Struggling to get settled on Levothyroxine

[London3891]

Hi there,

This is my first post, but I’ve been reading comments on the community for a couple of months and have found it an immensely useful resource - so thank you!

I’m hoping to get a bit of advice from people on my options regarding Levothyroxine / alternatives.

I was diagnosed with sub-clinical hypothyroidism (with raised antibodies) in March this year. My GP was unwilling to treat me until my T4 dropped below the ‘normal range', despite my having symptoms (severe constipation, hair loss and thinning, mild weight gain, tiredness, and tingling fingers and toes). These were my results:

March:

TSH 5.34 (0.30-5.00) (retested in July: 8.3 and October: 8.5)

T4 9.7 (9.00-19.00) (retested in July: 10.7 and October: 12)

T3 3.6 (3.25-6.21) (retested in October: 2.38)

Thyroid Peroxidase Antibodies 119.4 (00.00-6.00)

B12 535 (200.00-1000.00)

Folate 7 (4.00-18.00)

Ferritin 53 (9.00-120.00)

Apparently my Vit D is "excellent" but I don't have the test results to hand

I have also suffered from IBS for around 10 years.

In August I got a private referral to an endocrinologist who said I would feel much better on Levothyroxine and prescribed 50mcg daily. I started on Teva and almost immediately felt more energetic and my constipation disappeared. However, after a few days I started to suffer from what I thought was worsening IBS (abdominal bloating, pain, fatigue) as well as getting a nasty bitter taste in my mouth and my tongue developing a yellow/blue coating. The oral symptoms subsided, but the ‘IBS’ persisted and the endo told me to stop taking the Teva (and said the brand was notorious for side effects).

I had a lovely couple of medication-free weeks with next to no IBS symptoms while still feeling energetic (the endo thinks this was the lasting effects of the levothyroxine without the unpleasant side-effects of the binders in the tablets). The bouncy feeling eventually wore off though and so I started again with 50mcg Actavis / Accord. I was hopeful about Actavis since it doesn’t contain mannitol, which is one of the known triggers of IBS and one of the binders in Teva. I felt great initially, but on day 4 I developed a sweet taste in my mouth, the yellow tongue coating returned (although not as dramatically as on Teva) and the abdominal discomfort set in. I have now been taking Actavis for 15 days and am experiencing fairly continual bloating, wind, discomfort and mucus in my stool. During this time I have been following the low-FODMAP diet (designed to eliminate IBS triggers, no lactose, no gluten etc. ) so I’m convinced that my symptoms are a reaction to the levothyroxine rather than simply IBS. I’m confused though about what could be causing them. I know lactose is one of the fillers used in Actavis, but from what I can gather, it’s present in such tiny quantities that you’d need to have a very severe lactose-intolerance to be bothered (and until recently I was regularly consuming milk so don’t think this can be the case for me).

My endo is looking into solid levothyroxine options that are free from mannitol, lactose and gluten, but as I haven’t been able to pinpoint what might be causing the reaction, I’m feeling less optimistic that I’ll find a medication I can get on with. The endo says the next step would be liquid thyroxine, but I’m interested in others’ views on whether a liquid form is likely to fix the gastro issues, or whether I should be asking for something else (NDT, T3…?), or whether I should stick with the Actavis and see if the symptoms improve.

Sorry this is such a long post! I’m struggling to unpick the different issues and wanted to give as much detail as possible.

Thanks very much in advance for any suggestions!

R

[Nanaedake]

You made a lot of changes at once, ie different diet and levo brand. Also stopping and starting levothyroxine. This makes it difficult to determine what is unsettling your digestive system. It can take 5 or 6 months on levothyroxine to get to the right dose.. Most people feel better when TSH is around 1 and FT3 and FT4 in the upper end of the lab range. Your Ferritin level is a little low. Generally said to be better above 70. Have you had a full iron panel done? Folate is on the low side, best in double figures. You really need to get hold of vit D result too.

[London3891 in reply to Nanaedake]

Thanks for your reply, Nanaedake! Definitely agree, the timing is less than ideal with the low-FODMAP diet and starting Levothyroxine. I think I had a false impression of how starting Levo was ‘something and nothing’ after the endo reassured me that it was well tolerated by practically everyone and would slot unnoticed into my life...

The thing about the diet is that it’s designed to reduce intake of anything that could potential cause a gut flare up, so, now that I’m having trouble, I’m reluctant to revert to a normal diet as it will make it impossible for me to be sure about which symptoms are caused by the medication and what might just be the result of something I ate. I started the diet a couple of weeks before starting Actavis and felt very settled, so my suspicion is that what I'm experiencing is a malabsorption issue connected with something in the Actavis, rather than a diet issue. But does that sound right to you, or is this a symptom that can occur on starting Levo and then disappear? I know that to get hypothyroid symptoms under control might take many months, but I was under the impression that if symptoms are caused by not tolerating the binders in the medication, this is something that won’t settle and it’s better to stop and try something else…is that right?

I did have iron panels done in March:

Serum transferrin 3.19 (2.00-3.20)

Serum ferritin 53 (9.00-120.00)

Serum iron level 25 (12.00-28.00)

Serum TIBC 80 (45.00-80.00)

Saturation iron binding capacity 31% (15.00-50.00%)

And I’ll try to get hold of more recent ones as well as Vit D. My endo did offer to prescribe iron but (ironically) I said I'd wait to see how I got on with the Levo to avoid changing too much at once 😂

Many thanks again!

[Nanaedake in reply to London3891]

I can only speak from my experience that you'll need to get onto the right dose of levothyroxine before you will know whether symptoms are just the adjustment phase or something actually in the levothyroxine. Retest every 6 weeks and adjust dose until TSH is around 1 and FT4 and FT3 in the upper range. This can take a few months. After that symptoms should settle down but symptoms often lag behind changes by 6 to 8 weeks. It takes 6 to 8 weeks for levothyroxine to get into all your cells so the process is slow and dose adjustment does not bring an instant effect. Actavis is generally well tolerated so I think you need more time to get the dose right and adjust. If you have a known intolerance to one of the ingredients then if course you should switch. Otherwise you may impede or complicate the process.

Are you taking other medications or vitamins as you need to think about interactions.

The symptoms you had before you started levothyroxine may not all be due to thyroid since many symptoms are the same in other conditions. Therefore you need to focus on adjusting according to blood tests in the first instance and keep an open mind about symptoms.

If you have coexisting conditions or are taking medication other than levothyroxine, symptoms can be due to side effects of medicines.

Your TSH was only just slightly elevated before you started on levothyroxine so my guess is that symptoms could be partly due to other problems and if so, they won't clear up simply by taking levothyroxine. You do have elevated Thyroid Antibodies showing that you have thyroid autoimmune disease known as Hashimotos thyroiditis. Therefore starting on levothyroxine is sensible. You can read about Hashimotos on Thyroid UKs website.

[London3891 in reply to Nanaedake]

Thank you, Nanaedake.

I’m not taking any other medication or vitamins except the contraceptive pill (which I’ve been taking for 15 years) which the endo doesn’t think will be interfering with the Levothyroxine.

I’ll focus on getting the dose right to get my levels where they need to be and see if this makes a difference. I must say, I’m not relishing the idea of many more weeks of GI symptoms though!

[tattybogle]

Digestive issues aside , it seems pretty obvious that your dose of thyroid Hormone needs increasing , your TSH has gone up since starting ( Thyroid Stimulating Hormone is a signal from the pituitary to the thyroid to ask for more hormone )

And even though your FT4 (the storage/ transport form ) has risen a bit , it's still only 30 % of the way through the range , your FT3 (the active hormone ) has dropped from crawling along the bottom of the range , to falling through the floor.

So according to your October blood results you are in a worse position than you were in march.

But i notice you've had a couple of weeks off , and have only been on actavis 50mcg for 15 days. So this would impact your TSH reading as you need t be on stable dose for 6 weeks before TSH tells you anything.

Had you been on 50mcg consistently for 6 weeks before the July test where TSH was also at 8.3 ? if so then this definitely indicated you needed an increase in dose and /or that you were not absorbing enough of the dose you were taking.

50mcg is unlikely to be enough. it's just the recommended starting dose.

[London3891 in reply to tattybogle]

Thank you, tattybogle. And sorry, I should have been clearer on the chronology!

I was first diagnosed in March with the results in my initial post. The GP wouldn’t treat me, but I was retested in July just to monitor (this is when my TSH reached 8.3).

I first saw the endocrinologist in August and started on 50mcg of Teva which I took for 5 weeks in total. I had blood tests a couple of weeks into the treatment which showed my TSH had dropped to 1.97 and my T4 was at 13.8. Unfortunately I was having such a bad time on the Teva that the endo said I should stop. I took a break for 4 weeks and the GI symptoms disappeared.

At the end of the 4 week break, I had new blood tests which are the October figures you refer to. It was after these tests that I restarted Levothyroxine (Actavis) - I think the rationale for my endo starting again with just 50mcg was to begin slowly in case the GI symptoms returned...which they have 😞 My fear is that long-term I will be forced to choose between being sufficiently treated for hypothyroidism and having a happy gut.

[Roadrunnergreg]

Hiya bee reading the posts, I'd bet your root cause us low stomach acid, digestive enzymes and leaky gut, that's allowed for a systemic overgrowth of candida or EBV or another critter, if you don't know you need to identify and kill it off, once that happens your thyroid should stabilise and antibodies normalise. Having an irratic thyroid is a symptom of the critter being in the thyroid, the white coating on the tongue suggests systemic candida overgrowth too

The bloating and ibs ties back to low stomach acid and leaky gut, to heal the gut L-Glutamine@5grams/1tsp for a month in 8oz water or juice should heal the gut lining, to raise stomach acid supplement with BetaineHCL with peosin start at 3tablets per meal, and increase by 1 tablet per meal until. You feel a mild burn, then back off 1tablet per meal. Also use a digestive enzymes supplement with ox bile in if you suffer with digesting protein and the lactase should resolve lactose intolerance, true allergies we are born with...

As for diet use a low glycemic diet with a 55 or below on the glycemic scale, with fruits like blueberries strawberries in that also help kill the candida, the BetaineHCL should kill off candida overgrowth in the gut, and nutrient levels like iron and foliate should rise too because of increased absorption.

Hope that helps...

[London3891 in reply to Roadrunnergreg]

Hi Roadrunnergreg, and thanks for your message! This is interesting, I never knew that digestive issues could actually be a cause of hypothyroidism.

Has anyone else had experiences of thyroid correcting itself after digestive issues were addressed?

In my case, my IBS was well controlled with the low-FODMAP diet before I started taking Levothyroxine, so I can’t help but connect the two. When I took a break from Teva for a few weeks, my symptoms went away, and then came back with the new medication (Actavis). I also had an ENT consultant look at my tongue and throat and she ruled out candida or other infection and suspects a reaction to the medication.

My symptoms have definitely been slowly improving as I get used to the latest medication (Accord) but, ideally, if I am going to be taking it long-term, I want to get rid of all the side effects.

[vocalEK]

the endo told me to stop taking the Teva (and said the brand was notorious for side effects).

Ahem! Then why, pray tell, does he prescribe it?

[helvella Administrator Thyroid UK in reply to vocalEK]

Almost certainly, he doesn't - as such.

He probably writes a prescription saying "Levothyroxine" - it is almost universally generically prescribed in the UK.

Then the pharmacy dispensed Teva product against that prescription.

The prescriber (whether the consultant or a GP) can, technically, prescribe a specific branded product. But how on earth would they know which of the several available would be best for the patient as they are new to levothyroxine?

There are some who do better on Teva than any other product.

Once a satisfactory product has been found, it is probably still best to ask the pharmacy to supply that rather than raise the problems which can occur when a specific brand is prescribed.

[Roadrunnergreg in reply to vocalEK]

Part of the problem is the inactive ingredients, most are gluten related in my brand, if your gluten intolerant that's what'slikely causing the side effects, same as some meds contain SLS (sodium lauryl sulphate) which is a notorious inflammatory agent... but yes need to look up the inactive ingredients, I'm sure they put some in to promote a need for other medications like anti-inflammatory or not optimising levels for the same reasons, anti-inflammatory and antidepressants etc

[helvella Administrator Thyroid UK]

Lactose intolerance, when an ingredient of levothyroxine tablets, seems far, far worse than the small amount of lactose would be expected to cause. No-one seems to have produced a good explanation.

Some people do better on liquid levothyroxine but, as it is much more expensive, many are refused.

My documented list of levothyroxine products lists which have lactose and (so far as I can) how much:

UK Levothyroxine Tablets

➖➖➖➖➖➖➖➖➖➖➖➖➖➖

Last updated 13/09/2020.

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 (marketing authorisation holder) – formerly Actavis

🏭 Accord-UK (manufacturer)

🥛 contains lactose – 39.95mg in 50 microgram tablet, 54.90mg in 100 microgram tablet

  50 microgram  PL 0142/0104

  100 microgram  PL 0142/0105

🟢 50 microgram and 100 microgram PIL: mhraproducts4853.blob.core....

🟣 50 microgram SPC: mhraproducts4853.blob.core....

🟣 100 microgram SPC: mhraproducts4853.blob.core....

—————————————————————

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

🏭 Custom Pharmaceuticals Ltd. (manufacturer)

🥛 contains lactose – 30.49mg in 25 microgram tablet, 48.86mg in 50 and 100 microgram tablets

  25 microgram  PL 12762/0016 5.5mm diameter

  50 microgram  PL 10972/0031

  100 microgram  PL 10972/0032

🟢 Eltroxin 25 microgram PIL: mhraproducts4853.blob.core....

🟢 Eltroxin 50 & 100 microgram PIL: mhraproducts4853.blob.core....

🟢 Levothyroxine 25 microgram PIL: mhraproducts4853.blob.core....

🟢 Levothyroxine 50 & 100 microgram PIL: mhraproducts4853.blob.core....

🟣 Eltroxin and Levothyroxine 25 microgram SPC: mhraproducts4853.blob.core....

🟣 Eltroxin and Levothyroxine 50 microgram SPC: mhraproducts4853.blob.core....

🟣 Eltroxin and Levothyroxine 100 microgram SPC: mhraproducts4853.blob.core....

—————————————————————

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

  50 microgram – This is repackaged Accord – formerly Actavis.

  100 microgram – This is repackaged Accord – formerly Actavis.

—————————————————————

🔹 Aristo (marketing authorisation holder)

🏭 Aristo Pharma GmbH (manufacturer)

No lactose ingredient

  100 microgram  PL 40546-0159

🟢 PIL: mhraproducts4853.blob.core....

🟣 SPC: mhraproducts4853.blob.core....

—————————————————————

🔹 Glenmark (marketing authorisation holder)

Note: This product may not currently be dispensed.

🏭 Glenmark Pharmaceuticals Europe Limited (manufacturer)

No lactose ingredient

  25 microgram  PL 25258/0293

  50 microgram  PL 25258/0294

  100 microgram  PL 25258/0295

🟢 PIL: mhraproducts4853.blob.core....

🟣 25 microgram SPC: mhraproducts4853.blob.core....

🟣 50 microgram SPC: mhraproducts4853.blob.core....

🟣 100 microgram SPC: mhraproducts4853.blob.core....

—————————————————————

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

  25 microgram – This is repackaged Teva. ❗

  50 microgram – This is repackaged Accord – formerly Actavis. ❗

  100 microgram – This is repackaged Accord – formerly Actavis. ❗

—————————————————————

🔹 Teva (marketing authorisation holder)

🏭 PLIVA Croatia Ltd (manufacturer)

No lactose ingredient

  12.5 microgram  PL 00289/1971

  25 microgram  PL 00289/1972

  50 microgram  PL 00289/0038

  75 microgram  PL 00289/1973

  100 microgram  PL 00289/0039

🟢 12.5 and 50 microgram PIL: mhraproducts4853.blob.core....

🟢 25, 75 and 100 microgram PIL: mhraproducts4853.blob.core....

🟣 12.5 microgram SPC: mhraproducts4853.blob.core....

🟣 25 microgram SPC: mhraproducts4853.blob.core....

🟣 50 microgram SPC: mhraproducts4853.blob.core....

🟣 75 microgram SPC: mhraproducts4853.blob.core....

🟣 100 microgram SPC: mhraproducts4853.blob.core....

—————————————————————

🔹 Wockhardt (marketing authorisation holder)

🏭 CP Pharmaceuticals Ltd (manufacturer)

🥛 contains lactose

  25 microgram  PL 29831/0130

🟢 PIL: mhraproducts4853.blob.core....

🟣 SPC: mhraproducts4853.blob.core....

➖➖➖➖➖➖➖➖➖➖➖➖➖➖

🔹 – identifies marketing authorisation holder

🔸 – identifies ‘own label supplier’ products

🏭 – identifies manufacturers (where known)

🥛 – contains lactose

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

🟢 PIL – Patient Information Leaflet

🟣 SPC – Summary of Product Characteristics document

🟢🟣 Single document combining typical PIL and SPC information

—————————————————————

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

There are links to product information on the MHRA (Medicines and Healthcare products Regulatory Agency) website. products.mhra.gov.uk/ These are the latest versions known.

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

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/6h3h0qi4eqwi6...

The PDF version of this document has QR code above this sentence. If your device has a camera and can interpret QR codes, this QR code should take you to the same place as the link and make it easier to download on devices, such as phones and tablets.

[London3891 in reply to helvella]

helvella, thanks for all the information – your list is an incredibly useful resource which I’ve made use of in conversations with my endocrinologist.

Can I ask you about liquid thyroxine please? My endo is suggesting this for me as the next step, as it’s purer and doesn’t have the fillers that seem to be problematic for some people. However, my concern with liquid is that you’re relying on the pharmacist to make it up correctly each time, and it seems that there’s quite a bit of scope for stuff to go wrong. This paper (US not UK) seems to suggest that accuracy of dosing is likely to vary considerably, and that the potency of the medication declines significantly over time:

sciencedirect.com/science/a...

If this is the case, it seems like a less stable treatment than pills. What do you think?

Thank you!

[helvella Administrator Thyroid UK in reply to London3891]

No - the pharmacist doesn't make it up to order.

It is a factory-produced product made to tight standards.

That paper is fascinating. Looks to me like they used techniques which no-one should be using! (And it reports that one compounding pharmacy supplied a solution of liothyronine instead of levothyroxine!!!)

Until a few years ago, the poor solubility of levothyroxine made solutions effectively impossible. Indeed the paper refers to suspensions rather than solutions.

The development which made solutions possible was a process whereby the levothyroxine is dissolved in an alkaline solution. (Levothyroxine has long been known to be far more soluble in an alkali than an acidic or neutral solution.)

Then they mix the levothyroxine solution with glycerol. Finally, they add an acid to neutralise the solution. Remarkably, the levothyroxine remains in solution.

(Tirosint Sol, mentioned in the paper, might not be made in exactly this way.)

This is a thoroughly tested process. Levothyroxine oral solutions have been approved many times over.

Given the results reported, they do have a case that levothyroxine suspensions made as described should not be allowed.

[London3891 in reply to helvella]

Aha - that is greatly reassuring - thanks very much helvella! (I really wasn't loving the idea of hoping for the best each time I collected my prescription!)

Given this, I'm definitely inclined to give the liquid solutions a try. I can see that there's a little bit of variety in the ingredients lists for the ones available in the UK : thyroiduk.org/medications-f...

I can't see any of the ingredients that seem to be behind many of the issues people have with the sold form (like lactose, gluten, mannitol etc.) but, I don't know whether things like glycerol, citric acid monohydrate, propylene glycol, maltitol liquid can also be potential triggers for adverse reactions.

From your experience, are there any ingredients in the liquid solutions that are best avoided? Or any solutions that are known to be well tolerated? I have no idea if I will have the opportunity to request a particular brand, but, if I can, I'd like to be informed.

Thanks once again - I massively appreciate the information and support you and others on this forum provide!

[helvella Administrator Thyroid UK in reply to London3891]

I have no personal experience.

A few people seem unable to tolerate glycerol in the quantities used.

Things like citric acid monohydrate will no longer exist in that form - it is used to neutralise the alkaline solution.

With a few exceptions, no UK medicines contain gluten.

The oral solutions do vary a little.

UK Levothyroxine Oral Solutions

➖➖➖➖➖➖➖➖➖➖➖➖➖➖

Last updated 17/09/2020.

This is a list of currently marketed levothyroxine oral solutions 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.

—————————————————————

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

🏭 manufactured by FAMAR Netherlands BV

🧪 Solution in glycerol and water in multidose bottle

  25 micrograms per 5ml  PL 12762/0459

  50 micrograms per 5ml  PL 12762/0461

  100 micrograms per 5ml  PL 12762/0462

🟢 PIL 25, 50 & 100 mhraproducts4853.blob.core....

🟣 SPC 25 mhraproducts4853.blob.core....

🟣 SPC 50 mhraproducts4853.blob.core....

🟣 SPC 100 mhraproducts4853.blob.core....

—————————————————————

🔹 Creo (marketing authorisation holder)

🏭 manufactured by Quantum Pharmaceutical Limited

🧪 Solution in glycerol and water in multidose bottle

  25 micrograms/5ml  PL 31862/0035

  50 micrograms/5ml  PL 31862/0036

  100 micrograms/5ml  PL 31862/0037

  125 micrograms/5ml  PL 31862/0038

🟢 PIL 25, 50, 100 & 125 mhraproducts4853.blob.core....

🟣 SPC 25 mhraproducts4853.blob.core....

🟣 SPC 50 mhraproducts4853.blob.core....

🟣 SPC 100 mhraproducts4853.blob.core....

🟣 SPC 125 mhraproducts4853.blob.core....

—————————————————————

🔹 Ten Pharma (marketing authorisation holder)

🏭 manufactured by BCM Limited

🧪 Solution in glycerol and water in multidose bottle

  25 micrograms/5ml  PL 34777/0003

  50 micrograms/5ml  PL34777/0004

  100 micrograms/5ml  PL34777/0005

🟢 PIL 25 mhraproducts4853.blob.core....

🟢 PIL 50 mhraproducts4853.blob.core....

🟢 PIL 100 mhraproducts4853.blob.core....

🟣 SPC 25 mhraproducts4853.blob.core....

🟣 SPC 50 mhraproducts4853.blob.core....

🟣 SPC 100 mhraproducts4853.blob.core....

—————————————————————

🔹 Teva (marketing authorisation holder)

🏭 manufactured by Delpharm Bladel B.V., The Netherlands

🧪 Solution in glycerol and water in multidose bottle

  25 micrograms/5ml  PL 00289/1593

  50 micrograms/5ml  PL 00289/1594

  100 micrograms/5ml  PL 00289/1595

🟢 PIL 25, 50 & 100 mhraproducts4853.blob.core....

🟣 SPC 25 mhraproducts4853.blob.core....

🟣 SPC 50 mhraproducts4853.blob.core....

🟣 SPC 100 mhraproducts4853.blob.core....

—————————————————————

🔹 Wockhardt (marketing authorisation holder)

🏭 manufactured by CP Pharmaceuticals Ltd

🧪 Solution in glycerol and water in multidose bottle

  25 micrograms/5ml  PL 29831/0493

  50 micrograms/5ml  PL 29831/0494

  100 micrograms/5ml  PL 29831/0495

🟢 PIL 25, 50 & 100 mhraproducts4853.blob.core....

🟣 SPC 25 mhraproducts4853.blob.core....

🟣 SPC 50 mhraproducts4853.blob.core....

🟣 SPC 100 mhraproducts4853.blob.core....

—————————————————————

Non-UK Levothyroxine Oral Solutions

🔹 IBSA (marketing authorisation holder) – branded Tirosint Sol

🏭 manufactured by IBSA Institut Biochimique SA, Switzerland

🧪 Solution in glycerol and water in single-dose ampules

Details below are from the USA.

  13 microgram/mL  NDC 71858-0105-5

  25 microgram/mL  NDC 71858-0110-5

  50 microgram/mL  NDC 71858-0115-5

  75 microgram/mL  NDC 71858-0120-5

  88 microgram/mL  NDC 71858-0125-5

  100 microgram/mL  NDC 71858-0130-5

  112 microgram/mL  NDC 71858-0135-5

  125 microgram/mL  NDC 71858-0140-5

  137 microgram/mL  NDC 71858-0145-5

  150 microgram/mL  NDC 71858-0150-5

  175 microgram/mL  NDC 71858-0155-5

  200 microgram/mL  NDC 71858-0160-5

🟢🟣 dailymed.nlm.nih.gov/dailym...

—————————————————————

🔹 SERB (marketing authorisation holder) – branded L-THYROXINE SERB

🏭 manufactured by SERB, PARIS, FRANCE

🧪 Solution in ethanol (alcohol) in multidose bottle

  150 microgrammes/ml

🟢 base-donnees-publique.medic... (in French)

➖➖➖➖➖➖➖➖➖➖➖➖➖➖

🔹 – identifies marketing authorisation holder (or equivalent in other countries)

🔸 – identifies ‘own label supplier’ products

🏭 – identifies manufacturers (where known)

🧪 – primary solvent(s)

🟢 PIL – Patient Information Leaflet

🟣 SPC – Summary of Product Characteristics document

🟢🟣 – Single document combining typical PIL and SPC information

—————————————————————

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

healthunlocked.com/user/hel...

➖➖➖➖➖➖➖➖➖➖➖➖➖➖

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[London3891 in reply to helvella]

Many thanks, helvella! I will see what I can get hold of 👍

[Roadrunnergreg]

Sorry my bad, I did a fair bit of reading and replying yesterday, and replied as I thought you had high levels of antibodies, and maybe you don't. But as stated most all gut issues tend to stem from low stomach acid, low digestive enzymes, and low fibre and leaky gut from the previous dietary habits. Hope this is more relevant for you....