Levothyroxine Side effects

[Coop20]

How long after starting levo for the very first time did people start to get slight side effects and do they last long?

I’ve been started on just 25mg

[SlowDragon Administrator]

Standard starter dose of levothyroxine is 50mcg

Which brand of levothyroxine have you got?

Many people can’t tolerate Teva levothyroxine

Starting on too low a dose can also cause symptoms

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. 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...

Have you had vitamin D,folate, ferritin and B12 tested at all ...or recently

What vitamin supplements are you currently taking?

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)

[Katrina999666]

If you are on Teva I too suffered side effects on Teva 25mgs changed over to Mercury Pharma and they resolved.

[SlowDragon Administrator]

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

Aim is to increase levothyroxine dose up in 25mcg steps (retesting 6-8 weeks after each increase) ...increased as fast as tolerated, until, for vast majority of people, on full replacement dose

Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.

RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

[Coop20]

It is TEVA I’m on, it only the second day taking it so i wasn’t sure if it would kick in this soon.

[Katrina999666]

I persevered for 6 weeks then when my next prescription was due I asked the pharmacist to source Mercury Pharma for me after reading many posts on here regarding Teva. If you put it into the search bar you will be able to read up on issues people have had when prescribed Teva it has a bulking agent Mannitol which doesn't agree with some people.

[Coop20 in reply to Katrina999666]

Ok thankyou, i guess i will see how i go over the next few days / weeks!