MRHA change prescribing guidance for thyroxine

[haggisplant]

btf-thyroid.org/new-levothy...

As many of us have found before

[helvella Administrator Thyroid UK]

There have been a few posts directly quoting the MHRA.

Your link includes this statement:

BTF medical advisor, Dr Slamn Razvi said:

'Levothyroxine is one of the most commonly prescribed drugs in the UK. The vast majority of patients feel well on this medication. There are some, however, that appear to be sensitive to minor changes in dose or excipients (substances added to provide bulk, flavour or stability). The new guidance from the MHRA should be welcome news for those for whom switching between products may have an unfavourable impact. As levothyroxine is prescribed generically (by its chemical name) the challenge now would be for clinicians (who prescribe), pharmacists (who dispense), and patients (who consume) to be fully aware of this guidance.'

Bizarre that he provides a somewhat patronising explanation of the word excipients by including "flavour". Something not relevant for any levothyroxine tablet - at least in the UK!

[haggisplant in reply to helvella]

Sorry I hadn’t seen them. They got his name wrong too. I wonder if the oral solution is flavoured for children?

[helvella Administrator Thyroid UK in reply to haggisplant]

None that I have checked are. It is very sweet so doesn't really need flavour!

Apology NOT needed!

In case you or anyone else is interested in the other comments:

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

[haggisplant in reply to helvella]

I’m definitely v sensitive to slight changes.

My recent panicked confused post about results I now wonder is because I was using two 50’s for my 100 for ten days about a week before the test.

I’ve begun to theorise a sweet point where metabolism v half life is good but too much either way quickly tips me either way.

A friend is working with Dr S. They’re starting to look at the issues around treating hypothyroidism well. I think S Pearce is involved. (But don’t quote me!)

[helvella Administrator Thyroid UK in reply to haggisplant]

I agree!

Doctors have long been unwilling to consider dose change of less than 25 micrograms per day. I am absolutely certain I can tell a 12.5 microgram change easily enough.

With lots of additional technology coming to things like fitness bands and Apple Watches, hopefully something will eventually appear that in some way reflects thyroid hormone dosing.

Being out of kilter on dosing for pretty much a full year between annual TSH tests is crazy. It might be something transient, such as change of make, or diet, or weather, or exercise, or ...

[Nanaedake]

I agree, the method of levothyroxine dosing and testing is much too crude at present. I've recently found myself overdosed and I only increased by 15mcgs. I have to say that for me being overdosed is worse than underdosed. Blood tests didn't pick up the excess as still within NHS range since it doesn't test FT3 and FT4 alongside TSH.

It's often hard to recognise symptoms when they're developing because they are similar to other things like tiredness, stress etc.

I think a lot of people are far more sensitive than is supposed or than perhaps they realise?

I once had a doctor tell me that levothyroxine is a very tolerant medication which is not my experience. I would also question that assertion on the basis that it behaves like a low index drug - a small change makes a big difference.

Would be much better to have a regular way to monitor bloods and I agree that once a year testing is not enough.

[haggisplant in reply to Nanaedake]

Yes I agree it’s hard to recognise being over dosed as symptoms can be the same as under. There’s a particular shoulder and hip ache I experience I now recognise.

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Here we have a change being introduced to rightly benefit a relatively small number of patients but leaves those with the need to take NDT in limbo.