Side effects levothyroxine

[Meadowpark]

Has anyone had stomach problems since being on levothyroxine ?

[Hibs1]

Yes definitely. Not sure if the actual levo or other ingredients. I'm taking accord which is better than rest, as the others have acacia in them. I don't do I well on meds in general. Severe bloating in the morning and loose stools and bloating contues. I also get pains at night towards time due to take it. Roughly between 4 and 5 am. The more I've taken the worse it is.

[SlowDragon Administrator]

Extremely common, especially when under medicated

How much levothyroxine are you currently taking

When was dose last increased

What are your most recent thyroid results and ranges

Are you currently taking any vitamin supplements

Have you had vitamin D, folate, ferritin and B12 tested

When under medicated and hypothyroid patients frequently have low stomach acid, acid reflux and bloating

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

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)

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 vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

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

monitormyhealth.org.uk/thyr...

[Meadowpark in reply to SlowDragon]

100 mg haven’t had a blood test since before lockdown but am sick quite regularly and always feel sick only started once I was diagnosed in 2018

[SlowDragon Administrator in reply to Meadowpark]

Recommend you get full thyroid and vitamin testing done ASAP

Which brand of levothyroxine are you currently taking

Is it usually this brand?

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

Are you currently taking Teva?

Teva, Aristo and Glenmark 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)

[SlowDragon Administrator]

guidelines on dose levothyroxine by weight

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...

[helvella Administrator]

As you are having issues, may I suggest a Yellow Card report?

healthunlocked.com/thyroidu...

[Anthea55]

Try taking levo with food. It won't be touching the walls for so long. May help.

Taking with food recommended by Kenneth Blanchard in his book 'The Functional Approach to Hypothyroidism'. Summarised by Dr Myhill in this link, section about timing of dosing.

drmyhill.co.uk/wiki/Thyroid...

A quote which I like from Kenneth Blanchard's book, he has a theory that

'thyroid hormone contacting the stomach wall has never occurred in the evolution of the human race until we started taking oral thyroid about a century ago'

Of course many people take their meds with food because nobody has told them otherwise.

Worth a try.

[milkwoman]

Yes. For me, it is the filler ingredients. I can only take name brand Tirosint. I have no issues with Tirosint.

[Eelaines]

Hi. The only problems I've had are when I've been over or under medicated. Then it could cause diarrhoea or constipation. Otherwise no real problems.

[Bookworm1961]

Hi Meadowpark

I have been on levothyroxine for 11 years highest dose was 75mg then found it was too much so my ideal dose for few years now is 75 mg one day then 50 mg next. I am on Accord 50mg and Wockhardt 25mg. My bloating loose stools and weight loss started about 3 years ago during am endo app I mentioned it and was asked to do a faecal elastase test which is giving a sample of poo in a small plastic container. I was diagnosed with virtually no stomach acid so even though I ate like a horse my body was starving as nothing being absorbed. I was placed with a gastroenterologist I had CT scan my pancreas was fine for some reason my body stopped producing much stomach acid probably linked to thyroid or aging I'm 59.I have been on a medication called Creon for over year with no meds side effects number 2 has improved I'm back at a healthy weight bloating has gone I do get occasional bit of gas but much better now.

You could ask your doctor to do you this test faecal elastase

[helvella Administrator]

Anyone in the UK who believes they are having issues with any medicine should consider making a Yellow Card report. I posted the other day:

healthunlocked.com/thyroidu...

[MitziMax]

You need to be on a brand one. its the excipients or filler they use that cause all the problems. I am on Eltroxin I sourced it for 150mg 2 months supply for £6.30 in a UK pharmacy site. Good luck

[helvella Administrator in reply to MitziMax]

Why is "a brand one" needed?

Indeed, in the UK context, what do you mean by "a brand one"?

[RedApple Administrator in reply to MitziMax]

MitziMax If you are in the UK and are getting your levothyroxine on NHS prescription, why are you paying a UK pharmacy for your Eltroxin?

[vickilou]

Yes i have constant problems with stomach issues, namely bloated and constipation normally when i am under medicated. But i have been finding that increasingly having more issues lately with food intolerance i have started taking a pro biotic drink in the morning, which seems to be helping. i was very deficient in vitamin D too, so taking capsules and seems to be working. I do wonder if i am allergic to some of the fillers they use in the levothyroxine and depends on which brand i get from the chemist. I have had hypothyroidism all my life and i am 57 now, its only really the last few years i have had so many issues.

[helvella Administrator in reply to vickilou]

Many of us feel better on some makes, and worse on others.

Possible the most commonly discussed issue is that so many feel bad on Teva levothyroxine. (Including me.) But some feel better on that than any other make.

Usual advice is to stick to one make, so far as possible, once you find one that you find OK.

[Tobernemo]

I have only recently been diagnosed and started levothyroxine at the end of may. Ok for about 5 weeks, then increasing and unpredictable bouts of stomach pain and vomiting. Although have had gastric problems For several years this was different. Came off the pills for 3 weeks and no trouble, resumed with half a dose (25mg) and within 24 hours acute pain and nausea as before. Have tried at least 3 different brands with same issues.Now believe it is the drug itself that I am not tolerating - has anyone else reacted to the drug (not excipients) in the same way?