Thyroid Meds Advice

Recently changed from NDT back to T4 due to not being able to tolerate the T3 aspect of NDT. Due to intolerance testing stating gluten and lactose intolerant (which I kind of knew anyway) received Teva Levothyroxine. Had previously been taking Actavis before the NDT which gave me joint pain, so thought we would try the Teva. Have only been on it about a week and a half but keep getting crippling stomach pains and a numb chest pain. Could it be linked to the medication? And if so are there other lactose/gluten free medications available in the UK?

[SlowDragon Administrator]

How much levothyroxine are you currently taking

Results from previous post shows extremely hypothyroid

TSH 65.3 (0.27-4.2mlU/L

FT4 2.610 (12.0-22.0 pmol/L

FT3 1.45 (3.1-6.8 pmol/L)

FT4/FT3 1.8

Absolutely essential to test vitamin D, folate, ferritin and B12

Low iron can cause chest pain

What vitamin supplements are you currently taking

When were vitamin levels last tested

Teva, Aristo and Glenmark are lactose free tablets

Aristo and Glenmark not widely available

List of different brands available in U.K.

thyroiduk.org/medications-f...

Alternatively your endocrinologist could prescribe liquid levothyroxine

Many people who can’t tolerate levothyroxine tablets do well on liquid levothyroxine

[Hidden in reply to SlowDragon]

I am taking 100mg. It is Teva that I have recently changed to. The endocrinologist I see told me about six months ago, when I said I didn’t seem to be able to take any of the different things I had been advised , that perhaps it would be better to not take anything. Hence how I ended up with the results that you see.After changing GPS due to moving house they seem happy to work alongside but readily admit they don’t know an awful lot. They have recently in past couple of days redone blood tests (not got results yet) and I thought they were going to do Vitamin levels but when I got there the vitamin tests weren’t down on the form, and the dr was off for the week.

I thought the Teva might be the answer due to not being able to tolerate the gluten and lactose but am wondering if this might be the cause of the stomach problems......or if the stomach problems are due to everything being so messed up?

[SlowDragon Administrator in reply to Hidden]

Well you may simply need next dose increase in levothyroxine

Recommend you get FULL thyroid and vitamin testing done privately

Vitamins likely very low after being so hypothyroid, and they take long time to recover

What vitamin supplements are you currently taking

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 with Hashimoto’s and if under medicated

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)

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 antibodies and vitamins

medichecks.com/products/adv...

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 down to £26.10 if go on thyroid uk for code

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

monitormyhealth.org.uk/

Also vitamin D available as separate test via MMH

Or alternative Vitamin D NHS postal kit

vitamindtest.org.uk

[SlowDragon Administrator in reply to Hidden]

Roughly how much do you weigh in kilo

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 eventually on, or near 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.

Also here

cks.nice.org.uk/topics/hypo...

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

Do you normally take levothyroxine waking or bedtime?

[Hidden in reply to SlowDragon]

Also I take levo at about 4 in the morning. Vitamins . None really as get told so many things from different sources I would be there all day taking different vitamins? And different drs tell me different things? Also where most days I don't have much memory, thought process a lot of the time I don't know which route to believe.

It has been quite nice on the TEVA not to have the racing mind but that seems to be the only plus point.

[SlowDragon Administrator in reply to Hidden]

Strongly Recommend you get vitamin D, folate, ferritin and B12 levels tested

Either via GP or privately

[Kazbe in reply to Hidden]

Teva made me feel very off it

I’d change brand try mercury pharma if you can get it that worked for me better than any !

But I still have stomach issues I’m beginning to wonder if it’s levothyroxine itself I do feel better myself on NDT but like you I find it hard to get the right dose because of the T3 in it .

Hope you get some relief on a different

Brand

take care

Kazbe 😀

[helvella Administrator Thyroid UK]

The UK's Coeliac Society say this about gluten and medicines:

Medication

The vast majority of medicines prescribed by your GP are gluten free

A very small number of medicines contain wheat starch which contains low levels of gluten. Wheat starch is one of many ingredients so even when wheat starch is used, the overall gluten content of the medicine is very low

In most cases, an alternative medicinal product can be prescribed which does not contain wheat starch

Sometimes medications can cause side effects that are similar to symptoms that occur after eating gluten. Speak to your GP if you have any unexpected side effects

Where wheat starch has not been used in a medicinal product, the product can be regarded as gluten free.

coeliac.org.uk/information-...

Stomach pains from Teva levothyroxine have been reported by quite a number of members.

SlowDragon

[Hidden in reply to helvella]

Ok so I am roughly about 78kg at last weigh in. Weight has increased a lot for me. I'm not in any way saying to anyone else that 78kg is a lot. After the NDT I went back onto the Actavis brand but almost straight the way it seems to change moods and I start bleeding . I have not had periods for 7 years (I'm 44) apart from when I take Actavis. It also gives me a kidney type pain bit when I have adrenals (blood and saliva) tested they are normal.

I'm thoroughly confused as to whether I need to stick things out, or what the next step is? As you are probably aware I have lost all faith in medical channels tried. Including when I came off medication complete though I felt ok, the results read as above.

Also I would not recommend to anyone to stop their thyroid medication, to anyone reading this. It was just when I told the endo I felt better off it, and he said.... Maybe that's the answer.

I want to put out there to anyone who is reading this........it's not the answer.

And thank you slow dragon for your replies , as I say on a positive day I asked at the GPS for the blood tests, which in this set they will be including FT3. I just thought they were going to do the Vitamin tests as well.

[helvella Administrator Thyroid UK in reply to Hidden]

Are your kidneys OK? Do you have Glomerular Filtration Rate (GFR) results?

[Hidden in reply to helvella]

No I don't. I can ask if they have any at the surgery?

[helvella Administrator Thyroid UK in reply to Hidden]

It would be a good idea to get all your recent results printed - at least for months, preferably for a few years.

[Hidden in reply to helvella]

Ok. And how would I see if anything was out of kilter? Is it by looking at the result and then the range?

[helvella Administrator Thyroid UK in reply to Hidden]

Yes. GFR (sometimes eGFR) is one of the few tests which has a series of bands - something like from OK, though slightly low through to seriously low. The ranges vary a little but it is more standardised than many.

[Hidden in reply to helvella]

Thank you for your help. I just have no idea what is linked to what if that makes sense? And it gets to the point where you just feel like a pain. .... A pain that most of the doctors don't listen to. Yet as we all know on this forum it completely debilitates when it is out of kilter.

[SlowDragon Administrator in reply to Hidden]

So you likely need next dose increase in levothyroxine

78 x 1.6 = 124.8 mcg per day

Nice and easy .....125mcg levothyroxine per day likely to be near enough

I use to get terrible adrenal pain if under medicated

[Hidden in reply to SlowDragon]

And do you think stick with the Teva and the stomach pains etc or go back in to Actavis with other side effects? But not the excruciating stomach pains.

[SlowDragon Administrator in reply to Hidden]

Only ever change one thing at a time

How long have you been on 100mcg?

Bloods should be retested 6-8 weeks after each dose or brand change in levothyroxine

I would get full thyroid and vitamin testing done first before changing anything

[Hidden in reply to SlowDragon]

Ok. Thank you for your reply and your help. This community is a lifeline for many and the administrators seem to be an absolute encyclopedia. Thank you.

[helvella Administrator Thyroid UK in reply to Hidden]

We admins are just ordinary members who try to keep the forum going without bad things happening!

[Hidden in reply to helvella]

Thank you. Xx