Levothyroxine

[clairebenett]

I want to change my levothyroxine from Teva back to Actavis. I haven't yet made my endo aware of this because the problems I have had with Teva did not come about until a few months of taking it. I am worried the endo will give me a diagnosis of irritable bowel like my GP did. Any ideas how to go about this please.

[greygoose]

Irritable Bowel is not a diagnosis, because it's a symptom. You can't be diagnosed with a symptom. You have to find out what's causing the symptom. And, it could very well be the Teva.

[clairebenett in reply to greygoose]

Thanks for that reason I have been taking a lower dose of levothyroxine and the symptoms have gone away

[greygoose in reply to clairebenett]

OK But be careful you don't become under-medicated.

[clairebenett in reply to greygoose]

I am undermedicated

TSH 4.68 (0.2 - 4.2)

FREE T4 14.9 (12 - 22)

FREE T3 2.1 (3.1 - 6.8)

GP has said she will not increase

[greygoose in reply to clairebenett]

Then you cannot afford to reduce the dose. Your FT3 is already under-range. You will become very ill if you don't increase it.

What reason did your GP give for refusing to increase?

[clairebenett in reply to greygoose]

GP thinks I will be overmedicated if I increase. Thanks

[greygoose in reply to clairebenett]

GP is stupid! You would only increase by 25 mcg, anyway. And that won't take you over the top of the FT3 range. And that is the definition of 'over-medicated'. Nothing to do with the TSH, as she probably believes.

In fact, whilst it might help to alleviate your symptoms, it won't raise your FT3 by very much at all, because you are a very poor converter.

It's not surprising you have symptoms with such a low FT3, but some of them are to do with low nutrients. Pins and needles in the feet, for example, is low B12. Heavy periods is due to low iron.

Optimising your nutrients will also help your conversion.

[clairebenett in reply to greygoose]

Thanks I supplement but feel like giving up with them because levels do not improve

[greygoose in reply to clairebenett]

Perhaps you're not taking enough. Or, perhaps you need to investigate your stomach acid, which is probably low. Have a look at the home test at the end of this article :

scdlifestyle.com/2012/03/3-...

[clairebenett in reply to greygoose]

List of symptoms

Pins and needles in feet

Dry skin

Puffy eyes

Constipation

Hair loss

Cold intolerance

Joint pain

Heavy and painful periods

Loss of appetite

Goitre

Depression

Sweats

[helvella Administrator]

clairebenett,

Does your prescription actually state "Teva"? Or does it include 12.5 or 75 microgram tablets (which are only available in Teva)?

If the above problems don't apply, you can just ask the pharmacy for Actavis (or Almus or Northstar which are just repackaged Actavis) when you present our prescription. If they won't supply, go somewhere else.

[clairebenett in reply to helvella]

Prescription states lactose free levothyroxine Teva

[helvella Administrator in reply to clairebenett]

Ah! I see.

It would be possible for a pharmacy to dispense Aliud or Henning (both lactose-free, both from Germany) - and I don't know how the prescription should be written for that.

Do you not know feel you need lactose-free? Or is it just that Teva is worse than the lactose-containing Actavis?

[clairebenett in reply to helvella]

Endo established I have lactose intolerance based on symptoms of bloating, diarrhoea and abdominal cramps on levothyroxine that is not lactose free. Thanks

[helvella Administrator in reply to clairebenett]

Afraid you'll have to get a new prescription that forces the pharmacy to dispense another lactose-free make such as one fo those suggested.

I am not lactose-intolerant but for various reasons have actually tried both products - and would be very happy to get them all the time!

[SlowDragon Administrator in reply to clairebenett]

The fact you still get same symptoms on Teva suggests it's not lactose but low stomach acid caused probably by under medication

And/or gluten intolerance

Majority of us with Hashimoto's find strictly gluten free diet helps or is essential. Endo's are not up with reassert but from last 20 years. They often have no idea

Dose of Levothyroxine must be high enough to bring TSH down to around one and FT4 near top of range and FT3 at least half way in range

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

please email Dionne:
[e-mail]

Prof Toft - article just published now saying T3 is likely essential for many

rcpe.ac.uk/sites/default/fi...

Essential to get vitamins optimal first. TSH down to around one and FT4 towards top of range

Strictly gluten free diet too

Then if FT3 remains low you may need addition of small dose of T3

[Tallbird-Sammi in reply to helvella]

Hi.

Is Northstar definitely Actavis but in a different packet?

I have been given Northstar a few times and have always asked them to change it to Actavis before leaving the chemist??

Thanks.

[helvella Administrator in reply to Tallbird-Sammi]

Tallbird-Sammi,

Definitely.

It is very disappointing that the pharmacy were unable to read the packet, look at the blister pack, or read the Patient Information Leaflet. All of which confirm the fact. They could so easily have shown you, explained, and backed it up. Instead of which they appear to be ignorant of the fact.

healthunlocked.com/thyroidu...

Northstar is a brand name owned by Celesio - who own Lloyds and AAH.

[Tallbird-Sammi in reply to helvella]

Thank you helvella

I didn't open the box to look at the paperwork inside while in the chemist so they would take the tablets back and still be able to issue them to someone else.

It's a bit odd that the person handling the prescriptions didn't know they are the same brand??

[helvella Administrator in reply to Tallbird-Sammi]

Tallbird-Sammi,

That is exactly what I meant - it should be them knowing, you shouldn't have to.

At the pharmacy I use, even the counter person (i.e. not pharmacist) was well aware. Mind, that was a bit of a surprise.

[Tallbird-Sammi in reply to helvella]

Oh well at least I know for the future if I get the Northstar box the tablets inside will still be Actavis.

I must say since moving and having to change doctors, I'm very impressed with how helpful our local chemist is and how they do work with my surgery and me. Even if they don't know whats in the box!!

Thanks again helvella

[helvella Administrator in reply to Tallbird-Sammi]

Tallbird-Sammi,

On the long bottom edge of the box of 100 microgram Northstar, it says:

PL Holder

Actavis, Barnstaple,

EX32 8NS, UK.

[POM] PL 0142/0105

I know because I have literally picked my prescription up since my last response here so could check the box.

Same is basically true for Almus levothyroxine. That brand is owned by Walgreen Boots Alliance.

[Cup-cake7]

.....I had gut problems which all went when I took a product to heal leaky porous gut and went gluten free, I've slipped up badly the few weeks before Christmas and some of the symptoms returned so back to it! My levels were similar to yours maybe a bit higher and I definately noticed my symptoms reduce when got on vitamin regime, just in case anything helps x

Also had defiant doctors saying I'm normal, 4.5 tsh - Iv just last week found one in the practice to actively take me down to a 1 - appreciate how frustrating and tedious but hang on in there x

[SlowDragon Administrator]

Loads of people have had problems with Teva

Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Reducing your medication will make you very hypo

Do you have Hashimoto's also called autoimmune thyroid disease diagnosed by high thyroid antibodies?

Can you add thyroid results and ranges, also vitamin D, folate, ferritin and B12 results too

Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take on waking, but it may be more convenient and possibly more effective taken at bedtime

verywell.com/should-i-take-...

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results

If you have Hashimoto's then food intolerances are extremely common

Gluten most likely and dairy pretty common too

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ask GP for coeliac blood test first

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

thyroidpharmacist.com/artic...

Low stomach acid can be an issue

Lots of posts on here about how to improve with Apple cider vinegar or Betaine HCL

thyroidpharmacist.com/artic...

drmyhill.co.uk/wiki/hypochl...

scdlifestyle.com/2012/03/3-...

healthunlocked.com/thyroidu...

Other things to help heal gut lining

Bone broth

thyroidpharmacist.com/artic...

Probiotics

carolinasthyroidinstitute.c...

Importance of magnesium

hypothyroidmom.com/two-vita...

[clairebenett in reply to SlowDragon]

Thanks no I don't have Hashimotos

TPO antibody 89 (0 - 34)

TG antibody 255.3 (0 - 115)

[SlowDragon Administrator in reply to clairebenett]

Yes you do

TPO is above 34

TG is above 115

If your GP said you didn't they don't know much

They often just call it autoimmune thyroid disease, it's the same thing

[Sheffield6]

I've forgot which one but my GP names Actavis. The previous one brought me out in a rash.

[carolineshields]

I cant take levothyroxine. So was given Armour Thyroid but after a few months that was taken away from me and i was told by my GP to research on the bet to find sonething suitable which i did and found a tablet that u can take. I started it 6 months ago and have never felt better then i do now after suffering for 24 years with underactive thyroid. Maybe you should do some research, you never know x

[Tallbird-Sammi]

I have never gone to my GP to change the make of my medication. I have always had a word with the chemist who gives me my prescription and they have always been happy to change it and have even made notes on their system to give me the one I prefer in the future.