Thyroxine; mixing of different brands

[Hamste]

Hi I am new to this forum and reading some of the posts am I right in thinking that it is best not to mix the different brands available? Currently I have teva, wockhardt uk and Mercury pharma: I frequently suffer from upset stomach and am now wondering if this is the reason? Any advice much appreciated

[SeasideSusie Remembering]

Hamste

Can you pinpoint the upset stomach to when you added one particular brand?

Some people can take any brand, mix and match them with no problem, but generally we tend to suggest that once you know a certain brand suits you then stick to it. I believe the guidelines now suggest retesting a few weeks after a brand change to see if it affects levels in any way.

[Hamste in reply to SeasideSusie]

No because I just keep taking the tablets without looking at the brand, but now I will! I have been on thyroxine for 15 years with few problems but Now I am armed with this knowledge I shall check frequently!

[SlowDragon Administrator]

Once you work out which brand suits you best, always get that brand at each prescription

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Recommend getting FULL thyroid and vitamin testing after 6-8 weeks on constant unchanging dose and brand of levothyroxine

How much levothyroxine are you currently taking

What vitamin supplements are you currently taking

Do you have Hashimoto’s?

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 at least annually

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.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/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

[Hamste in reply to SlowDragon]

Thanks for all this advice. I currently take 25mcg per day and have recently been tested for iron levels which have come back as normal. I did not ask for vitamin testing, I note the comments on blood tests so will do this next time.For the last 15 years I have had alopecia which is why I have ended up on thyroxine as my thyroid levels were under active; as far as I am aware I don’t have hashimotos. So how is hashimotos diagnosed? Is that a different blood test? I don’t take any supplements.

[Localhero in reply to Hamste]

25mcg a day of Levothyroxine? Have you been on this for 15 years? If so, it’s a very low amount and may be doing more harm than good. Which makes me wonder if your stomach issues and alopecia are symptoms of under medication.

As for Hashimotos, it’s the most common form of hypothyroidism. It’s an autoimmune condition caused by anti thyroid antibodies. Your doctor should be able to test for it. If not, one of the tests SlowDragon lists definitely will.

[Hamste in reply to Localhero]

Sorry I should have said that I started on 125 mcg 15 years ago and this has gradually decreased over the years to 50 mcg. Due to stomach issues I was advised by my gp in the last two weeks to take 25mcg for two weeks to see if it helps

[shaws Administrator in reply to Hamste]

Why does your GP think that your 'stomach issues' are due to thyroid hormone replacements of which 50mcg is a very small dose.

The following hint is from an expert (now deceased) on thyroid hormones.

Take one antihistamine tablet one hour before your dose of levothyroxine, and if this resolves your stomach problems, ask for another levo by another pharma company.

[Hamste in reply to shaws]

Not sure but thanks for the tip on antihistamine

[SlowDragon Administrator in reply to Hamste]

Good grief…standard STARTER dose levothyroxine is 50mcg and dose is increased slowly upwards in 25mcg steps until TSH is always under 2

Most important results are ALWAYS Ft3 followed by Ft4 and frequently TSH is well under one when adequately treated

Levothyroxine doesn’t top up failing thyroid, it replaces it, so it’s important to be on high enough dose

Will likely need to increase very slowly, having been left on tiny dose so long

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

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

Guidelines are just that ....guidelines.

Some people need more …..some need less

healthunlocked.com/thyroidu...

[SlowDragon Administrator in reply to Hamste]

About 90% of primary hypothyroidism is autoimmune thyroid disease also called Hashimoto’s (or Ord’s thyoiditis when no goitre)

20% of autoimmune thyroid patients never have high thyroid antibodies

If both TPO and TG antibodies are negative an ultrasound scan of thyroid can diagnose

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

[Rita-D]

I have issues with 2 brands of levothyroxine. Teva, I have IBS symptoms and Wockhardt makes me scratch until I have marks on my arms. I have reported both on the yellow card system and insist my pharmacy only gives me Mercury Pharma which I can tolerate. I always pick up my prescription from the GP surgery so that I can check that the pharmacy will dispense Mercury Pharma before I give them the prescription as they will not change it once it’s been dispensed.

I have a spreadsheet of all the medications that I take with all the excipients. I cannot identify what I am allergic to. Somethings I thought were the culprits are in other medication that I take. It makes me think that they don’t show all the excipients in the Patient information leaflet.

I know it’s definitely the excipients as I took an antihistamine from a well known supermarket and i was itchy all over - it was Wockhardt brand when I checked!

If I were you I would stick to Mercury Pharma and avoid Teva like the plague.

Good luck and I hope you get to the bottom of your issues.

[Hamste in reply to Rita-D]

Thankyou! If i wasn’t on this forum I would have had no idea about the pitfalls of mixing the brands.

[Rita-D in reply to Hamste]

I got a lot of very useful information on this forum which has really helped with managing my Hashimoto’s. The admins are so knowledgeable and everyone just wants to help. Good luck in sorting your symptoms out. xxx