Different brands of levothyroxine

[Caroline888]

I'm just wondering why it matters if you get different brands of levothyroxine. Is it important to stay with the same one. At the moment I am taking 25 mcg Wockhardt one day and 50 mcg Northstar the next. Is this combination ok? Would be grateful for any advice. I was only diagnosed in October so don't know what I'm doing really. Without this site i would be totally at a loss. Thank you so much for all your help.

[greygoose]

The only person that can answer that question is you. How do you feel? Some people are very sensitive to different brands. Others aren't.

However, if you were diagnosed in October, and are now taking 25 mcg one day, and 50 the next, I would say your doctor is probably being a little over cautious. Why not 50 every day? Do you have copies of your results? If so, post them here with the ranges, and let's have a look.

[Clutter]

Caroline888,

The different ingredients in different Levothyroxine makes can affect absorption and how the patient feels. Actavis (also known as NorthStarr and Almus) is only made in 50mcg and 100mcg doses which is why you have been prescribed 25mcg Wockhardt. Wockhardt has the least fillers of all the brands so is usually okay.

If you are switched to a different brand and experience adverse effects you should tell your pharmacist and ask that they dispense the previous brand/s you were okay with.

[Nanaedake]

Have a look at the Northstar packaging to find out what Levothyroxine they are packaging. Northstar are a supplier and not a manufacturer of Levothyroxine so they package generic levo in their branded packaging

It could be anything but the package details will inform you. All tablets have to have a PL number which is the licence number so look for that to find out what is in the packaging.

I stick to one formulation as I find it critical to exclude as many variable factors as possible to control my medication and stay well.

Levothyroxine has such tiny amounts of active ingredient in each tablet that a minute variation makes a big difference I find. The quality of our lives depends on the quality of the meds unless you have enough thyroid left to compensate.

[Caroline888 in reply to Nanaedake]

Thank you for all that very useful information. I have now looked again at the box and the 50mcg tablet is made by Actavis. In view of what you've said, I'll certainly try to stay with the same brands. Does it matter that I am taking tablets from two different manufacturers? I don't feel well but have only been taking levo for a short time - about 8 weeks. My doctor is being very cautious about increasing the dose because he didn't really want to treat me at all as my tsh was only 8.8 originally.(My free t4 was towards the bottom of the range). He didn't want to prescribe for a tsh less than 10. My last result two weeks ago was 5.4 which he said was in range. However when pressed he agreed to increase by 12.5 mcg. I think he is being extra cautious because I am 68. I do worry that perhaps I shouldn't have insisted on being treated as a lot of my symptoms could be down to ageing. The symptom that led to my asking for a thyroid function test was a persistent but mild discomfort at the front of my neck and it was very tender to touch sometimes. This was worrying because I had it for months. It's almost gone now which might be a coincidence i guess.

I have rambled a bit! Sorry for that. I don't like taking medication and it's really difficult when the gp is not exactly on your side.

Anyway thank you - I'm grateful for your support.

[Nanaedake in reply to Caroline888]

Yes, it is difficult when the doctor is not exactly cooperative. There has been some recent research stating that older people with subclinical hypothyroidism don't benefit from levothyroxine. However, I'm not sure what they classed as subclinical.

I would think a TSH reading of 8.8 was overt hypothyroid and not subclinical but that's my non-medical opinion. Some doctors don't want to treat unless TSH reaches 10. So there is some debate about the right course of treatment but if you have symptoms of hypothyroidism then it seems worth a trial.

Have you had your thyroid antibodies tested? TPO Thyroid peroxidase and TgAb Thyroglobulin antibodies? If you've got thyroid antibodies there would be a likelyhood that hypothyroidism would progress due to autoimmune condition so it might be worth getting that tested.

You could also get vitamin levels tested at the same time as some symptoms of hypothyroidism are similar to vitamin deficiencies which may increase when we get older as our gut absorption sometimes decreases.

Check vit D, Vitamin B12, Folate, ferritin. All need to be mid-range with vitamin B12 near top of range for thyroid hormones to work well.

I would stick to one type of levothyroxine for now so that you eliminate as many variables as possible while you adjust to levothyroxine.

Here is the research about levothyroxine in older people - sorry, I can't evaluate whether it's reliable from a scientific point of view. Other people might be able to comment. I would not let it put you off trialling levothyroxine though.

nejm.org/doi/full/10.1056/N...

You do need to get your vitamin levels checked because if deficient you're never going to feel well on levothyrxoine. Don't take the docs word for it that they are fine. Get a copy and post them here. Docs often say they are fine when rocking along the bottom of NHS range which isn't every going to make you feel well.

[Caroline888]

All vitamins seemed fine although humanbean has already said my serum ferritin level was dreadful at 33 ug/l [12.0 - 300.0]. My vitamin D is 108 nmol (I take a supplement after being diagnosed with vitamin D deficiency about four years ago) and my vitamin b12 and folate are a little above range. I posted a photo of my full blood count results last week. I don't think I'm anaemic tho my ferritin is indeed low. Do you think I should take an iron supplement? I am a vegetarian.

Thank you for the link to the study carried out on older people with subclinical hypothyroidism - it was very interesting. I will continue with the levothyroxine until my next blood test due mid january but am undecided what I will do then if my doctor is still reluctant to treat me appropriately. I guess I'll look into it further before then. I am concerned that the throat discomfort might recur. Could it have been caused by temporary thyroiditis? Is there such a thing? Also I do have a lot of bone and muscle pain tho I rarely suffer from it when walking. Is muscle pain and weakness a symptom of hypothyroidism?

One last thing: is it harmful to stop taking levothyroxine once you've started taking it? I don't really want to stop because I'm so hopeful that it will make me feel better but I will need to be more confident that taking it is the right thing to do if I have to take on my gp at each and every appointment.

Thank you so much for all your advice.