Armour to still work. Or there is always the option of adding T3 to that T4. We take both synthetics similar to the amounts that are represented in Armour i.e one grain is 38 mcg T4 and 9 mcg T3, which is roughly equivalent to 4 times more T4 than T3. And with either, this is our goal with raising:

      • Jen S

        Aaron, do you by chance supplement with Selenium? I won’t say there isn’t a connection with the NP but I just went through everything you did with terrible gut pain and bloating. I’ve tried taking selenium on and off and it’s always made me feel awful. I had tried again with a lower dose because it’s supposed to be something we need. I had thought I was doing ok with it because I wasn’t having the terrible headaches and other issues it normally gives me. It took months of supplementation for it to build up to level of discomfort I was having. Spoke to my neuro, GP and had a CT scan and a colonoscopy all showing nothing. I finally thought having I been doing ANYTHING different? The selenium. It only took days when I stopped taking it for the symptoms to subside. I mentioned it to my gastroenterologist and he confirmed absolutely yes, selenium can have that affect on some people. I used to take NP for years till the issues. My doc tried me on tirisint and cytomel because synthroid gives me awful migraines. Even with optimal numbers my symptoms came rushing back along with terrible pain in my back and awful gut pain. So I’m back on armour until the other NDT manufacturers figure out how to properly make their meds.

  13. Kate

    Thank you Janie for your books–have read all of them since 2019, though I’ve referred to your website since 2017. I read the recent October comment from someone on NP Thyroid who is doing well. I, too, am doing well on NP Thyroid since switching over to it on 10/04/21. My hair is doing better these past few weeks, and I feel better, in general, and am sleeping well. Plus I can get NP mostly covered now by insurance, whereas I had to get Nature-Throid through my ND at my cost since 2017.

    I am 62. I take 5 grains/day of NP sublingually, taking one grain every five hours–it must have more T3 and T4 in it than the Nature-Throid. My recent Free T4 was 2.0ng and Total T3 was 202ng. With going up to 5 grains of Nature-Throid T4 a few months ago, trying to get hair to grow in better–helped–it was anywhere from a Free T4 range of 1.3 to 1.8. Total T3 was anywhere from 156 to 220. I’m guessing such variation was due to NDT pill inconsistencies of T3/T4. (I can get only Total T3 testing–insurance doesn’t cover “Free” T3 testing.)

    My primary D.O. physician says T4 is now too high and that I need to back off. I feel very good at five grains of NP though, and my hair is doing much better–like it has life to it now and is growing a little. I take my last grain by 6 p.m. the day before lab testing at 8 a.m. I’ve read online some labs go as high as normal range of 2.3 for T4 and 200 for Total T3. My healthcare provider’s range goes only to 1.7 for T4 and 170 for total T3. I am able to get more frequent thyroid testing, up to every two weeks if I want, due to thyroid problems in 2019, which I’ll explain later.

    I was started by an ND on WP Thyroid (not NP) in January 2017, after doing poorly on Synthroid since 2012 and gaining about 60 pounds between 2012 and 2017. I swallowed the WP pills. I lost weight more easily over time. Then because of a recall, I was switched to Nature-Throid in Oct. 2017 and was okay with the switch, swallowing those pills until later in the month, when I began taking them sublingually (again, will explain later why I did so). I felt so much better right away, being on NDT.

    I had stockpiled quite a bit of Nature-Throid (learning from previous recalls) and used them up until my recent switch to NP Thyroid, though I had to increase the Nature-Throid dose to five grains a day from my usual four/day (taking one grain approximately every five hours) because it didn’t seem to work as well. Since Oct. 2017 I have taken Nature-Throid sublingually after an appendectomy, after an iodine contrast CT Scan (took about three months to not feel hypothyroid from that–probably Wolff-Chaikoff Effect), when it seemed pills were not working anymore after swallowing them. Taking NDT sublingually, instead of swallowing them, may be the reason NDT has worked fairly well for me during the recalls.

    Still, the Nature-Throid T4 part of pills were evidently much lower than the T3 part, according to my labs since 2019. This ratio I believe was not as good for me. I noticed a difference in my hair with a little breakage beginning in earlier 2019, though, especially the day after eating foods with iodine in them. My hair was good, though in February 2019. By June 2019, though, it wasn’t so great, and my thyroid lab numbers were lower, though normal.

    Then my hair suffered greatly with breakage and shedding since at least August 2019, when I evidently went very hyperthyroid from taking only 5 to 10 mg daily of B6 supplementation since that June, because of low B6 labs. Has anyone ever heard of such a thing? By the time I called (in tears) to get lab tests in late August–after three weeks of steadily losing a lot of hair and weight–that’s when I found out I had gone hyperthyroid from the B6 supplementation. I had already stopped taking B6 a couple of weeks earlier, suspecting it was bothering my hair.

    It has taken a long time to recover from the B6 hyperthyroidism effects (Free T4 was 3.1 and Total T3 was 473), after starting again from scratch–hypo again (from stopping NDT suddenly to bring lab numbers down, when lowering NDT didn’t bring them down fast enough; and then going too low in lab numbers with the restart with too low of Levothyroxine only).

    However, I did learn some things about my renewed hypo symptoms from that experience (itchy rashes that had mostly stopped with NDT now started again, etc., that had started in 2006 suddenly, due to, I now believe, sudden exposure to too many pool chemicals while swimming–the too high amounts of bromine, copper, ash, etc., put into the pool by my now Ex husband).

    Also after going hyper, I had bladder spasms and vaginal pain (had to use Estrace cream for first time). The bladder problems and vaginal thinning went away when I increased my Nature-Throid dosage. Had to get it above at least 3 1/2 grains to do so. Any lower, and the bladder/vaginal problems would start up again. A good, older thyroid book by Kenneth Ain, M.D., “The Complete Thyroid Book,” supports this, for me. He talks about how he first tests and puts women on thyroid medication when in perimenopause, rather than starting them on HRT, and how it solves the vaginal problems. It’s a very good book, although I disagree with his not believing that many people can be poor converters of T4 to T3.

    Also, I experienced subsequent food sensitivities back then in 2006 to present time (MSG and dyes, iodine, fruits and vegetables (skins), especially–thyroid not addressed until 2009, and then not very well, because although initially on Levothroid and felt well, I was forced to switch to Synthroid in 2012, and was probably undermedicated; also know now since this 2019 Levothyroxine experience/labs that I am a poor converter of T4 to T3).

    After the hyperthyroidism and starting over on Levothyroxine, I resumed taking Nature-Throid in January 2020, as no matter how much Levothyroxine I took, I still had cold hands and feet, and my hair was not recovering as quickly as I would have liked, though the shedding and most of the breakage had stopped. Plus weight gain started again (which I needed for awhile, since I had lost too much weight with going hyper).

    In trying to help my hair, in January 2020, I began taking various supplements carefully, using a food/mood symptom log– which I’ve done off and on since 2007. Taking calcium carbonate has greatly helped my hair. My calcium lab number had gone lower, than it ever had, to right below the low range number. Now it is getting closer to where it used to be.

    I finally found an organic children’s gummy multivitamin by Garden of Life with only 2.5 mg of B6. I do well with it. I also took methylcobalamin since 2018 (take at bedtime since makes me very sleepy), but yesterday I switched to Adenosyl/Hydroxy B12 (have MTHFR and am an overmethylator). I take an iron supplement, Betaine HCL with Pepsin, Gaba, magnesium, l. acidophilus, 3 mg melatonin, and recently Dr. Lam’s Adrenal Rescue.

    I had chronic nightly vulva itching from 2006 to this year (never was yeast infection related. Was nerve damage doctor said from bladder sling). Triamcinolone Acetonide ointment applied to the vulva had to be used to manage it. I could go three days without applying it after awhile, but any longer, and the itching would begin again. Since taking biotin and acidophilus in April, the itching went away after three weeks of taking these supplements. Since stopping the biotin in August, I have continued to have no vulva itching, so maybe it was the acidophilus that has greatly helped.

    D3 and biotin supplements made my hair worse, for some reason. I have been using estradiol patches since six months before my complete hysterectomy in 2008. I had rectocele surgery in 2009, and that is when afterwards, my D.O. listened to my hypo symptoms and was willing to treat the symptoms with Levothroid. Since going hyperthryoid in 2019 and then hypo briefly, and having horrible nerve head stinging, my body seems to require more estradiol now to keep the head stinging at bay. My D.O. says the head stinging is from occipital neuralgia, which I never had experienced, until stopping NDT suddenly, along with the estradiol patches.

    Thank you, again, for your website and books. And thank you to those who have written in for help, or to offer suggestions and stories. I have learned so much over the years from this website. It’s because after reading from someone else’s successful NP Thyroid experience that I felt compelled to write for the first time. Maybe it will speak to someone else experiencing any of what I’ve experienced.

    • Janie Bowthorpe

      Hi Kate. Glad you are doing well! By the way, it’s always about the free T3, not the total T3. Free in front means it’s measuring what is unbound and available for use, whereas total is mostly measuring what is mostly bound and UNusable. Thus with both being the frees, you compare to what’s on this page:

      The B6 may simply be causing you to hyper-methylate i.e to hyper break things down. B6 does the same to me if I take too much, and makes me feel awful .

      • Kate

        Hi Janie! I wrote to you in 2021 and thank you for replying! I am now 64. Things were fine taking 5 one-grain NP Thyroid sublingually, spread out daily, until last Friday afternoon. Almost always I receive by mail from the Kaiser pharmacy the NP Thyroid in amber bottles. This time there was a white Acella NP Thyroid bottle, as if straight from the manufacturer with Kaiser instructions attached, plus one usual amber bottle by the Kaiser pharmacy, both with the same exp. date.

        Last Friday afternoon I began taking the white Acella bottle NP Thyroid. It was very pulpy and didn’t dissolve well. Within half an hour I had severe pain in my left breast, which I attributed to the coffee I drank for two days prior and quit the day before starting the white bottle (am not a coffee drinker but wanted to try it–had tried it in 2018 without problems). I have fibrosis in my breasts, and I figured somehow this time the caffeine did a number on me. I had swelling in that breast and a large cyst.

        I have had left breast pain since then, until this morning, when for my second dose, I took an NP from the amber pharmacy bottle, after wondering if there could be a difference. It dissolved under my tongue without leaving any pulp. The pain from my left breast was gone. Feels normal again! I will take NP from the amber bottle and see if I continue to experience a pain-free breast. I have been using estradiol patches for years and have made no changes there.

        After reading some of these posts, and seeing that some people are still doing well on NP Thyroid and others are not, could there be a difference in strengths/fillers between the white Acella manufacturer’s bottle and what pharmacies dispense in their amber bottles from their source of Acella NP? Have you heard of why there might be differences? My last labs in April were 1.6 Free T4 and 156 Total T3 (I know Free T3 is best, but it’s all Kaiser will do). Usually T3 is higher. I do not take NP past 4 p.m. the day before 9 a.m. labs. Thank you, Janie!

        • Janie Bowthorpe

          Those who aren’t doing well have never taken the time to understand this: Or this: They even use the word “optimal”, and their labs are definitely not optimal. People need to READ.

          But as far as your different bottles with different experiences, it makes you wonder if Kaiser gave you a bottle of NP that was bad. It wasn’t that long ago that NP sucked. I would personally be firm with Kaiser about what happened.

          As far as the free T3, order your own. Or use a different doc to get it. Total T3 is measuring most bound, unusable T3. You need the free T3.

  14. Beth T

    Long time fan! Thank you for your dedication to the community.

    I just wanted to report that I have been doing well on NP Thyroid. I managed to dodge the recalled NP Thyroid. I suspect it was sheer luck and the fact that I maintain a 90 day supply of thyroid Hormone replacement for natural disasters (or pandemics). I did encounter the foul tasting NP Thyroid earlier and reached out to Acella. However, my labs (and how I felt) did not reflect any problems. I was previously on Armour for over 20 years, but switched to NP Thyroid due to pricing increases. My insurer covers NDT because it is clearly labeled gluten free and I have celiac disease (biopsy-confirmed remission, so my meds have never caused a celiac disease reaction). I do realize that people can have intolerances to other fillers, such as corn. But again, never a celiac disease/gluten “reaction” with Armour or NP Thyroid.

    I am concerned about all our thyroid hormone replacement options. There is literally no FDA oversight on drugs produced in China or India (where most generics are manufactured). This was presented to Congress in 11/2019, but it seems this issue has been forgotten due to the pandemic.
    I would expect more thyroid patients to start complaining even more about synthetics (and sadly NDTs as well).

    Again, NP Thyroid is clearly working now (at least for me).

    • Janie Bowthorpe

      By the way, it is not true that there is “literally no insight whatsoever on drugs produced in China.”. There was a new version of NDT that came out a couple years ago, and which was made in China. It was totally shut down after the FDA did an inspection of the facility and found they had poor manufacturing processes. So though there may be other areas the FDA fails us in when it comes to China, this wasn’t one.

  15. Linda Morten

    Hello Janie…. H E L P. I lost my long time dr. We found a new family dr. We really like him in many ways but he’s an idiot. I have NOT had blood work for 5 years. Am still on the thyroid doses from my old dr. NP & CYTOMEL. I have multiple health issues. EBV, HASHIMOTOS, PERNICIOUS ANEMIA, HIGH BP/CHOLESTEROL, FIBRO, CFS. BIPOLAR 1, PANIC ANXIETY. On thyroid meds for 50 yrs. After a case of meningitis/encephalitis….5 days in a coms. 4 months of Vancomycin, Rocephin piggybacked twice a day. Multiple does after of prednisone, antibiotics. Short term memory loss, Retention, comprehension issues. I have STTM. It has helped me…but I cannot retain. And am extremely confused with all of the NP thyroid or Armour. I have only left my home aprox. 20 times since Nov. 2019. I am in So. Ca. most drs. do NOT have labs in their office. You need to go to a separate lab. I am not comfortable they are not the cleanest IMO. They are packed, wait times horrible. Plus I have a HORRIBLE FEAR of needles, bad, rolling veins. I know I need labs. My dr. is not into doing all the recommended labs in your book . I am on medicare. No natural drs. covered. I know I need T3 & T4…..but am so confused and not comprehending all the info. Should I stop the NP thyroid ? THANK YOU.

  16. Leigh

    Requested a refill of my NP Thyroid 15 mg beginning of the week from Walmart Pharmacy, Monticello, NY. Said they were out of stock and had to order. By the end of the week, Walmart said they were just alerted that they won’t get more until September, from any distributor. Checked Walgreen’s near my mother at Knolls Crescent location in Bronx, NY; they had it, as did Walgreen’s in Liberty, NY.

    Couldn’t get to either of those Walgreen’s locations, so checked with Walgreen’s on Pine Tree Road up in Ithaca, NY. Nope. Pharmacist said it’s not a Walgreen’s or Walmart problem, it’s a problem at the Acella end of the supply chain.

    I ended up getting the prescription filled in Liberty, NY (debacle! Do NOT use that phcy if you’re in the area, yikes!), and the pills look different: bright white, no speckles, with a shiny coating. And after taking only synthetic in the past few days, having taken some of the NP, I have been overstimulated and badly nauseated all day. The nausea is just terrible.

    Could it be something else? Sure. But apart from recovering from travel & sleep deprivation, the NP is the only weak link in today’s routine.

  17. Jennifer

    Janie, I just ran across this very interesting excerpt from “Running on Empty: Hypothyroidism, Introduction to an Underactive Thyroid Gland”. It states that (quote) natural thyroid preparations should be placed in vegetable capsules and not gelatin ones. The reason for this is that about 40% of the thyroxine in gelatin capsules is absorbed by the gastrointestinal tract. This will have an obvious effect on hormone levels, T4 concentrations may appear too low and T3 concentrations too high. Trying to keep both hormones within the reference ranges or at a person’s optimal set points may be difficult. Vegetable capsules do not have the same binding effect on T4 and absorption is not hindered. (unquote) Have you ever heard that or agree with that? I take my compounded thyroid in gelatin caps and do have problems from time to time. Do you think there’s a possibility that this is correct about gelatin vs. veggie capsules? I’ve never read that anywhere else. Thanks.

    • Jennifer

      Reference my sentences above: “Natural thyroid preparations should be placed in vegetable capsules and not gelatin ones. The reason for this is that only around 40% of the thyroxine in gelatin capsules is absorbed by the gastrointestinal tract.” I did a little test on vegetable vs. gelatin capsule. The vegetable cap dissolved almost instantly in water. It’s been 3 hours since I placed them both in separate waters and the gelatin cap is swollen and soggy and almost closed together on itself, not dissolving but holding the shape of a tube. I can see how it could trap or bind medications. I don’t know how much difference it would make if it was in the stomach instead of just water, but what I see concerns me. Has anybody else noticed a slow decline since getting compounded NDT in gelatin caps?

  18. Betty

    I am a mess, I was taking the np that they said was recalled I never had a problem with them. I was still doing great. I got a new prescription last month for the same dosage from our new drug store. It has been three weeks and I feel horrible. I can’t sleep, have calf pains at night, breathless throughout the day and just feel horrible. Nothing has changed in my life except these pills. I called Acella and they said that the new bottles were not on the recall list.
    Any advice?

    • Janie Bowthorpe

      All I can say that if your experience were mine, I’d get a prescription for T4/T3. And if you choose to, there still appear to be quite a few people doing well on Armour, even if others are not.

      • Betty White

        What do I ask the doctor for T4/T3 and what is it? I can’t take armour for various reasons.

  19. Jennifer

    I have a question about Armour. I did great on Armour before they added the MCC many years ago. I was thinking I read that it might be adsorbed if one were to take cellulase to break down the cellulose in it. If so, would you take the cellulase at the same time as the Armor and how much would you need? Would it be based on your dosage of thyroid med?
    I recall that when Naturethroid changed their formula to include MCC that it no longer dissolved under the tongue and I went very hypo over the next 2-3 months. Later I read that some patients did okay if they chewed the tablet up rather than swallow the pill. Could this option work as well? Does the Armour no longer dissolve under the tongue either?
    Thanks for your help, Jennifer

    • Janie Bowthorpe

      Armour is now hard and bland. And yes, since cellulase in known to break down cellulose, seems like worth a try, to me.

    • Annette

      I believe I had absorption problems as well. The cellulose makes it nearly impossible to dissolve Armour under the tongue, but I crush it between 2 spoons and pour it under there anyway to finish dissolving. I know I still swallow some of it, but it has made a huge positive difference for me.

  20. Jenny Blue

    I started on a 1 1/2 grain of NP after felling fine on previous 2 grain bottle (cut in half and titrated according to symptoms or absence of)even taking it beyond it’s expiry date.

    I now feel horrible, same as when I’ve gone cold turkey and stopped taking anything atall once or twice in the past.

    I’m going to tell the pharmacy I bought the dodgy one from and have a new 2 grain bottle purchased last week that I’d intended to keep in back up, which I’ll start using now……

    This damned stuff is so expensive but has seemed somehow worth it just to feel human….then when this happens it’s just so disturbing.

    Does anyone know the suspect lot numbers at the moment and ought I tell the company. ?


  21. Stephen Farkash

    I wrote a while back mentioning that my CVS pharmacy stated they hadn’t received any of the recalled lots. So, I renewed my 90 day prescription which had increased 3 x’s in cost. Well, it did smell cat pissy. Called CVS and they said that’s just the way it smells. Three days into taking 90 mgs. a day, I totally crashed. Found a year old bottle of NPThyroid in the fridge at 120 mgs. Split it up to get to 90 and within 3 days I was getting back on track. I’m believing that none of the new NPThyroid is any good. All users are being forced to switch to Armour or synthetics. I have a televisit with my PCP today to see what my options are. I’m hoping for a combination of synthetic T3 and T4 and that it works. This is a terrible situation we’ve all been forced into.

    • Janie Bowthorpe

      Yup, you’re right. So far, it appears that most are simply going hypo on any remaining NP that’s out there. They definitely did not return it to what it used to be.

  22. Fran Ellsworth

    Hi all,
    I was optimal and feeling well on all levels with Naturethroid and a low dose of Synthroid last August before it all came crashing down with the recall. Since then, have tried Armour + small dose of Synthroid and then moved to compounded synthetic T4/T3. After first check I was still low so doc increased dosage of compounded T4/T3 — the numbers barely moved on the higher dose! Has anyone had this before? Do I need to change the time I am testing when on these meds? Is it more sensitive to changes in diet, missed doses etc? I am thinking of going back to Armour + Synthroid again as it’s covered by my health plan. Are there any current potency issues with Armour that we are aware of? Any other ideas are welcomed as I talk with my doctor tomorrow. So frustrating!

    • Janie Bowthorpe

      Sometimes patients just have to keep going up to find their right amount. This informational page should help as to the goal:, because those who don’t achieve it eventually see a decline. The individuality is when the decline happens.

      As far as Armour, the majority seem to doing well. But there have been occasional comments of a bad batch, it seems.

      By the way, Armour is already 80% T4. So we find no need to add more T4, for most of us.

  23. Linda Andrusko

    I have been switched from Armour, to Naturethroid, then several different dosages of NP, for which I too got the recall letter. I am waiting for my latest lab report from today, but on NP, my numbers skyrocketed, & even with increased dosages, it hasn’t returned to normal ranges, especially my free T4. Would it make any difference whether my doctor orders my natural thyroid from a compound pharmacy, or are they too receiving subpotent medication? I have too many unused bottles of different dosages, since nothing was helping to regulate it. Thoughts on compounding pharmacies, & if they have the same issue or not, please.

    • Janie Bowthorpe

      If you want to use a Compounder, you might want to call to see if they are even finding a reliable porcine powder. Because some have been reporting they haven’t. Then ask them where they are getting the powder. Both Erfa in Canada (years ago) and Acella reported they were now getting it from “Europe”. And though Erfa wasn’t recalled, patients reported noticing a negative difference. And we all know what happened to NP Thyroid by Acella.


    Ahh, The letter I received about the recall explains finally why I’ve been SO tired in the afternoons! I will again go back to Armour and try to get my refund from Acella for the NP.

  25. Ivy

    I’m hoping this is ok to ask but how can we go about ordering T3 overseas? Or getting it prescribed by a holistic practitioner? Cytomel and Generic from sigma just don’t agree with me anymore I’ve tried to use both recently and horrible hypothyroid symptoms came back with a vengeance. Compounded T3 is just so potent and strong I can’t tolerate not even 25mcg because just taking that alone for one day the affects will last me until the next day which isn’t normal on T3 since T3 is meant to take every hour, it’s like it just sits in my body and piles up every time I take compounded T3 every 3 hours but with regular T3 from the market and I can feel I need another dose usually every three hours idk what’s wrong and hoping giving liotir a shot I just don’t know how to go about this.

    With love,

    • Janie Bowthorpe

      Hi. Can you explain what you mean that neither Cytomel or Sigma Pharm work for you? Because they do work great. Is it possible you aren’t raising them high enough? Or they are revealing a cortisol problem?

  26. Susan Siens

    Hi, Janie, I wasn’t having problems with NP, but now I am. Horrible, horrible, horrible. So I guess I have to switch to Armour and drive a lot of miles to get a half-decent price (driving while absolutely exhausted because NP isn’t working).

  27. Vanessa Falstreaux

    I got a letter about my NPThyroid being recalled but the pharmacy says they did not receive any of those lot numbers. I have felt really bad for about 7 months now. Just had labs drawn and my TSH is 20.76. I think there are more lots out there that the manufacturer has not recalled. Obviously mine is not working

  28. George

    Called Acella today. They make you jump through a bunch of hoops just to get reimbursed for their failure. They want a receipt for the purchase that I made months ago. I do not keep those receipts. I told them I will try another manufacturer from now on.

    • Susan Siens

      Hi, George, they told me my pharmacy should print out another receipt. Frankly, I am sick of incompetence. I once heard an academic report that 10 percent of people are actually competent at their jobs. I’m not sure the number is that high when it comes to corporate executives and doctors!

  29. Sarah

    Any news about Metative from UK ? Porcine NDT

  30. Mele

    Good Rx is great and how I pay for my desiccated thyroid. Get the mobile phone app for Good Rx. You just show the price on the phone to the employee for the pharmacy you have chosen to fill your prescription at. Walmart will honor the price but it is much easier and faster at CVS, Walgreen’s, etc.

    I have one of the effected lots bottle of NP Thyroid and just got a letter late today from CVS about it. UGH.

  31. Amy

    FYI patient feedback:

    I have avoided Armour due to the $$$ but was out of options after the last Nature-throid debacle.
    I always liked Nature-throid and didn’t notice any issues but I simply can’t get it. I tried NP 2x in the past and it made me flu like sick so not an option. No idea why as I am not sensitive to meds, no allergies etc.

    My switch from Nature-throid to Armour was uneventful at the same dosage. Labs fine/same as before but what struck me is my hair! My hair is growing like never before… friend gave me a haircut and pointed out I have an “undercoat” of hair several inches long. My hair is curly so I didn’t notice it.
    I don’t know what else could be the cause but the timing coincides with my switch to Armour (I log everything). It seems my hair is returning to pre hypo, it is a superficial thing but my hair loss was devastating.

    Thank you from the bottom of my heart for everything you do,

  32. Larry

    I know you push Armour but my doctor and 2 endos never could get it right for me. Had switched to Nature throid and within 6 weeks my numbers came down so well my doctor neve prescribed Amour to anyone else. In 2017 when the shortage began I got switched to NP Thyroid and at first it was working but as time went on I had lots of side effects so went back to Nature Throid until I could not get it at all. I was put once again on NP and ended up with sever muscle and joint pain that my doctor and specialists could not figure out. I stopped the NP all together as I could not take the pain as I had always thought that wat the problem. After 1 week the pain was all gone, I started taking synthetic T3 and have added a little T4 and it’s much better that any of the NP stuff. I think I am a little hypo and will be getting the numbers checked in a few weeks again. Sure hope Nature Throid makes a comeback some day, I sure miss it.

    • Janie Bowthorpe

      Larry, just to clarify that I, as creator of STTM, don’t ‘push’ Armour. I simply report what patients have reported as to still working for them, (especially if they understand to take enough to get their free T3 and free T4 optimal.) Also being reported as working well is taking synthetic T4 with synthetic t3, and also understanding to get optimal. And there is always taking T3-only, multi-dosed three times a day, and getting the free T3 optimal. For all the latter is this:

      One of the reasons that it can appear that Endos never get armour right is that they obsess over the very normal low TSH it will cause. But since it sounds like you had tried armour in the past, that may have been when it had some problems around 2015 which were eventually fixed.

  33. Jennifer Wilson

    Hi Janie,

    My question is not related to the recall but I hope you can help answer it. I have absorption problems with MCC and cannot take thyroid meds that have it. Does such an absorption problem hold true with MCC in other drugs? Specifically as an example, I need some compounded Benadryl and the pharmacy uses MCC in the capsule as a filler. Since it’s just a loose form of it (not compacted into a tablet), would there likely be any problem with absorbing the Benadryl? Thanks so much for your help.

    • Janie Bowthorpe

      Yes, we figured out years ago that by some experiences, microcrystalline cellulose, which is refined wood pulp, can slow down the absorption of thyroid hormones in meds. That is in spite of it being called an inert and non-toxic filler! And it has seemed that some individuals notice this worse slower absorption problem more than others. We don’t know what it could do with other meds, though, like Benadryl.

  34. Jen

    I’m thinking that I may have gotten a subpotent batch. I increased my dose from 105mg to 120mg in Feb. Just had labs done and everything went down from labs done in Dec. FT4 was 0.9, now 0.8 (0.8-1.8). FT3 was 3.1, now 2.7 (2.3-4.2), TSH was 0.06, now 0.04 (0.40-4.50). What the heck?!

  35. Suze

    I posted recently that I was doing well on the current Erfa thyroid. I started at 60, then after ten days 90, then after 9 days, 120. I had an overall new feeling of well being from the first dose, but now I have periods of feeling hypo or hyper, interspersed with feeling well. I am still better every day than I was on the synthetics. However, I get extremely tired by late afternoon or evening on 60 and 90. When I took 120 today it caused a fast heartbeat. I don’t want to bounce back and forth with doses based on how I feel! I did that in the past and it did not work. Should I settle for being hypo and tired on 90 and wait longer to try 120? Should I skip a day? My dr. told me to get a blood test only when I’ve found the right dose!

    • Janie Bowthorpe

      This is where many of us realize that it’s not working well enough, or it’s revealing a cortisol problem when we try to raise.

      This is why we can’t go just by how we feel. Afternoon fatigue could be a sign of continued hypothyroid, too.

      • suze

        I had a euthyroid day today which I haven’t had in years. It was on 1 grain Erfa. I decided to take a conservative dose since 120 made me hyper. Somehow it was so perfect for me that I had energy all day. No hyperness after taking the dose, and no tiredness at all despite being active all day. This is rare as I’ve had no energy for 2 years. Again I felt this happiness and joy. I am certain there is something we vitally need in the natural thyroid, which I never got with Synthroid or Cytomel. It’s like my body was telling me, 120 is too high right now. Be patient and stay on 60 longer! I was all prepared to go back to the synthetics if I felt bad today, but instead I am more sure now that the Erfa is good. I won’t be raising it a grain at a time as that was too big a change. Just half a grain at a time.

  36. Rebecca

    Thanks for the notice! I actually switched from NP to synthetic levothyroxine/liothyronine 2 1/2 months ago. My NP labs were nearly non-existent (the FREES). That was the final straw. We have my levels optimal and feel good….it’s been awhile!
    I called Acella today just to express my outrage at their incompetence. They tried to offer me a replacement ND I said I wouldn’t take a lifetime supply for free if they gave them to me.
    My advice is, don’t disqualify the synthetic combination!

  37. CeCe

    I just opened the email from the FDA warning of the recall. I will try to post below. I rushed over here to share, but you already had info posted! Thank you! Knew we could count on you!

    Personally, I had moved to T4/T3 but I’m not quite where I need to be – it’s a process. I am actually wondering if the generic brand differences are throwing me off because I’ve had three different manufacturers now of the T3 (liothyronine) (MAYN, GREE, SUNP) and two different manufacturers of the T4 (Unithroid, MYLA) and I’m not only experiencing new hot flashes, but find myself getting cranky and REALLY tired in the afternoon again.

    So – two questions in the quest for consistency:
    1. Is Unithroid a reliably consistent option for the T4? (It has actually been more affordable than the generic for some reason), and,
    2. Is there a T3 manufacturer that has been shown to be more consistent/reliable?

    Thanks for your thoughts.

    Here’s that notice:

    May 3, 2021
    Acella Pharmaceuticals, LLC, Issues Voluntary Nationwide Recall of Certain Lots of NP Thyroid® (Thyroid Tablets, USP) Due to Sub Potency

    Acella Pharmaceuticals, LLC, is voluntarily recalling certain lots listed in the Tables 1 and 2 below of 15-mg, 30-mg, 60-mg, 90-mg and 120-mg NP Thyroid®, Thyroid Tablets, USP [levothyroxine (T4) and liothyronine (T3)] to the consumer level. The products are being recalled because routine testing has found these lots to be sub potent. The product contains less than 90% of the labeled amount of liothyronine (T3) and/or levothyroxine (T4).

    Risk Statement: Patients being treated for hypothyroidism (underactive thyroid), who receive sub potent NP Thyroid®, may experience signs and symptoms of hypothyroidism (underactive thyroid) which may include, fatigue, increased sensitivity to cold, constipation, dry skin, puffy face, hair loss, slow heart rate, depression, swelling of the thyroid gland and/or unexplained weight gain or difficulty losing weight. There is reasonable risk of serious injury in newborn infants or pregnant women with hypothyroidism including early miscarriage, fetal hyperthyroidism, and/or impairments to fetal neural and skeletal development.

    Read the full Company Recall Announcement


    FDA Office of Women’s Health

  38. Stephen Farkash

    I never received any foul smelling NPThyroid, but I have never gotten to an optimal level either. Continuing to have a puffy face and red cheeks…etc. Armour is 4 times the cost with my insurance co-pay. Guess it’s time to see what my PCP will prescribe for me but all this pretty much sucks. Naturally derived products not properly produced and Big Pharma wins the day.

  39. Starr D.

    Janie, why does our government allow companies to stay in business and get away with poor quality on
    these thyroid drugs, OVER and OVER again?? This makes me sick to read about this, as NP failed me
    miserably toward the end of my run, and what’s worse, there was a time when I encouraged my brother
    to go on it….he was only on it about two months, but I think it may have made his liver problems worse–
    his batch was in the list of “bad batches,” I found out later. And now, he is gone–and I don’t know how
    much being on that lousy NP may have made him worse or not–such guilt, for me. But being a thyroid patient
    shouldn’t be this hard, for some of us! So I made this petition, to get us better treatment, more consistent drugs, etc: I hope some of you will sign and share this.
    I’m asking the Biden Administration to help fund better and earlier testing and diagnosis for thyroid problems,
    funding for new and innovative drugs and treatments; BETTER OVERSIGHT of the drugs we already have,
    and better education for doctors on how treating the thyroid well and earlier can help prevent other health
    problems from happening…..This kind of thing with NP needs to stop; and in general, thyroid patients need
    to be respected and the medical and pharmaceutical community needs to stop treating us like CRAP!!! Thanks for
    any support on this petition, and Janie, thank you again for informing thyroid patients, like no one else does (but should!)

  40. Riley

    This website is hard for my current hypo brain to read but I am trying. This website mentions in many places that Armour is the “only” one working. It was the last one working and now as of April 2021 it’s obviously gone to crap again. It doesn’t even taste or crush the same. Just like people on nothing, I gained 15lbs in 2 months and my diet and life has not changed. Armour changed.

    I found after the last Armour reformulation that I needed T3 along with it to be optimal. Now, I can’t figure out how to replace Armour with T4 while continuing my 75mcg T3 dosage. Starting low is my obvious guess but how soon can I check labs on Free T4 when I don’t care about it converting to T3? I’m already on T3!

    You say in multiple places that we can’t use those “conversion” charts but if there was 38mcg of T4 per grain of Armour, do I just swap it for a 50mcg pill cut in fours and take 12.5mcg X 3 and work my way up? Again, how soon can I get labs on Free T4 when I just need to build my storage back up?

    Thank you for any help and I apologize if I missed it.

    • Janie Bowthorpe

      So far, every single time a stray individual says armour has changed, it turns out to be user error. But if there is ever enough evidence to say it has, and with no obvious user error going on, I will say so, for sure.

      No, STTM says in several areas that the conversion charts on how to make an equal switch from T4 to NDT are in error. They are apples and oranges, plus fail on the individuality factor, as well.

      It’s impossible to answer your question without knowing your free T4, free T3, and RT3. So use this page:

  41. Waveylines

    Im amazed to discover this. Ive been on Acella for a number of years and not had a problem at all. The last recall my pharmacy (uk) said the super potency was very very tiny and I wouldnt notice and they dont notify patients for such a tiny change. Infact the pharmacy said across the board od all medications it is extremely common to get recalls. I did actually notice the difference and reduced my meds by one eighth of one grain tablet (i was taking four one grain of 60mg strength tablets at the time.)
    As for the smell or taste its never changed in the ones I had in over two years so that was confusing to read about. I don’t get on with Armour since they changed it (2011?) am not sure why but it maybe due to one of the fillers so not keen to change. In fairness it must be ten years since I tried Armour so if they’ve altered it back maybe I will be ok on it if Aceella is now unavailable.

    • Kelly

      Ivy, I am curious what you mean by the compounding T3 batches changing? Arent all synthetic compounded T3 the same? I thought it was only the NDT that changes?

  42. Ivy

    Such direct abs great information.
    It really ironic and saddening these past few weeks I haven’t had much luck with compounded t3. At first I did then once I got a new partial batch it was like I was on 100. High blood pressure, fast heart rate things I normally never ever ever feel on T3.
    I switched to another compounding pharmacy and that worked well to until I got another new partial batch from them and same thing, same symptoms and side effects. So now I’m left with no T3. I don’t tolerate generic. I’m thinking it could be the fillers in the medications, I used turmeric for the first and sucrose for the second. I feel so unwell after doing so well with T3 even when I had a cortisol problem I’d still feel happy and calm.

    I don’t know what to think or say I’ve experienced the bad batch of NP Thyroid and Armour for some reason just stopped working all together for me, too. So what else do I have left? I’m so unsure.


    Thank you so much for letting me know about this. I only have 7 NP Thyroid pills left! I would love to try both Tirosint & Cytomel, but my insurance doesn’t cover them. I looked up Tirosint on GoodRx and it’s outrageously expensive — $127.60 for 30 pills! Cytomel is not too bad — $13.78 at Rite Aid, but if I got that, I guess I’d have to go back to taking the generic Levothyroxine in order to get my T4 affordably. Bummer. I would love to go back on WP Thyroid, but it’s not available. Any suggestions?

  44. Mary Lue Walser

    I was on Nature Thyroid and doing o.k. They pulled it off the market and I had to go to NP Thyroid. I don’t think it works as well. I can’t take Armour as it makes me quite ill and I throw up every morning like I am pregnant and this 73-year-old does not need that. Not sure what to do now. My doctor writes prescriptions for whatever I request. I have Cytomel I can take and do when I start staying tired. My T3 absorption is not nor has it even been good. I had thyroid cancer and total thyroidectomy. Guess I will just have to monitor how I feel and maybe up the dosage. I know it is hit or miss but it is all I can think to do.

    • Janie Bowthorpe

      Have you ever gotten optimal on that t3?

    • Martha Brandt

      I’ve been struggling since last fall when Naturethroid was recalled. Got an NP prescription and just couldn’t handle the gaggy smell and taste. Tried Synthroid alone and then with slowly creeping up TSH, tried adding T3. Have high cortisol and just felt crazy! Was so discouraged, thinking I might have to ever so slowly add in the T3 to reach some sort of balance.

      Then yesterday I called my local compounding pharmacy on a whim (intuitive hunch?) to see if they had any idea when Naturethroid might return and they told me they just received their first new batch (65 mg, my dose!). Picked it up and started back on it this morning (looks and smells fine). Fingers so crossed they have gotten their dosage standardization down and will be shipping out to more places soon! I still have hope that hey can sustain a good NDT product.

  45. Dori

    I just picked up my Rx today and it does NOT smell bad. Same color and same smell as previously. Not yet tasted since I took it this morning. I don’t understand this….maybe these folks got an old batch number????

  46. Audrey Trombley

    I’ve been taking Cytomel and Tirosint for several years now and feel great. If one feels it necessary to continue wrestling with NDT then I’m not going to argue against that – but people should hear from those of us who have decided it’s not worth the aggravation and moved over to synthetics that the synthetics can work just as well as the natural. It may at least be worth a try for some. God bless all with the very best of health whichever way you choose to get there.

  47. Dawn

    What took them so long??? The medication was never corrected. This is a blessing and a curse. I was hoping almost two years into this debacle, that it would have been restored. This is setting us back further. Thank you for letting us know, Janie.

  48. susan mccoy

    Publix Pharmacy kept replacing my Armour with NP Thyroid when they were out of stock. Recently I took one before I noticed. It smelled terrible and made me feel terrible, it took 2 days to recover. I was also on Nature Throid and it made me sick for a long time. Why do these companies do this to us? Why do they get away with it? Without your site I wouldn’t have known about either. Thank you for what you do!

    • Janie Bowthorpe

      Acella admitted in 2019 that they now get their porcine powder from “Europe”. There could be a connection there.

      • Melannie

        HI Janie,
        If anything, getting their porc products from Europe should help not hinder the situation. I’m an american living in France and I can tell you that the conditions for raising pigs and other animals here are much stricter and much better than in the USA. The meat quality is MUCH better here than most of what is available in the USA. It is so different that US meat products are not allowed to be imported into Europe because they do not meat the quality requirements. I would say they’re either lying and sourcing from Asia or they are using some kind of filler / chemical component that is inhibiting absorption combined with not testing enough to save money.

  49. Pamela Payne

    I’ve been trying to tell my doctor it wasn’t working. For months I was dragging, barely able to function. Then 3 months ago I went slightly hyper, so she dropped my dose from 60 to 45. My heart rate went down, but I still don’t feel great. I can’t afford any other NDT because none of them are covered by my insurance. I guess it’s going to be levo and liothyronine from here on out.

    • Terry Schultz

      Even though I have Kaiser insurance, I started using GoodRx online recently for less expensive prescriptions. Then I call to make sure I can get that price and pick up at a local pharmacy. Check it out if you haven’t, it’s free. Just print out the information with the number they give you (a card will arrive within a couple of weeks). You can look up by lowest price for your area, closest, etc., and it’ll give you prices for different pharmacies.


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