Can anyone advise .e on T4 and T3 doses please?

[Shredder]

Hello again. Can anyone please advise about what im doing wrong with my T4 /T3 doses. I was on Armour NDT (2 grains) this time last year and felt brilliant. My health authority stopped prescribing it but when I bought it myself it has changed dramatically. Fast forward to now, back on Levo 75mcg but have gained 2 stone and look like a blob. Im adding T3 (currently about 13mcg) but still struggling. Despite very poor appetite and eating one small meal yesterday, I woke up this morning bloated and four pounds heavier. Can anyone please advise.

[SlowDragon Administrator]

How long have you been back on just 75mcg levothyroxine

Do you have results from just on levothyroxine

How long have you been on small dose T3 as well

Bloods should be retested 6-8 weeks after constant unchanging dose.

Do you always get same brand of levothyroxine

What vitamin supplements are you currently taking

When were vitamin levels last tested

[Shredder in reply to SlowDragon]

Months ago. I haven't been tested since last October when my endo changed my appointments from 3 to six months. My last appointment was cancelled because of lock down. I was taking 2 grains of NDT (Armour) but I had too much thytoxine in my system. I read 2 grains was equivalent to 100mcg of Levo so my G.P said I nedded just 75mcg when I went back to it. I take a good multi vitamin, magnesium, selenium and zinc plus b12 supplement and ashwagandha plus tumeric. The only brand of Levo available in every pharmacy in a 25 mile radius is the awful Teva. I take Uni pharma T3. I hate the Teva brand with a passion but my local chemist said thsts all they get. As you can imagine Im so frustrated and rather despondent hence my continued posts. NDT worked for me until they messed with them and now none work for me and Thai NDT hsve too many fillers to tolerate. I have been on Levo plus T3 for about a month now but my weight keeps ballooning.

[SlowDragon Administrator in reply to Shredder]

So did you not get full private test before adding T3?

Strongly recommend you get full thyroid and vitamin testing after 6-8 weeks on starter dose of T3

Essential to stop any supplements that contain biotin a week before ALL Blood tests as biotin can falsely affect test results

Multivitamins not recommended on here. Most contain iodine for a start

healthunlocked.com/thyroidu...

Which brand of levothyroxine do you prefer. Ask GP to write the desired brand on your repeat prescriptions or at least to write NO TEVA on all future prescriptions

Trying online pharmacies, or supermarket pharmacies.....often small independent pharmacies are more helpful

[Bari77 in reply to Shredder]

How about getting 50 mcg that is North Star by Actavis and using a pill cutter to make 25 mcg?That way you avoid TEVA problem.

[adin in reply to Shredder]

I'm in the same situation, try finding the right balance t4/t3.

[Lalatoot]

Multi-vitamins are not good. you should only take what you are deficient in. With a multi vitamin you could be setting something off balance by getting too much. This is what happened to me and it made me very ill with thyroid problems..

Ashwagandha alters cortisol. It can raise it or lower it. You can't be sure which it will do so I wouldn't recommend it.

Pharmacies can supply more than one brand of levo. It may be that the tablet size you require only comes from TEVA. this can be sorted by your surgery. Tell them that you are sick with TEVA and ask them to write no TEVA on the prescription. Be prepared to explain that you will cut tablets to get the required dose to avoid TEVA. My surgery does this.

You need to take in enough calories for the T4 to T3 conversion to work. If we don't eat enough our bodies begin to conserve their reserves and so your conversion will worsen and your thyroid hormones will be more out of sync.

I started adding T3 to levo 10 months ago and I am only now beginning to feel that I am on the correct doses. Because I was so hypo and ill it has taken me that time to build up lio to a dose then wait 8 weeks then blood tests then alter levo dose then 8 weeks then blood tests. It is a slow process.

It is essential to have regular blood tests particularly when you are trying to establish a dosing routine.

Have you recent blood test results to see how you are doing in this process?

[SlowDragon Administrator]

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.

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. Teva contains mannitol as a filler, which seems to be possible cause of problems

If prescription reads 75mcg tablet....Teva is inevitable

Teva is the 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

Teva and Aristo are the only lactose free tablets

healthunlocked.com/thyroidu...

Teva poll

healthunlocked.com/thyroidu...

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

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an 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 perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

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

[Bari77 in reply to SlowDragon]

How about vitamin D in drops? I assume it's the same as spray?

[SlowDragon Administrator in reply to Bari77]

Yes I guess so, they must be absorbed in mouth too

[Shredder in reply to SlowDragon]

Thanks so much for tge reply. I do tend to wake it before I leave for work. Either the meds or the condition has givrn me chronic insomnia so I don't take them at night. I only frink water with the meds snd don't eat or drink for at least two hours after.

[SlowDragon Administrator in reply to Shredder]

Insomnia often due to low Ft3 and/or low vitamin D

First step is to get full thyroid and vitamin testing

You have to approach this methodically....one step at a time

Come back with new post once you get results

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).)

If/when also on T3, or on NDT 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

[NWA6]

Hey Shredder. We’d really need to see thyroid results in order to help you with any direction. It’s obvious that you’re under-medicated. I too added 2stone and ate hardly anything and insomnia. I also had low Vit D, and not optimal Folate, b12 and ferritin. Maybe you need to optimise them aswell?

[Shredder in reply to NWA6]

Thats what exactly is happening to me. Awful insomnia for ages and I thought it may be the t3. I am taking iron tablets as my iron is low, prescribed by my G.P who if im honest doesn't seem to want to know. Am I on yoo low a dose of Levo as I am a male. I used to be a healthy forty something gym goer and rugby player. I am not a fat blob who strughles to climb stairs!

[Marz in reply to Shredder]

Did your GP tell you to take the iron well away from your Thyroid meds ? At least 4 hours. VitC helps absorption of iron too. Make sure you are re-tested for Iron from time to time as too much is also not good ...

[NWA6 in reply to Shredder]

The insomnia threw me and my GP said I wouldn’t have insomnia if I wasn’t so overmedicated (stupid woman who only went on TSH results) my FT4 was only about 60% through range but my FT3 was consistently 0% or lower. If I tried to raise my FT4 to 80% I’d feel wired but still it wouldn’t covert. Finally I found a good FT4 range and added T3 and I slept like a baby. It was such a relief. I now have about 10lbs to loose to feel good but I’m looking more toned and going steady with the exercise instead of doing HIT, walking instead of running, kettlebells and a little yoga/stretching. I should move to weights but I’d need a little direction as I’ve always been out of by weights as I seem to become quite muscular without trying. Now I am a little more educated I can see how it would help.

Why are you on low Levo because you’re male?

[Shredder in reply to NWA6]

Can you ell me how much t4, t3 you are taking please?

[NWA6 in reply to Shredder]

135.7 Levo and 25 T3

A couple years back I was up to 200mcg Levo, felt hyper, wired, came back down to 175, still hypo. Came down to 150. Still hypo but at least not wired/anxious. FT3 always the same except when FT4 dropped and then it would be well below range. Added T3 April 2019. Started of with 15mcg. After 6wks went up to 20mcg. Then June this year felt hypo again (very slight but I’m very intune with how it starts so try to catch it before it gets going) tested and added another 5mcg.

I’m still interested in why your Levo is low ‘because you’re male’?

[adin in reply to NWA6]

Hi, I'm in the same situation, transition ndt to levo +t3 and I try to find my doses. How do you take your t3 (all in one or split) along with your levo?How long it's last util the t3 is kik in?

[NWA6 in reply to adin]

I don’t feel ‘a kick’ I’m just very even all day long. I take my Levo + T3 (10mcg) at night, then T3 (10mcg) in the morning. Then Vits and minerals at midday and then T3 (5mcg) at 3pm. I’ll probably incorporate the increase of 5mcg to my morning or evening routine. I don’t know why I added it in the afternoon, maybe just being cautious.

[adin in reply to NWA6]

You can sleep if you take the levo at night?

[NWA6 in reply to adin]

adin yes it can actually help sleep. When I first introduced T3 I used to have vivid dreams for the first 6mths. I changed my timings but it didn’t make a difference. I’ve played aroubd with timings over the last year but I stay consistent in how I feel. I take Levo at night so that I can enjoy my coffee and cream in the mornings.

[adin in reply to NWA6]

I understand, you lowered your levo when you increase t3 dose? Your pulse /bp it's OK?

[NWA6 in reply to adin]

My BP has always been on the lower side. Even when pregnant the midwife would be amazed but while hypo it was raised and my pulse was ever so slow. At times my Apple Watch said it was 36 -56 beats per minute. Shockingly low if you ask me because I was overweight and unfit! I haven’t had my BP measured for a couple of years so don’t know but heart rate is now a steady 70bpm.

I lowered my Levo from 157 to 135.

[adin in reply to NWA6]

Thanks for the reply, you are very helpful. My pulse it's btw70- 80 in the morning and after I get the tirosint +t3 rising to 90 - 100.I lowered levo from 125 to 112 but I don't feel well. My endo prescribe only 5mcg t3in the morning and another 5 t3 in the afternoon but I think it's not enough from me.

[NWA6 in reply to adin]

Your pulse is still within limits at 90-100. Esp if not ‘fit’. I probably wouldn’t have lowered Levo by that alone.

[Shredder in reply to NWA6]

Yes me too and im not the smallest of males too. I was a fit and strong 16 stone until treatment, now I am an 18.5 stone blob with no energy to exercise. I was taking 2 grains of Armour and my last blood test in October said that I had too much thyroid hormone in my blood but felt like my old self on Armour though that now has gone South completely so I had to go back on Levo.

[NWA6 in reply to Shredder]

How do you know if that you were on too much Armour? You can’t go by blood tests alone. Symptoms or lack of are a much better way to understand if we are over or under medicating.

Were you ever on Levo or just started with armour? 16 stone is a lot, of course you’d need a high dose of Levo or armour.

You can’t exercise while under medicated so stop beating yourself. I hate feeling like a blob, I get it, I understand your self loathing but this isn’t your fault, be kind to yourself. Stress just exacerbates our conditions. Relax, get well and then you’ll be back training 💪

Sounds to me like you should get back on Armour if that suited you.

[Shredder in reply to NWA6]

I started on Teva Levo on ever increasing doses before my endo agreed to put me on Armour at my request as I felt rubbish on Levo. I was on Armour until my health trust said they would no longer prescribe it (around April 2019). I had to go back on Levo as a result but again felt awful so started to buy Armour myself around November last year but it wasn't the same. I felt like I was completely unmedicated not like before when I felt great. I took it for 2 months but had to stop as it clearly had been changed.

[Hookie01]

What brand of levo are you currently taking?

[Shredder in reply to Hookie01]

Awful Teva. I have enquired in every pharmacy within a 30 mile radius but they only stock Teva.

[NWA6 in reply to Shredder]

Is it Teva because they are giving you a 25mcg tablet? I think it’s only Teva that make them. You are on an unbelievably low dose of Levo for a man your size.

[helvella Administrator in reply to NWA6]

Wockhardt, Teva and Advanz all produce 25 microgram tablets. Though we have heard that there have recently been supply issues with Wockhardt's levothyroxine tablets.

UK Levothyroxine Tablets

➖➖➖➖➖➖➖➖➖➖➖➖➖➖

Last updated 30/04/2020.

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

Please note that re-branding (whether by a manufacturer or as an ‘own label supplier’ - which has happened with several products) does not mean any change to formulation.

—————————————————————

🔹 Accord – formerly Actavis (marketing authorisation holder)

🏭 Accord-UK (manufacturer)

🥛 contains lactose

  50  PL 0142/0104

  100  PL 0142/0105

White

6mm diameter

—————————————————————

🔹 Advanz – branded both “Mercury Pharma Levothyroxine” and “Mercury Pharma Eltroxin” which are identical (marketing authorisation holder)

🏭 Custom Pharmaceuticals Ltd. (manufacturer)

🥛 contains lactose

  25  PL 12762/0016 5.5mm diameter

  50  PL 10972/0031

  100  PL 10972/0032

—————————————————————

🔸 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 – (marketing authorisation holder)

🏭 Aristo Pharma GmbH (manufacturer)

  100  PL 40546-0159

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🔸 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. ❗

—————————————————————

🔹 Teva – (marketing authorisation holder)

🏭 PLIVA Croatia Ltd (manufacturer)

  12.5  PL 00289/1971

  25  PL 00289/1972

  50  PL 00289/0038

  75  PL 00289/1973

  100  PL 00289/0039

—————————————————————

🔹 Wockhardt – (marketing authorisation holder)

🏭 CP Pharmaceuticals Ltd (manufacturer)

🥛 contains lactose

  25  PL 29831/0130

➖➖➖➖➖➖➖➖➖➖➖➖➖➖

🔹 – identifies marketing authorisation holder.

🔸 – identifies ‘own label supplier’ products.

🏭 – identifies manufacturers (where known).

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

—————————————————————

Numbers refer to tablet dosages in micrograms.

Only products which definitely contain lactose are identified (🥛 contains lactose). Please check other products. Where products are ‘own label supplier’, check the marketing authorisation holder.

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

healthunlocked.com/user/hel...

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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/6h3h0qi4eqwi6...

[NWA6 in reply to helvella]

They’d only give me Teva for 25mcg tabs. That’s when I switched to the 50’s and just worked out my weekly intake rather than daily.

[helvella Administrator in reply to NWA6]

It depends on the pharmacy.

My current pharmacy claims by default to supply Accord for 50 and 100 microgram tablets (whether packaged as Accord, Actavis or Almus) and Mercury Pharma for 25 microgram tablets.

[Batty1]

¼ Grain2.25 mcg9.5 mcg

½ Grain4.5 mcg19 mcg

1 Grain9 mcg38 mcg

1½ Grain13.5 mcg57 mcg

2 Grain18 mcg76 mcg

3 Grain27 mcg114 mcg

4 Grain36 mcg152 mcg

5 Grain45 mcg190 mcg

Armour® Thyroid tablets

2 grains of AT contains 76mcg T4 and 18mcg T3 (your only taking 13mcg T3) So your actually taking less T3. I think it would be in your best interest to do a private blood test like SD suggested and then post your lab results here and you will get plenty of answers.

Were you diagnosed with Hasimotos disease or something else?

[Shredder in reply to Batty1]

Thank you for your reply. I had radio iodine treatment for Graves.

[NWA6 in reply to Shredder]

So your thyroid is probably dead and you need T3 and Levo combo. And considering your weight 2 grains probably isn’t enough.

[Shredder in reply to NWA6]

I bought W.P thyroid when it appeared again but took three and a half grains but sadly that, like all NDT has gone majorly South. I have spent hundreds over the last few months on NDT that simply and unfortunately has changed snd doesn't work for many now.