Switching T3 brands

[emmak77]

Hi all,

I am going to start adding T3 medication to my Levo. I've ordered SigmaPharm tablets and they have cost me over £200.

I can get Uni Pharma MUCH cheaper. Am I okay to start on SP then just switch to UP?

Thanks

[SeasideSusie Remembering]

emmakempson

Just bear in mind that Unipharma is 25mcg and MP is 20mcg. There may or may not be a difference in strength and you may or may not notice.

However, I would point out that we on this forum don't encourage members to take T3 unless they know they need it. As you are a new member today, and there is no information in your profile, you may wish to benefit from the experience of members by sharing your latest test results so that we can help you know if taking T3 is right for you.

Tests needed are:

TSH

FT4

FT3

Thyroid antibodies

and before adding T3 it is essential to know that your nutrient levels are optimal so the following tests are also needed:

Vit D

B12

Folate

Ferritin

[emmak77 in reply to SeasideSusie]

Hi,

Thank you for your reply.

I've got 25mcg of both MP & UP. But I'm not sure if switching doses will affect me.

No problem!

My latest bloods are:

TSH: 2.31

T4: 17 (12 - 22)

T3: 3.4 (3.1 - 6.8)

TPO: 132

I have had doses of Levo from 25mcg to 125mcg and it doesn't affect my T3 very much. At one point my T4 was 44(!!) whilst my T3 remained low, so I have a conversion problem.

As for the vitamins:

Vit D: 82 (>50)

B12: 515 (197 - 771)

Folate: 2.5 (3.3 - 19.3) I have since supplemented folic acid. I also take a B Complex.

Ferritin: 137.4 (15 - 150) I have high ferritin as a marker of inflammation

I am working with a nutritionist to increase my conversion, heal my SIBO, and get my nutrients optimal.

As you can see from my bloods, I have Hashimoto's.

My symptoms include 40lbs weight gain, impossibility to lose it, extreme fatigue, depression, body aches, edema, brain fog, low body temperature, high cholesterol, high blood sugar etc - the list goes on!

Thank you for your help.

[SeasideSusie Remembering in reply to emmak77]

As far as I am aware, Mercury Pharma comes in 20mcg tablets. It's one of those prescribed on the NHS:

Advanz – branded Mercury Pharma, formerly branded Tertroxin (marketing authorisation holder)

🏭 Custom Pharmaceuticals Ltd. (manufacturer)

🥛 contains lactose

  20  PL 10972-0033

[emmak77 in reply to SeasideSusie]

Apologies, I mean SigmaPharm! My Levo is Mercury, which is where the confusion comes from.

[SlowDragon Administrator in reply to emmak77]

So you have high antibodies confirms this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

Hashimoto's frequently 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. Dairy is second most common.

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

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

Are you on strictly gluten free diet?

Or dairy free

If not ...

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

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

restartmed.com/hashimotos-g...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

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

[emmak77 in reply to SlowDragon]

Thank you for the information.

Yes, I have SIBO, dysbiosis and malabsorption so I have no doubt that leaky gut caused my Hashimoto’s in the first place.

I’m 100% gluten free and eat reduced dairy. I’ve seen no improvement, however I know it’s best for my condition to avoid those things.

Please could you advise on the T3. Thank you!

[SeasideSusie Remembering in reply to emmak77]

Emmakempson

TSH: 2.31

T4: 17 (12 - 22)

T3: 3.4 (3.1 - 6.8)

Before adding T3 you need to get your TSH down to 1 or below to give the maximum FT4 and then see where your FT3 lies, so an increase in Levo should be your first step.

Recommended levels for vitamins are:

Vit D - 100-150nmol according to the Vit D Council/Vit D Society

B12 - at least 550, preferably top of range

Folate - at least half way through range

Ferritin - half way through range although I understand that Hashi's can cause high Ferritin due to inflammation

[emmak77 in reply to SeasideSusie]

Thank you. I’m currently on 50mcg levo. When I was on 75mcg by TSH went down to 0.03, my T4 went too high above 22 and my T3 was actually at 3.4 still. So we’ve reduced my dose of Levo to stop my T4 being so elevated.

I’m working on getting those vitamins up thank you 😊 and yes Hashimoto’s will be causing all my inflammation, which were also working on (my nutritionist and I)

[emmak77 in reply to emmak77]

Basically whatever dose of T4 I’m on my T3 remains bottom of the range. When I was on 125mcg levo my t4 was dangerously high (44) but my T3 was still low

[SlowDragon Administrator]

As a new member...can you explain a little of your thyroid journey

You can’t just add T3 without getting FULL Thyroid and vitamin testing FIRST

Before considering adding T3 we need optimal vitamin levels and Ft4 as high as possible on levothyroxine

Do you have Hashimoto’s, or had RAI or total thyroidectomy?

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 Graves diseases or autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels if not been tested yet

These need to be optimal before considering adding T3

You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative

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)

Is this how you do your tests?

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus ultra vitamin

medichecks.com/products/thy...

Medichecks often have special offers, if order on Thursdays

Thriva Thyroid plus vitamins

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

bluehorizonbloodtests.co.uk...

When adding T3 we need to do so extremely slowly

Levothyroxine may need reducing a little first....depending on where Ft4 is within range

Typically starting on 5mcg in morning alongside levothyroxine, for first week. Assuming going ok, add second 5mcg dose mid-late afternoon

Hold at that dose for 6-8 weeks before getting full thyroid testing

Before blood test

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

Presumably you have a prescription for T3?

You can get T3 on prescription much cheaper from Germany

Prescription needs to read 100 x 20mcg liothyronine

thyroiduk.org/treatment-opt...

[emmak77 in reply to SlowDragon]

Hi,

Thank you for your reply.

Please see my response above

[SlowDragon Administrator in reply to emmak77]

Have you had Dio2 gene test?

thyroiduk.org/getting-a-dia...

thyroiduk.org/wp-content/up...

[emmak77 in reply to SlowDragon]

No, as my doctor & Endo said they still won’t consider prescribing me t3 even if I have the DIO2 gene. They say my t3 is ‘normal’ which is why I’ve decided to order my own medication

[SlowDragon Administrator in reply to emmak77]

Well if your Ft3 is rock bottom it’s clearly not normal

Recommend getting Dio2 tested...it’s only available privately (unless under one endo in Kent)

[emmak77 in reply to SlowDragon]

Exactly, that’s what I keep saying to them. But they’ve said they won’t prescribe it me, even if I test positive for the DIO2 gene! I haven’t got a prescription, I’ve bought it privately.

I’m just wondering about switching brands

[emmak77 in reply to SlowDragon]

I did reply to this last night but it’s not showing for some reason!

It’s ‘normal’ to my gp and Endo and I keep telling them rock bottom isn’t normal.

They said if the DIO2 gene comes back positive they still won’t prescribe me t3, so I didn’t bother with it.

[SlowDragon Administrator in reply to emmak77]

So if your GP and endo don’t agree you need T3...who gave you T3 prescription

[emmak77 in reply to SlowDragon]

I don’t have a prescription, I will be self sourcing as I can’t go on feeling this poorly.

[SlowDragon Administrator in reply to emmak77]

Sigma Pharma is Prescription only ...so that seems unlikely

[emmak77 in reply to SlowDragon]

I’ve ordered SigmaPharm from America. I know I’m not allowed to put the source on here

[endomad]

I originally self sourced t3 to see if it helped before broaching it with gp. Started with cynomel, then nhs T3 which was stopped for 10 months. I have also used tiromel, UP and LA T3 all work for me however the nhs T3 is definitely weaker than the others. I can chop and change brands of T3 with no problems I am not sensitive to any of the fillers. I can't take t4 it makes me ill, endo said I had very poor conversion. I am thyroid resistant and on a large dose, I have never had any signs of tremor or over replacement. We are all different and react differently, as t3 hard to source these days most don't have the luxury of choosing which brand they take.

T3 is not a magic bullet and I still crash on T3 if I have been over doing things. Over the last 5 years getting t3 has become the holy grail, people think it's a miracle cure, I am certainly better but I still get joint pain and fatigue. Before my endo would prescribe I had bone density test, heart scan & ecg, shbg tested every 6 months, liver enzymes, cortisol etc have you considered changing Dr if yours is not helpful.

[emmak77 in reply to endomad]

Thank you for your help.

Once the pandemic is over and gp surgeries are taking on new patients, I will move. I’ve seen a few different doctors though so I don’t have much hope- all they look at is TSH and they don’t care about my symptoms.

What brand is the NHS T3 please?

I feel extremely ill on T4 regardless of my dose so I’m hoping T3 will offer some improvement

[endomad in reply to emmak77]

I can't remember what brand nhs T3 is, small white 20mcg tablets. It was always old stock nearly at expiry date, if it had expired I would refuse it. Always decanted into a bottle. I have moved to France and get cynomel on prescription here, always new stock with 2 years expiry date. It makes my blood boil, not only do nhs agree to pay more than any other country they accept old rubbish stock.

If you find a Dr who listens say you are happy to approach local ccg for individual funding. I had to fight ccg for funding it took 10 months.

Self sourcing if you find reliable supplier is certainly less stressful but for me I wanted it all to be on my medical records in case. One lady was refused her self sourced Ndt when in hospital for long period as not prescribed she became very ill, so I like everything official. Thyroid care is really disgraceful, good drs & endos are hard to find, they get unwanted attention for prescribing and because their patient lists are huge, people travel miles to see a t3 friendly endo.

[helvella Administrator Thyroid UK in reply to endomad]

Could be any one of three makes:

UK Liothyronine Tablets

➖➖➖➖➖➖➖➖➖➖➖➖➖➖

Last updated 30/04/2020.

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

—————————————————————

🔹 Advanz – branded Mercury Pharma, formerly branded Tertroxin (marketing authorisation holder)

🏭 Custom Pharmaceuticals Ltd. (manufacturer)

🥛 contains lactose

  20  PL 10972-0033

—————————————————————

🔹 Morningside – also branded Iraksin (marketing authorisation holder)

🏭 Morningside Pharmaceuticals Ltd. (manufacturer)

🥛 contains lactose

  5  PL 20117-0323

  10  PL 20117-0324

  20  PL 20117-0270

—————————————————————

🔹 Teva – (marketing authorisation holder)

  20  PL 00289/2116

➖➖➖➖➖➖➖➖➖➖➖➖➖➖

Some non-UK Liothyronine Tablets

🔹 Ace – branded Cytomel (marketing authorisation holder – Netherlands)

🏭 Ace (manufacturer)

  5

  12.5

  25

—————————————————————

🔹 Mayne Pharma – (marketing authorisation holder – USA)

🏭 manufactured in Germany

  5

  25

  50

—————————————————————

🔹 Pfizer – branded Cytomel (marketing authorisation holder – USA)

🏭 manufactured in Austria

  5

  25

  50

—————————————————————

🔹 Sanofi – branded Cynomel (marketing authorisation holders – France)

  25

—————————————————————

🔹 Sanofi Deutschland – branded Henning Thybon (marketing authorisation holders – Germany)

🏭 Sanofi-Aventb, S.A. Josep Pla, 2, 08019 Barcelona, Spain (manufacturer)

  20

  100

—————————————————————

🔹 SigmaPharm – (manufacturer – USA)

🏭 Sigmapharm Laboratories, LLC (manufacturer)

  5

  25

  50

➖➖➖➖➖➖➖➖➖➖➖➖➖➖

🔹 – identifies marketing authorisation holders

🏭 – identifies manufacturers (where known)

—————————————————————

Numbers refer to tablet dosages in micrograms.

Only products which definitely contain lactose are identified (🥛 contains lactose). Please check other products.

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

healthunlocked.com/user/hel...

➖➖➖➖➖➖➖➖➖➖➖➖➖➖

This document is updated whenever I am aware of any changes or enhancements are needed. Please check the Last updated date. The current version is available as a PDF here:

dropbox.com/s/xlibro9l9jbfb...

[endomad in reply to helvella]

Luckily in france it is all cynomel which is my brand of choice

[emmak77 in reply to helvella]

Thank you. So you believe it’s ok to switch between brands?

[helvella Administrator Thyroid UK in reply to emmak77]

It is sometimes necessary to switch brands.

We have seen a wide range of reports from people switching brands and noticing virtually no difference through to finding one good and another intolerable in one way or another.

Except when there is a clear issue, such as lactose-intolerance, it is next to impossible to predict who will do OK when they swap from A to B, and who will not.

Preferably, everyone would find a brand that works for them and stick to it. Sometimes that is impractical or impossible. So, if a switch is required:

🟢 Try B while you still have some A - if B is absolutely intolerable, you have the possibility of reverting to A.

🟢 Occasionally, a dose such as 20 micrograms in one make will feel too little and it will be necessary to increase to 25 micrograms. Or vice versa.

🟢 Make notes of everything. What make you take when. Any changes to symptoms, etc.

[emmak77 in reply to helvella]

Great, thanks for your help!

[emmak77 in reply to endomad]

The treatment for thyroid & hashimotos over here is awful. Every medical appointment I leave feeling deflated and cry for the rest of the day. Thank you for your help.

[McPammy]

My experience on Sigma wasn’t good. I came out in a rash on my torso. Also I didn’t feel well on them. I switched to Mayne Pharma from the NHS. However, the best T3 I’ve tried is ThyBon Henning.

Just saying this in case your initial experience isn’t positive although you may do better on Sigma than myself.

[emmak77 in reply to McPammy]

Thank you for your help.

If you self medicate, please could you send me a message with your source.