Levothyroxine

[Health4I]

I have been taking Levo since May at 50mg per day. GP wants this to be increased to 75mg which I am happy with.

I now currently have tablets as follows: 50mg of Levo by Almus and 25mg of Levo by Teva.

I assumed the medication would be from the same company.

Do you think taking one tablet of each daily will be OK (from different suppliers). Does anyone else do the same? Just checking to see if anyone had any health issues as a result of taking medication from different suppliers (together).

[Treepie]

Probably best to stick to one but not all brands supply 25 mcg tablets.

I had two brands for a while without problems.

[shaws Administrator]

Usually, when we first start on levothyroxine at 50mcg and after a blood test every six weeks, an increase of 25mcg until symptoms are relieved is usual. The aim is a TSH of 1 or lower and a Free T4 and Free T3 should be in the upper part of the ranges. The latter two are rarely tested.

All blood tests should be at the earliest possible, fasting (you can drink water) and allow a gap of 24 hours between last dose of levothyroxine and the test and take it afterwards.

Always get a print-out of your results, with the ranges. Ranges are important for members to respond. Labs differ and so do the ranges.

GP should test B12, Vit D, iron, ferritin and folate as we can be deficient, which also can cause symptoms.

I think it would be preferable to have the same make of levothyroxine because if you have a sensitivity you wouldn't be able to know what levo was causing symptoms.

[SlowDragon Administrator]

Many people find Levothyroxine brands are not interchangeable.

Almus, Activis and Northstar are all same brand. They don't come in 25mcg tablets. Suggest you get new prescription just for 50mcg tablets and cut one in half each alternate day (easy to do with sharp craft knife)

List of different brands available

thyroiduk.org.uk/tuk/treatm...

Once you find a brand that suits you, best to make sure to only get that one at each prescription. Watch out for brand change when dose is increased or at repeat prescription.

Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients. Teva is the only brand that makes 75mcg tablet.

No other medication at same as Levothyroxine, leave at least 2 hour gap. Some like calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

Levothyroxine should always be taken on empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and more effective taken at bedtime

verywellhealth.com/best-tim...

Bloods should be retested 6-8 weeks after each dose change

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

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels and antibodies if not been done yet

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

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

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that FT4 in top third of range and FT3 at least half way in range

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)

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

Come back with new post once you get results

[spongecat]

I was given Wockhardt 25 mcg when I was on a 75 mcg dose . It's still available as far as I know if Teva brand doesn't agree with you.