Query, Brand of Levo

[Goldengirl01]

Hi there I have been dispensed a different brand of 100 mcg Levothyroxine - NorthStar by Actavis, has anybody had these because it may be a coincidence but I really feel dizzy. It doesn’t happen straight away but about 4hrs later so a bit weird or just a coincidence. Any ideas, thanks

[SlowDragon Administrator]

What brand were you on before?

Previous test results show very low FT3

healthunlocked.com/thyroidu....

Do you have Hashimoto's?

What vitamin supplements do you currently take

Bloods should be retested 6-8 weeks after any brand change in Levothyroxine

Definitely get FULL testing BEFORE seeing any endocrinologist

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

If/when also on T3, make sure to take last dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Is this how you do your tests?

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

[Goldengirl01 in reply to SlowDragon]

Hi yes I do all that and was told to get vitamins optimal before seeing endo. Gp and hospital won’t prescribe t3 as said before. I know I’m a poor converter. Take vit D oral spray (betteryou) along with K2 mk7, igennus super B complex but have left them off for a week as have blood test tomorrow. Also have just bought iron oral spray. Have had B12 injection a few weeks back. Just feel nauseous and dizzy along with sweating. Was told to take 75 & 100 mcg on alternate days as tsh too low before. New prescription came up with northstar and Ugh!. I have no thyroid (total thyroidectomy)

[helvella Administrator]

What make did you have before?

[Goldengirl01 in reply to helvella]

Mercury pharma

[SlowDragon Administrator in reply to Goldengirl01]

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.

At the very least you will need bloods retested 6-8 weeks after changing brand ....but see if you can get Mercury Pharma brand - best option is to try small independent pharmacies, generally far more helpful

20% Patients with no thyroid after thyroidectomy can not regain full health on just Levothyroxine

ncbi.nlm.nih.gov/pmc/articl...

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

88mcg is very small dose for someone with no thyroid function

Essential to test both FT4 and FT3....plus all four vitamins

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

Guidelines on dose by weight

healthunlocked.com/thyroidu...

NICE guidelines

cks.nice.org.uk/hypothyroid...

The initial recommended dose is: For most people: 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (such as coffee or tea), or other drugs.This should be adjusted in increments of 25–50 micrograms every 3–4 weeks according to response. The usual maintenance dose is 100–200 micrograms once daily.

FT4 should be in top third of range and FT3 at least half way through range

Useful calculator for results

chorobytarczycy.eu/kalkulator

[Goldengirl01 in reply to SlowDragon]

My local pharmacy that gave me the North Star Levo only has mercury pharma 50mcg Levo so have rung around and a nearby one has mercury pharma 100 mcg. The 75mcg is Teva which is not good but after the test tomorrow depending on results I will go back to 100mcg and try and get another prescription for that as only just picked up North Star but they may not agree to a new prescription at the moment.

[SlowDragon Administrator in reply to Goldengirl01]

Teva is only brand that makes 75mcg tablet

Mercury Pharma comes in 25mcg, 50mcg and 100mcg

Easy to cut tablets

[Goldengirl01 in reply to SlowDragon]

Ok thanks, don’t want Teva though. But I think I will only need mercury pharma 100mcg from tomorrow but my dr won’t like it as she said do alternate as my tsh was too low last time and said I was over medicated. I tried to do as she said but it could be why I’m feeling like I am as there was room from last bloods to carry on with 100mcg. When I get next results I’ll put them up. Thanks a lot for all your info.x

[SlowDragon Administrator in reply to Goldengirl01]

Most important results are FT3 and FT4

TSH often goes "low" long before we get high enough dose of replacement thyroid hormones

[Goldengirl01 in reply to SlowDragon]

TSH was 0.11 and that’s when Dr says it’s too low and to take 75 & 100 mcg Levo on alternate days but it’s not low enough so I’m going to go back to 100mcg after bloods. I did what dr said to satisfy her but I will have to tell her I feel so lousy with her suggestion of alternate days although she did say it will affect my bones and will cause cardiac problems if tsh is low. What do Dr’s know 🤭

[SlowDragon Administrator in reply to Goldengirl01]

TSH is pituitary hormone.

Taking replacement thyroid hormones is not the natural way that body is use to

Most important results are FT3 and FT4

Canadian Thyroid association on Low TSH

thyroidpatients.ca/rational...

Osteoporosis and low FT3

thyroidpatients.ca/2018/07/...

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

New NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking Levo thyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Research into Low TSH no heart issues

academic.oup.com/jcem/artic...

In summary, patients on long-term T4 with either an increased serum TSH (>4 mU/liter) or a suppressed TSH (<0.03 mU/liter) have an increased risk of cardiovascular disease, dysrhythmias, and fractures when compared with patients with a TSH within the laboratory reference range. Patients with a low, but not suppressed, TSH (0.04–0.4 mU/liter) had no increased risk of these outcomes in this study.

[orangeturquoise in reply to Goldengirl01]

Hi,

I searched this site for ' Northstar Actavis' because I recently was given this brand and my hypothyroid symptoms returned. I also had dizzy spells (though I didn't associate these with the tablets until I read your post). My chemist has changed me back to Mercury Pharma and I am starting to feel better. I have taken lots of different brands over the last 15 years and the only other one I experienced similar problems with was TEVA in late 2017. I have googled 'Actavis TEVA' and found that TEVA is the parent company of Actavis. It makes me wonder if they have repackaged the TEVA levothyroxine under Northstar Actavis because many people say they have had problems with TEVA .

Five years ago, like you, was told to reduce my thyroxine. This was following my thyroid swelling up. I went from 175mcg per day to 75mcg per day. It was horrendous. My endocrinologist said he couldn't increase it back because it could cause problems with my heart. I said I'd rather have a shorter life with some quality than a longer one trying to live like that. He tried me on combination treatment - 20mcg Liothyronine and 75mcg Levothyroxine daily and my life has been transformed. Unfortunately, our CCG blacklisted Liothyronine after its price rocketed, so I now get a private prescription for this from my GP and get my Liothyronine from Germany. It costs Euros 30.50 for 100 tablets (plus postage). In this country 100 tablets costs the chemist and NHS £997!

Hope this is of some help.

[Goldengirl01 in reply to orangeturquoise]

Thank you very much for that, I am going to try and get a private prescription from my GP as a couple of other on here get theirs from germany. We’re all your vitamins at optimal range?

[helvella Administrator in reply to orangeturquoise]

I have googled 'Actavis TEVA' and found that TEVA is the parent company of Actavis. It makes me wonder if they have repackaged the TEVA levothyroxine under Northstar Actavis because many people say they have had problems with TEVA .

This is WRONG.

Actavis (the bit in Barnstaple that makes Actavis levothyroxine) was temporarily owned by Teva because Teva bought the whole of Actavis. However, one of the conditions of them being allowed to do so was a requirement that they divest themselves of Actavis (in Barnstaple). Which they did. And it is now a part of Accord.

There is absolutely NO evidence that Actavis levothyroxine has anything whatsoever to do with Teva. If it were repackaged Teva, the list of ingredients would be the same. It isn't.