Hi, i think I'm experiencing a reaction to levothyroxine.
4 weeks ago I was feeling fine on 50mcg (Accord) Northstar, I had my routine yearly blood test which showed TSH 9.8 so GP increased me to 75mcg with an additional 25mcg tablet, from Northstar but inside is from TEVA. 3 weeks in taking them and I feel horrible, heart skipping beat (palpations) hungry and gurgling tummy, heart rate normal but occasionally missing beat. Seems a coincidence!!
Has anyone else experienced anything like this?
There is a very long-running poll regarding Teva levothyroxine - here:
healthunlocked.com/thyroidu...
My thyroid hormone medicines document does highlight what product is in which packaging in the UK:
dropbox.com/s/shcwdwpedzr93...
I suggest you put in a Yellow Card report:
healthunlocked.com/thyroidu...
Then contact the pharmacy and explain. You might be lucky - they could offer Wockhardt or Mercury Pharma 25 microgram tablets as a replacement.
Or contact your GP and request you prescription be written for 50 microgram tablets and split them.
I've read about TEVA levothyroxine issues, checked my new prescription and it had TEVA in. I've been fine for a year on accord now feel terrible after taking the additional 25mcg. Rang GP who said couldn't be the levothyroxine and sent me for ECG which waiting for results. I am going to suggest sticking to the 5mcg and splitting them to make up the dose, I stopped taking the Teva 4 days ago but still feel horrible, how long before it goes if that is the issue? Any advice appreciated
On the basis that doctors everywhere are insisting their treatment of patients is, and should/must be evidence-based, what evidence does your GP have that it COULDN'T BE the levothyroxine?
Your experience is your experience. Your GP needs to provide a sensible alternative cause if they insist it is not the levothyroxine. Then prove it.
GP’s frequently deny it’s the brand..... it usually is
Accord don’t make 25mcg tablets
Many people find Levothyroxine brands are not interchangeable.
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
But for some people (usually if lactose intolerant, Teva is by far the best option)
Teva, Aristo and Glenmark are the only lactose free tablets
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but beware 25mcg Northstar is Teva
List of different brands available in U.K.
thyroiduk.org/medications-f...
Teva poll
healthunlocked.com/thyroidu...
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.
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)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
How long have you been left on 50mcg levothyroxine
This is only a starter dose
Likely to need further increase in levothyroxine over coming months
Essential to test vitamin D, folate, ferritin and B12 too
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
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)
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 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...
NHS easy postal kit vitamin D test £29 via
I've been on 50mcg for just over a year when I was first diagnosed 8weeks later I had follow up test which was ok. Then 4 weeks ago I contacted them for yearly check up. I felt fine before seems a coincidence that they give me Teva and now I feel terrible, anxiety bad tummy for sure lots of noise's!
He said the test showed me at 9.8 and I need to be below 4 so I do need a bit more. Didn't realize I was getting a different brand as they both come in Northstar boxes but 25mcg tablet is bigger than the 50mcg from accord
What were thyroid results after 8 weeks on 50mcg levothyroxine
On levothyroxine TSH should ALWAYS be under 2 as absolute maximum
Most people when adequately treated will have TSH well under one
If GP thinks TSH of 4 is ok you need new GP or see recommended endocrinologist
Having been left extremely under medicated for year you may need to increase levothyroxine dose slowly
Dose is increased slowly upwards in 25mcg steps, retesting 6-8 weeks after each dose increase
Likely to have low vitamin levels as direct result of being under medicated
gponline.com/endocrinology-...
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine
Note that it says test should be in morning BEFORE taking levothyroxine
Also to test vitamin D, folate, B12 and ferritin
sps.nhs.uk/wp-content/uploa...
Aim is to bring a TSH under 2.5
UK guidance suggests aiming for a TSH of 0.5–2.5
gp-update.co.uk/SM4/Mutable...
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance.
But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
(That’s Ft3 at 58% minimum through range)
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor
please email Dionne at
tukadmin@thyroiduk.org
guidelines on dose levothyroxine by weight
Even if we frequently 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
Ask GP to test vitamin D, folate, ferritin and B12 levels NOW
Plus thyroid antibodies if not had these tested yet
About 90% of primary hypothyroidism is caused by autoimmune thyroid disease also called Hashimoto’s diagnosed by high thyroid antibodies
Retest thyroid levels 6-8 weeks after each dose change or brand change in levothyroxine
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)
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 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...
NHS easy postal kit vitamin D test £29 via
I'm going to ring gp again to discuss, original was not helpful problem is I get different one each time I go!! I'll speak to pharmacy too about taking Teva off my supply. Many thanks for the advice
After being left too long on low dose it’s likely you need to increase dose SLOWLY upwards in 25mcg steps
Most GP’s pretty clueless on how to manage hypothyroidism, despite levothyroxine being 2nd or 3rd most prescribed medication in U.K. and almost 2 million people in U.K. on levothyroxine
Yes Northstar 25mcg catches many many people unawares
Outrageous really that it’s allowed
Wholeheartedly agree that it should not be allowed.
However, the issue of some tablets being different has been around since the introduction of 25 microgram tablets. (The change in potency of levothyroxine in 1980 was one reason for at least one make of them to be launched.)
I have never taken Teva (not in the UK) but took Euthyrox for years without problems until they reformulated it to include mannitol (just like Teva). I felt horrible and went downhill on the reformulated version. Once I was switched to a different brand symptoms resolved. So yes, the brand can be the problem. Mannitol seems to cause a lot of problems to many people
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