Thyroid UK
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Thyroxine gel capsules?

Can you get gel thyroxine in Europe? For the past few years, I have struggled with constipation. This seems to have coincided with starting to take Levothyroxine. My diet is really good, and I have tried everything I can think of to tweak further improvements from it. I exercise regularly too but the situation seems to be getting worse and my weight is increasing as a consequence. Since I already get my T3 from Germany, I am wondering if there is a L-thyroxine I could try from there which might have different or no fillers. Any suggestions of brand names?

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I believe that Tirosint is going through approval processes in more than one European country at present. Trouble is, this is just what I have picked up from various documents around the place and is not properly referenced. Do bear in mind that though we see most references to it in the USA, it seems actually to be a European product, see:

Manufactured for Akrimax Pharmaceuticals, LLC by: IBSA Institut Biochimique SA, 6903 Lugano, Switzerland

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Thanks. I will have a dig about. My German Pharmacy offers 215 variants of Thyroxine, but as far as I can make out, none of them are the gel type, and they certainly don't stock tirosint. I wonder if it might be called something else?

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I don't think so. It is now such a well-established product name it would seem perverse to sell it as something else.

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Document listing all levothyroxine products licensed in the EU in 2016:

ema.europa.eu/docs/en_GB/do...

Includes the following countries:

Denmark

Germany

Netherlands

Greece

Italy

Slovakia

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Good supplements of Magnesium and VitC should help the constipation - increase to bowel tolerance 😊

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Thanks Marz. Been there done that. Magnesium makes me feel really tired, and I already take around 3g per day of vit C. It's not helping anymore.

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Do you practice yoga ? ! Ask google - Yoga for constipation ...

Many asanas stimulate peristalsis .... 😊

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I've tried all that shizzle. I would like to deal with the problem at source rather than find ways to mitigate it.

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So it's all shizzle ! OK well as I teach yoga and suffered Ileo -caecal TB in my 20's followed by Crohns I think I may know a thing or two about both.

Have clicked onto your name to read your Profile for more information but nothing there. You can click onto mine if you wish 😊

Hope you soon find the answers you are looking for ...

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Marz, I didn't intend to cause offence. It sounds like I did - sorry. I am very open to yoga etc. I regularly attend Pilates, and do daily stretching & mobility work. It's just that it hasn't helped me with this particular problem, and can't find anything which does, so I am hoping to find and address the root cause.

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Well, the root cause is hypothyroidism - more than likely. So, you need to optimise your T3. Have you had your FT3 tested?

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I have added a reply - in the wrong place apparently!

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Yes, but Marz notified me, so I saw it.

Each site has its own peculiarities. On here, when you click on the reply button, the person you are replying to is notified. So, we wait for that notification, and don't go looking for replies. The whole lay-out here is totally different to Facebook, therefore the method of using it has to be different.

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Hi greygoose. My last labs were taken on 3rd August and were:

TSH 0.008 (0.27-4.2)

FreeT4 12.4 (12.00-22)

FreeT3 5.33 (3.10-6.80)

I was on 100mcg levo & 30mcg T3. Ironically I would like to get my TSH a little higher as I know it's contentious for it to be that low - especially when I suspect I could really do with upping my Levo & T3.

Oddly, last time I raised my Levo (which was before I added T3) my TSH actually went up and FreeT4 went down.

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greygoose will not have seen your reply to her as you did not click onto the button beneath her post - easily done 😊

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Thanks Marz. I am fairly new to this, and don't know how it works. In some of the facebook groups you get told off for using the reply button :)

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You had managed perfectly until then ....

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I was doing some 'proper' work in between. I'm trying to get it done so I can go to the pub!

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When you are taking T3, the TSH and FT4 are irrelevant. You don't need to bring either of them up. And, trying to raise your TSH would lower your FT3, and make you even worse.

It's not in the least contentious for anyone that knows anything about thyroid. The TSH is low because the pituitary senses that you have sufficient T3 in the pituitary - which always gets served first. Therefore, it considers you don't need it. Your FT3 isn't bad, but could be higher. It's probably too low for you.

But, if you consider that you shouldn't have constipation with these levels, then you should ask for a referral to a gastroenterologist, so that he can investigate your gut. :)

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Is there any good research on that which I can show my GP who will worry about my TSH being so low? He is reasonably switched on and happy to help where he can as long as I can substantiate my claims.

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Depends on why he thinks a low TSH is a bad idea.

I don't have any links to research but if you post a new question, explaining why he's worried, I'm sure someone will come up with something.

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OK. Will do. Thanks. I would love to keep him on side as he has been very compliant / helpful. He even posted my last T3 prescription direct to the pharmacy in Germany for me so I didn't have to collect it from the surgery! Plus he is quite happy to tell me when he doesn't know something rather than bluff it.

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He sounds like a dream! Can we clone him? :D

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if only .... I had another disastrous consultation today ... my GP smirked at me and told me I was "between a rock and a hard place" as I am no longer prepared to take synthetic T4 - saw the letter from the Endo (whom I would rather refer to now as a Diabetologist as that is all he really knows about!) and let's put it this way - a letter from me to him is now being composed! (( *** sigh *** ))

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Don't you just hate it, when they smirk!?!

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More than he will ever know - I am not given to crying in public - I am a very strong person but when I left the consultation with him this morning I went to the loo and cried for 5 minutes ..... I am quite ill at the moment and the associated depression and anxiety I am experiencing as a result of poorly treated and mis-managed hypothryroidism simply got to me ... I start a new part time job tomorrow to pay for the private meds I now need to buy .... I do not feel well enough to work and am dreading making stupid ditzy mistakes due to the brain fog but I need to be able to buy meds to make my life bearable again ....... wish me luck!

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Oh, I do! With all my heart! :)

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Thank you very much - had to fight to get any bloods at all done today (in spite of the "Endo" saying he would recommend them - he did not) so will post my results on here as soon as I have them for your excellent advice ...... This is the first place I have been in 15 years that has given me any kind of hope and true help ... Thank God for you and SeasideSusie and all the other very knowledgeable others out there prepared to give their time to help the legions of us who are suffering X

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You're very welcome. :)

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healthunlocked.com/thyroidu...

An earlier post above - here on the forum about suppressed TSH - you can use the Search box for other links - there are loads as it is often discussed.

If you click onto the first name in the thread above - diogenes - you can read his Profile and his other posts/replies. He is a Research Doctor who invented tests for the Thyroid and continues to bring awareness to us all and the powers that dictate thyroid treatment. He is also an advisor to Thyroid UK. You can read in his posts the research papers that have been recently published or are about to be .... When we need answers they are usually in this forum somewhere :-)

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That's brilliant Marz. Thank you. I will have a thorough look through it all when I have time.

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Levothyroxine does reduce your TSH function. It is replacing the natural function so reduces he bodies need to produce it. The only way to increase it, is to stop taking it, or reduce your dose. It's the end result that counts however. Your levels look ok, much better than mine were, but it affects everyone differently. It depends what your body needs to function.

I would focus on how 'well' you feel and not one the levels.

I had the same problem with constipation and like you, I'm very healthy.

The weight gain is not because of constipation, it's because you are underactive.

How long have you been on medication?

I've gone the other way now. I've severely overactive, but not because I was over medicated, it's because I have autoimmune condition that attacks my thyroid gland, making it produce too many hormones. I have goitre and nodules all over my thyroid gland.

It's not a pleasant feeling and can be dangerous. You are better to be under, your body will get used to the meds eventually.

Be careful not to overmedicate tomfix the problem, as you really don't want to be over.

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What about folate, ferritin, vitamin D and B12 levels

Are you strictly gluten and soya free

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Lab results from 31st May were

Folate 24 (1-17)

Ferritin 39 (15-250) I have been working on that since

Vitamin D 93 (75-200) Permanently working on that as it was 26 about 5 years ago! with 5000iu a day with vit K, plus also 100,000 once a month dose as suggested by Dr.

B12 942 (200-900) Dr said to continue supplementing with B12

I am not gluten free, although my diet of choice is pretty low gluten - I rarely eat bread etc.

TpAb was 10 when tested last year (0-50)

TSH receptor ab less than 0.4 (0-0.4)

I am not strictly soya free, but I tend to avoid it as I know it affects levo absorption.

I didn't have any digestive issues prior to starting Levothyroxine about 2 years ago.

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Why did you have TSH receptor antibodies tested? That's for Grave's.

Soy doesn't affect levo absorption, it prevents T3 getting into the cells. Just as bad, but just so you know. :)

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Ah. I think my GP just did every test he could think of! I did go totally gluten free for about 6 months last year, but it didn't make any noticeable difference.

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Being gluten free might have made antibodies fall, which is why they should be monitored 3-4 times a year. But NHS only ever test once, and only reluctantly then.

It does need to be absolutely 100% to be affective

Personally I noticed a difference changing from soya free to also being soya lecithin free.

You can find chocolate without soya lecithin in .....if you look hard enough

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I don't eat refined sugar anyway, and no artificial sweeteners (or stuff like Stevia) so I stick to 99% or 100% chocolate anyway - which has no lecithin in.... fortunately!

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He would have done better to test the Thyroglobulin antibodies, because a positive result there would point to Hashi's, too.

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He said he couldn't for some reason (and he has never refused me any test I have asked for), so I did a medichecks antibody test last month. TGAB was 107 (0-115) & TPO AB 12 (0-34)

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That TGab is very high in range. Given that antibodies fluctuate all the time, I think you should take that as a positive, and continue as if you have Hashi's. 100% gluten-free, selenium and a suppressed TSH.

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Urggghhhh. OK. Understood. I'm taking 200mcg Selenium a day anyway. I just need to find some info on suppressed TSH. At least that bit (edit: supressing it) will be easy!

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Not as easy as you might think. Unless you look on here. There is a prevalence of doctors writing on internet about how dangerous a suppressed TSH is, and how it causes heart attacks and osteoporosis. But, they are wrong. They are not keeping up with the latest research.

It's long-term high FT3 that causes those problems - which, of course, will suppress the TSH. But, it's not the TSH itself that is the problem.

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My TSH was 0.008 when I tested last month.

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That's good. That's where you want it when you have Hashi's. But, in any case, it should be where it falls when your Frees are high enough to make you well. It's the Frees that are important, not the TSH.

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OK. I was going to test tomorrow morning anyway. I guess I will be putting up my T3. I've been aiming for a 4:1 ratio so I am not too reliant on T3 and the Levo can smooth out some of the blood level fluctuations - or is that not worth doing?

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Ratios are for healthy people. Your aim should be to take as much T3 as you need to be well.

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OK. So aim for mid range ft4 and upper third ft3?

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Not necessarily, no. If you're taking T3, don't try and get the FT4 anywhere. Because the body just hangs on to what it needs. No point in trying to force it to hang on to more.

And, just keep increasing the T3 slowly, by small amounts, until you feel well. That might be the upper third, and it might not. Might even be slightly over the top of the range. The aim is to feel well, not get your levels to any specific point in a man-made range.

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Apart from the constipation, I feel OK tbh. I suppose there's always room to feel better though!

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Well, only you can know that. You can try increasing T3 a tiny bit. If it doesn't make you feel better, reduce it again. There's no pressure to take any set amount. :)

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Thanks for all your help. I'll track down some research on suppressed TSH for my GP, and will have a fiddle with my T3 and Levo dosage armed with a bit more knowledge .

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Well, you could ask a new question on here, about it. There are people that have links to research on the subject. Just not me. :)

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UPDATE: As per my original post I thought I might be sensitive to my Levo. I have been taking a combo of Mercury Pharma (25mcg) and Actavis (50mcg). As an experiment, I dropped the Mercury Pharma one. I'm on day two of Actavis only, and already things have significantly improved. Looks like the only difference between the two brands is that Mercury Pharma Levo contains Acacia powder, so I think that might be a possible culprit. Looking online, it seems Acacia powder may be an issue for people who get hayfever, as i do!

I also have a latex allergy, and have previously been told to avoid Aloe Vera because of this, so I am wondering if this is linked too.

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I don't think there's any link between latex, acacia and aloe vera except that a lot of people are allergic to them, so they all contain something that upsets hayfever. It's pretty common, and you would think that doctors would know about it. But they either don't know or just don't care!

Glad you've found a solution, anyway. :)

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Hi hypo123, I have the same problem with constipation too. I eat lots of veggies, apples pears and avocado, drink 3 litres of water a day and my bowels just won't move. I'm now suffering chronic anal fissures from all the straining. Magnesium Citrate was helping with motility, but now that's stopped working . I had a blissful 6 weeks of no fissures or constipation taking Aloe Vera capsules, now that doesn't work, I wonder if there was a change in ingredients? Going to try drinking the juice, but worry as I have interstitial cystitis. It's so miserable I feel sorry for you. Some people on an anal fissure site recommended drinking a tablespoon of olive oil to lubricate things.

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I don't think I am in quite as bad a state as you. It sounds awful!

I can't go near Aloe Vera, as I have a latex allergy, and the proteins are similar.

Good luck.

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When everything else fails Movicol is quite good, but it can irritate the anus if you take it a lot. It does work quite quickly if you're really blocked. But of course it doesn't address what's causing the problem. I wonder if you have a tight anal sphincter that spasms instead of letting all the poo through? That's what's going on with me, i'm getting surgery for it, it's basically a snip in the tight sphincter to loosen things up, and then goodbye to the fissures.

Not sure of your sex and confess I haven't read all the replies here yet, but could your problem be caused by childbirth? Apparently it's very common. Both my daughter and I had surgical deliveries first time around, and she has the exact same problem, not fissures yet, but well on the way. She's seeing a colorectal surgeon who is helping with her pelvic floor and has prescribed something that really helps to ease things. I never had any problems until I had a high forceps delivery many years ago. The ridiculous thing with my problem is that the stool can be quite soft but still just sits there, it's a nightmare!

Good luck to you too!

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helcaster - I've just started to take Levo and just experiencing these symptoms for the first time - I eat plenty of fruit and veggies so don't usually get this sort of problem. I'm hoping your surgery works but really hoping I can find a way around it!

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My eldest daughter is hypo too SamanthaVictory, in her case her bowels were better on levo! She tried NDT and got worse. I take NDT and T3, but being hypo has definitely made things worse, I take pretty high doses too. Everything gets sluggish though doesn't it, just being hypo.

Not looking forward to the surgery, but the pain can't be as bad as having this all the time.

I hope you find a solution. X

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If I do then i'll be sure to let you know - it really is a pain in the behind in every sense!

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Thank you Samantha. X

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Samantha, please read info I've posted on flax seeds. Going to give this a go, I'll just add them to my porridge.

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Flax seeds can also bung you up more (been there, bought the tshirt!) so maybe stick to having them in the morning. You can also soak them for a few hours in water before you have them. They produce a sort of slime, which is what helps with the constipation, and soaking makes them better because they absorb some water before they hit your stomach & bowel and soak it up there (which is what can make you more bunged up).

I have also read that they are not great for your thyroid as they are estrogenic - although as usual, there is mixed info about that. mayoclinic.org/drugs-supple...

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Thanks for the warning hypo! I haven't tried them myself, but on one of the many anal fissure forums I've been reading, they are supposed to go slimy in the gut to provide lubrication to stools. I might give this a miss then!

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UPDATE: As per my original post I thought I might be sensitive to my Levo. I have been taking a combo of Mercury Pharma (25mcg) and Actavis (50mcg). As an experiment, I dropped the Mercury Pharma one. I'm on day two of Actavis only, and already things have significantly improved. Looks like the only difference between the two brands is that Mercury Pharma Levo contains Acacia powder, so I think that might be a possible culprit. Looking online, it seems Acacia powder may be an issue for people who get hayfever, as i do!

Perhaps it is worth you looking at the ingredients of whatever you are taking.

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I'm so relieved for you! Yes I will certainly look into this, thank you.

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I’m trying to resolve the same problem however, I don’t know why you want Tirosint. When I was switched to it almost imediately I could not “go”. I tried everything. I mean EVERYTHING. And finally ended up getting “triple prep” for a colonoscopy because I got so sick. My gallbladder, liver pancreas were all checked including ovaries all normal. The colonoscopy results were normal and I was told everythingcwas fine though I still had my original problem. I insisted it was the Tirosint and finally stopped it and within 2 days I could go again. The entire time my doc didn’t believe me. So I found another doctor. I still struggle a bit with constipation but my meds aren’t figured out yet. TSH is above 4. Just posting to warn you about my experience with Tirosint. The listed inactive ingredients are gelatin and glicerin so I’ve been trying to stay away from both while I figure this out.

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I have now switched to Levo which doesn't contain Acacia powder (aka gum arabic) and the problem resolved within a few days.

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Glad to hear it. I’ll put Acacia powder (gum arabic) on my list of things to pay attention to.

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