Update - Why is there a shortage of desiccated thyroid (e.g. Armour thyroid, Thyroid (dessicated), Nature-Throid, Westhroid, Thyrolar))

The tincture of time has not helped to resolve the shortage. In fact, since my last post, the shortage has worsened leaving patients with few options to manage diseases of low thyroid.

Reason for the Shortage

• Several thyroid (desiccated) products have been discontinued. The manufacturers would not provide a reason for the discontinuations; however these products are not FDA-approved. Forest states that the shortage of Armour Thyroid is due to a shortage of raw material. Major and RLC will not provide a reason for the shortage.

Estimated Resupply Dates

Major has all strengths on back order and the company cannot estimate a release date.

Forest has available Armour Thyroid 240 mg and 300 mg tablets. All other strengths are on back order and the company cannot estimate a release date.

RLC has all presentations of Nature-Throid on back order and the company estimates a release date of early-December, 2009.

RLC also has all presentations of Westhroid on back order and the company estimates a release date of early-December, 2009.

Products in short supply

Thyroid (desiccated) 120 mg tablets, Major - discontinued
Thyroid (desiccated) 30 mg tablets, Major
Thyroid (desiccated) 30 mg tablets, Major
Thyroid (desiccated) 60 mg tablets, Major
Thyroid (desiccated) 60 mg tablets, Major
Thyroid (desiccated) 120 mg tablets, Major
Thyroid (desiccated) 180 mg tablets, Major

Armour Thyroid 15 mg tablets, Forest
Armour Thyroid 30 mg tablets, Forest
Armour Thyroid 30 mg tablets, unit dose, Forest
Armour Thyroid 30 mg tablets, Forest
Armour Thyroid 60 mg tablets, Forest
Armour Thyroid 60 mg tablets, unit dose, Forest
Armour Thyroid 60 mg tablets, Forest
Armour Thyroid 90 mg tablets, Forest
Armour Thyroid 120 mg tablets, Forest
Armour Thyroid 120 mg tablets, unit dose,Forest
Armour Thyroid 120 mg tablets, Forest
Armour Thyroid 180 mg tablets, Forest
Armour Thyroid 180 mg tablets, Forest

Nature-Throid NT-1/4 16.25 mg (1/4 grain) tablets, RLC
Nature-Throid NT-1/2 32.4 mg (1/2 grain) tablets, RLC
Nature-Throid NT-1 64.8 mg (1 grain) tablets, RLC
Nature-Throid NT-2 129.6 mg (2 grain) tablets, RLC
Nature-Throid NT-3 194.4 mg (3 grain) tablets, RLC

Westhroid 32.5 mg (1/2 grain) tablets, RLC
Westhroid 32.5 mg (1/2 grain) tablets, RLC
Westhroid 65 mg (1 grain) tablets, RLC
Westhroid 65 mg (1 grain) tablets, RLC
Westhroid 130 mg (2 grain) tablets, RLC
Westhroid 130 mg (2 grain) tablets, RLC

Thyrolar tablets, Forest Laboratories - all strengths
12.5/3.1, 25/6.25, 50/12.5, 100/25, 150/37.5

Discontinued Products

Thyroid (desiccated) capsules (Bio-Tech Pharm) - discontinued
Thyroid (desiccated) tablets (Qualitest) - discontinued
Thyroid (desiccated) tablets (Time-Cap) - discontinued

Why is there a shortage of desiccated thyroid (e.g. Armour thyroid, Thyroid (dessicated), Nature-Throid)

There is a lot of speculation about the reasons for the shortages of desiccated thyroid preparations. Typically drug shortages exist due to the discontinuation of a product by a manufacturer, raw ingredient shortage, manufacturing problems, or regulatory action by the FDA. In the case of the current desiccated thyroid shortage, it may be a combination of factors. The only manufacturer to provide information about the shortage is Forest who stated their shortage is due to a manufacturing change.

The shortage has required patients to switch to levothyroxine (T4), Cytomel (T3), or alternative desiccated thyroid preparations (if they can find them). Coordination of these switches should occur under the supervision of a physician to ensure appropriate monitoring. There is a small subset of patients unable able to use levothyroxine as they lack the ability to covert T4 to T3. A combination synthetic T4/T3 combination product is marketed but is also currently on backorder (Thyrolar, Forrest).

At the beginning of August the following preparations were experiencing shortages:

Thyroid (desiccated) 30 mg tablets (Major)
Thyroid (desiccated) 30 mg tablets, (Major)
Thyroid (desiccated) 60 mg tablets, (Major)
Thyroid (desiccated) 180 mg tablets, (Major)

Armour Thyroid 15 mg tablets, (Forest)
Armour Thyroid 30 mg tablets, (Forest)
Armour Thyroid 30 mg tablets, (Forest)
Armour Thyroid 30 mg tablets, (Forest)
Armour Thyroid 60 mg tablets, (Forest)
Armour Thyroid 60 mg tablets, (Forest)
Armour Thyroid 60 mg tablets, (Forest)
Armour Thyroid 90 mg tablets, (Forest)
Armour Thyroid 180 mg tablets, (Forest)
Armour Thyroid 180 mg tablets, (Forest)

Nature-Throid NT-3 194.4 mg (3 grain) tablets, (RLC)

The following products have been discontinued:

Thyroid (desiccated) 120 mg tablets, (Major)

Thyroid (desiccated) capsules (Bio-Tech Pharm)
Thyroid (desiccated) tablets (Qualitest)
Thyroid (desiccated) tablets (Time-Cap)

Is the pharmacist shortage over?

Over the last decade or so, the U.S. has experienced a pharmacist shortage. This has resulted in a high job vacancy rate, higher salaries, and increased workload. It appears that the pharmacist shortage may be coming to an end. This is due in part to the opening of dozens of new pharmacy schools increasing the graduation rate and the increased use of automation. In addition, healthcare reform will have an impact. With finite healthcare resources, pharmacists will need to continue to become more operationally efficient. Also, as quality becomes a more important metric, the provision of high-quality pharmacy services will be required of pharmacists.

The next decade is likely to see changes to the profession and a shift to more clinical activities and less dispensing related functions. Although the demand/need for medication experts is likely to continue to expand, it appears that their will be the supply to meet this demand.