Stopiing B&R by myself: Hi all, 21.febr Tsh 0.0... - Thyroid UK

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Stopiing B&R by myself

Denisa87 profile image
40 Replies

Hi all,

21.febr Tsh 0.05, T3 7.2 T4 20.1

Took 20mg carb a week and started Block and Replace 40mg carb+75mcg Levothyroxine.

I have a week of B&R treatment and i think Levothyroxine gives me a cough so i would like to experiment 2 days without to see if it's really Levo's fault.

Questions

●Can you stop B&R all of the sudden after a week?

●Should i take a small dose of Carbimazole in this time until i speak to my doctor next week?

I am due for blood test at the beginning of April.

(Before B&R i was on titration with Carb for 1 year)

Many thanks

Denisa

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Denisa87
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40 Replies
SlowDragon profile image
SlowDragonAdministrator

As you are on 75mcg levothyroxine this is presumably Teva brand?

Teva brand upsets many, many people

Suggest you try a different brand ...but will need new prescription as Teva is only brand that makes 75mcg tablet

So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

List of different brands here

healthunlocked.com/thyroidu...

Teva poll

healthunlocked.com/thyroidu...

Denisa87 profile image
Denisa87 in reply toSlowDragon

Thank you for replying.I had Teva brand, yes.

I gave up for only 4 days just to experiment, now i'm back on it.

Trying to push my doctor to put me back on carbimazole alone.

SlowDragon profile image
SlowDragonAdministrator in reply toDenisa87

Try different brand of levothyroxine.....

Getting different prescription....either should read 42 tablets per month 50mcg tablets

Or 50mcg plus 25mcg tablets - 28 tablets each (both are much are cheaper than 75mcg tablet anyway, so saves NHS money)

Denisa87 profile image
Denisa87 in reply toSlowDragon

I have 75 mg teva brand and 25mg and 50mg teva brand as well.It's easier for me to take just one pill instead of 2.I also take 2 carbimazole a day..so it's too much..i will give it another try with 75mg teva and if i feel bad again, i will change the brand.

helvella profile image
helvellaAdministrator in reply toDenisa87

Levothyroxine is usually dosed in micrograms - not milligrams.

dropbox.com/s/sgv815w8hkexl...

Denisa87 profile image
Denisa87 in reply tohelvella

I wrote mcg on my other comments so it's a mistake.Yes, i know and thank you.

SlowDragon profile image
SlowDragonAdministrator in reply toDenisa87

The point is it’s Teva that really upsets thousands of patients....Teva is the ONLY lactose free levothyroxine tablet ...and contains mannitol instead of lactose

Research suggests Mannitol is responsible for upsetting gut biome

bmj.com/content/360/bmj.k71...

If you are Lactose intolerant (and many patients on levothyroxine are) then if Teva upsets you, there’s liquid levothyroxine available...but it’s relatively expensive and usually only prescribed by endocrinologist ...

see full list here

thyroiduk.org/tuk/treatment...

Are you on strictly Lactose free diet?

Denisa87 profile image
Denisa87 in reply toSlowDragon

Thanks.No gut problems, no bloating, no rash...just a cough..which everyone told me is not a usual side effect from teva levothyroxine.I stoped treatment for 3 days, still coughing..so..don t really k ow.I self isolated anyway.x

No lactose free diet, just gluten free

Denisa87 profile image
Denisa87 in reply toSlowDragon

I will change the brand with my next prescription.I saw that Teva has dairy in the ingredients which i don't tolerate quite well.And acacia powder which is considerate an allergen.I gave up to see if my symptoms(cough) improves and not really..so i don t think it's levothyroxine 's fault

helvella profile image
helvellaAdministrator in reply toDenisa87

You have been misinformed - Teva does NOT have dairy ingredients. (Nor does Aristo.) ALL other UK makes contain lactose.

UK Levothyroxine Tablets

➖➖➖➖➖➖➖➖➖➖➖➖➖➖

Last updated 09/03/2020.

This is a list of currently marketed levothyroxine tablets in the UK.

—————————————————————

🔹 Accord – formerly Actavis (manufacturer)

50

100

—————————————————————

🔸 Almus (an ‘own label supplier’ brand owned by Walgreen Boots Alliance – Boots pharmacies and Alliance distributor)

50 – This is repackaged Accord – formerly Actavis.

100 – This is repackaged Accord – formerly Actavis.

—————————————————————

🔹 Aristo (manufacturer)

100

—————————————————————

🔹 Mercury Pharma (manufacturer – part of Advanz) includes both “Levothyroxine” and “Eltroxin” which are identical.

25

50

100

—————————————————————

🔹 Teva (manufacturer)

12.5

25

50

75

100

—————————————————————

🔸 Northstar (an ‘own label supplier’ brand owned by McKesson – Lloyds pharmacies and AAH distributor)

25 – This is repackaged Teva. ❗

50 – This is repackaged Accord - formerly Actavis. ❗

100 – This is repackaged Accord - formerly Actavis. ❗

—————————————————————

🔹 Wockhardt (manufacturer)

25

➖➖➖➖➖➖➖➖➖➖➖➖➖➖

🔹 – identifies manufacturers.

🔸 – identifies ‘own label supplier’ products.

– Take particular note of the actual product which varies by dosage.

—————————————————————

Numbers refer to tablet dosages in micrograms.

If there is anything inaccurate in this information, please let me know by Private Message:

healthunlocked.com/user/hel...

➖➖➖➖➖➖➖➖➖➖➖➖➖➖

Denisa87 profile image
Denisa87 in reply tohelvella

That is corect, it doesn't.My bad.Thank you for letting me know 😊

Denisa87 profile image
Denisa87 in reply toSlowDragon

It's a nightmare as with high doses of Carb you can have side effects as well.With Coronavirus now is very difficult to go for a blood test or appointment.Not to say i am self isolating for 7 days because of the cough.I hope is ok i've discontinued the treatment for 3 days.

indiesnow profile image
indiesnow

Hi Denise, as far as I understand it takes a while for carbimazole to have any effect so stopping for a short time won't do much, you are better keeping to the regime the doctor gave you and waiting for the blood test. It is frustrating as you constantly have weird symptoms with this horrible condition. My doctor switched me from b&r to titration and after 18 months have been told to take nothing which I have done for 6 months and my bloods come back bang in the middle of normal. I mostly feel normal but still get some symptoms although they are mild. Hope this helps

Denisa87 profile image
Denisa87 in reply toindiesnow

Thank you.How many months were you on B&R and why the change into titration with carbimazole alone?

indiesnow profile image
indiesnow in reply toDenisa87

Hi Denise,

I was on B&R for 9 months and as my blood tests were always normal the doctor asked me if I wanted to change as I would be on less drugs and if I stayed like this with titration it meant I would be taking less carbimazole which is obviously good. I had been on 40mg of carbimazole and 100 of levothyroxene. I dropped to 15 mg of carbimazole but that pushed me towards hypothyroidism so it was then dropped to 5mg every other day for 6 months. I remained euthyroid (normal) so I have now stopped all drugs, I still feel some symptoms in a minor way so we shall see. Throughout I followed the regime but I did have panics, felt symptoms and in the beginning, went up and down and did speak with my GP a lot. I think doctors have a long way to go in their understanding of thyroid conditions and it is very frustrating having to wait between blood tests but that is all we have at the moment and for the most part I do feel fairly normal now. All the best Indie

Denisa87 profile image
Denisa87 in reply toindiesnow

Thank you so much!I hope you will be off the carbimazole for good with no symptoms back!All the best and take care 🙏

SlowDragon profile image
SlowDragonAdministrator

Persistent cough can be GERD or acid reflux...extremely common when hypothyroid due to LOW stomach acid

healthline.com/health/gerd/...

theinvisiblehypothyroidism....

thyroidpharmacist.com/artic...

holtorfmed.com/gerd-and-thy...

But if you mention acid reflux to a GP they would almost always assume it’s due to high stomach acid and prescribe PPI ...making it worse

Thousands of posts on here about LOW stomach acid

healthunlocked.com/search/p...

Links about connection between being hypothyroid and lo2 stomach acid

articles.mercola.com/sites/...

thyroidpharmacist.com/artic...

stopthethyroidmadness.com/s...

healthygut.com/articles/3-t...

naturalendocrinesolutions.c...

Denisa87 profile image
Denisa87 in reply toSlowDragon

I am due to a blood test in 2 weeks.

Hopefully it will all get sorted.

SlowDragon profile image
SlowDragonAdministrator in reply toDenisa87

There’s little point testing thyroid levels until been on constant unchanging dose levothyroxine (and same brand of levothyroxine) for minimum of 6-8 weeks

Just testing TSH and Ft4 is completely inadequate

You will need FULL thyroid and vitamin testing

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

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)

If/when also on T3, make sure to take last 1/2 or 1/3rd of daily 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

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

For thyroid including antibodies and vitamins

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

Denisa87 profile image
Denisa87 in reply toSlowDragon

Thank you.He tests my tsh, ft3, ft4 and trab.I know it's not enough and i will order a blood test kit from Medichecks .Is the finger prick accurate?

I am on my first 2 weeks of block and replace.40mg carb and 75Mcg Levo.

He said that he will keep my carb at 40mg and just change Levothyroxine's dose after each blood test result.

I am.very sensitive at carbimazole as even 10mg can make my Tsh go 40.

So i hope he knows what he's doing.

Before that i was on titration, Carb alone..and not stable..with 2.5mg alternate days - hyper and 2.5 mg daily hypo..He said that because i am.not stable on titration we can give B&R a try.

SlowDragon profile image
SlowDragonAdministrator in reply toDenisa87

Have you tried strictly gluten free diet? Helps thousands of patients with Graves’ disease or Hashimoto’s

Denisa87 profile image
Denisa87 in reply toSlowDragon

Yes as i have celiac disease.

SlowDragon profile image
SlowDragonAdministrator in reply toDenisa87

Then your vitamins are likely poor

What vitamin supplements are you currently taking?

When gluten intolerant we frequently have very low vitamin D and magnesium. B vitamins frequently low if vitamin D is low

Denisa87 profile image
Denisa87 in reply toSlowDragon

I don't take any supplements or vitamins.I used to take iron because my levels were low.My doctor is not the best in checking everything but i will make sure to test myself privately.I already take 3 pills and i struggle..i can't imagine taking more pills.

SlowDragon profile image
SlowDragonAdministrator in reply toDenisa87

You will definitely need to test vitamin levels

Vitamin D supplement is easy...best option is mouth spray

Magnesium can be tablets or liquid

Low B vitamins linked to low vitamin D

But get tested vitamin levels tested FIRST ...via GP or privately

Perhaps start with just vitamin D if cost is an issue

NHS postal kit £29

vitamindtest.org.uk

Vitamin D ...GP will only prescribe to bring levels to 50nmol.

ouh.nhs.uk/osteoporosis/use...

But improving to around 80nmol or 100nmol may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7 ...good for strong bones

It’s trial and error what dose we need, with coeliac or gluten intolerance we frequently need higher dose than average

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Also read up on importance of magnesium and vitamin K2 Mk7 supplements when taking vitamins

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Bone pain

easy-immune-health.com/pain...

naturalnews.com/038286_magn...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

If vitamin D is low, B vitamins may be too. As explained by Dr Gominack

drgominak.com/sleep/vitamin...

healthunlocked.com/thyroidu...

Levothyroxine or T3 won’t work without good vitamin levels

Poor conversion of Ft4 to Ft3 frequently improves when vitamin levels are optimal

Denisa87 profile image
Denisa87 in reply toSlowDragon

Thank you so much for taking the time to send me and give me so much information.

I really appreciate it.I hope to find out why i have this cough and if hypo with my blood test result, to have the right dose of B&R.

It's difficult to talk to a doctor now..i am trying to talk to my endo from friday, been said by his secretary that he is busy with coronavirus emergency...

SlowDragon profile image
SlowDragonAdministrator in reply toDenisa87

If your iron was low this suggests you perhaps never had a Graves’ disease but have Hashimoto’s

Graves’ disease patients usually have high iron/ferritin

We see many early stage Hashimoto’s patients misdiagnosed as having Graves diseases...because medics assume high Ft4 and high Ft3 is hyperthyroid ....but Hashimoto’s almost always starts with transient hyperthyroid phase

Did you get Graves’ disease confirmed by high TSI or Trab antibodies?

Hashimoto’s is confirmed by high TPO or high TG antibodies...though these can be slightly raised with Graves’ disease too

It’s also possible to have BOTH Graves’ disease and Hashimoto’s at the same time .....standard treatment then is block and replace

Always get all antibodies tested

Denisa87 profile image
Denisa87 in reply toSlowDragon

I was first diagnosed with Hashimoto's (tpo over 300).Now in uk i've been told it's Graves.

Since 2016 with my Hashimoto i managed one year and a half of remission and in march 2019 i went to A&E with Ft4 100 a d Tsh<0.0005...So think i have both..."lucky" me

SlowDragon profile image
SlowDragonAdministrator in reply toDenisa87

Sound like it then....I would still want to see that endo had actually tested TSI or Trab antibodies

Getting vitamin levels optimal helps both Graves and hashimoto’s

Denisa87 profile image
Denisa87 in reply toSlowDragon

I could find my antibodies results from May 2019

trab - 2.40 and tpo-92

SlowDragon profile image
SlowDragonAdministrator in reply toDenisa87

What’s the range on Trab?

TPO range is usually positive for Hashimoto’s if over 34

Denisa87 profile image
Denisa87 in reply toSlowDragon

I don;t have the range...i am just looking on my old records...i found that in october my trab was <0.90...which i think is negative....i will test everything in about a week.What happens if i don't have Graves and they treat me with B&R?I mean, my levels are still showing hyper, but maybe is just Hashimoto.

SlowDragon profile image
SlowDragonAdministrator in reply toDenisa87

Ask endo if can't find out ranges

SlowDragon profile image
SlowDragonAdministrator in reply toDenisa87

How long since diagnosed as coeliac?

coeliac.org.uk/information-...

Denisa87 profile image
Denisa87 in reply toSlowDragon

Almost a year and a half.Blood test and gastroscopy.But because i gave up gluten at first(with my blood test), gastroscopy(which was one year after) showed no damage.

SlowDragon profile image
SlowDragonAdministrator in reply toDenisa87

Ludicrous isn’t it ...endoscopy should be maximum of 6 weeks wait after positive Coeliac blood test

Denisa87 profile image
Denisa87 in reply toSlowDragon

I know..it's insane

SlowDragon profile image
SlowDragonAdministrator in reply toDenisa87

I paid for mine.....NHS won’t do one if “only” gluten intolerant

Denisa87 profile image
Denisa87 in reply toSlowDragon

No words...

SlowDragon profile image
SlowDragonAdministrator in reply toDenisa87

Meant I only waited 4 days!

Pity it took 24 years before connecting the dots!

More on my profile

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