Raise with adding NDT or stick to LEVO - Thyroid UK

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Raise with adding NDT or stick to LEVO

MariaStrawCinar profile image
7 Replies

Morning!

I have been on 50mgs Levo for two weeks raising slowly as when I started on a higher dose I felt bad with digestion, anxiety and racy feeling.

I previously asked for advice after my test a few weeks ago.My T3 was at the top of the range and T4 low range with a high TSH.

Would it be beneficial to add 0.5 Armour instead of go up 25mgs Levo or should I plough on with the Levo and see if it helps lower TSH after four more weeks before I test my bloods again.

From 2015-2020 I always took NDT 2-3 grains but due to sourcing issues and having Covid last year and high TSH I decided to try and see if Levo would work for me.

Many thanks,

Maria

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SlowDragon profile image
SlowDragonAdministrator

It takes minimum 6 weeks to settle on any dose

Which brand of levothyroxine are you currently taking

Many people find different brands are not interchangeable

Teva brand upsets many people

How much do you weigh approx in kilo

Likely to need several further increases in levothyroxine over coming months, to get to around 1.6mcg Levo per kilo of your weight

Have you tested vitamin D, folate, ferritin and B12

What vitamin supplements are you currently taking

Important to maintain OPTIMAL Vitamin levels

Do you have Hashimoto’s ?

If yes, have you had coeliac blood test done

If not get coeliac blood test done before trialing strictly gluten free diet

MariaStrawCinar profile image
MariaStrawCinar in reply toSlowDragon

Hi I am taking Teva - in what way does it upset people ? Yes I have Hashimoto’s. I will test my vitamin levels as it’s been a while that I tested them.

Thanks

SlowDragon profile image
SlowDragonAdministrator in reply toMariaStrawCinar

Teva contains mannitol as a filler, which seems to be possible cause of problems. Mannitol changes gut flora

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, or Aristo (100mcg only) are the only lactose free tablets

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

List of different brands available in U.K.

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

Posts that mention Teva

healthunlocked.com/search/p...

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.

New guidelines for GP if you find it difficult/impossible to change brands

healthunlocked.com/thyroidu...

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

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

MariaStrawCinar profile image
MariaStrawCinar in reply toSlowDragon

Thanks for your reply. I now see that I have been taking two brands Teva for the 50 and the 25 is from Wockhardt - I imagine it’s not good to be taking two different brands.I may but Teva 50 in half for now.

SlowDragon profile image
SlowDragonAdministrator in reply toMariaStrawCinar

Are you lactose intolerant?

If not, you might find it better to avoid Teva brand

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, or Aristo (100mcg only) are the only lactose free tablets

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

Wockhart only make 25mcg tablets

List of different brands available in U.K.

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

Posts that mention Teva

healthunlocked.com/search/p...

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.

New guidelines for GP if you find it difficult/impossible to change brands

healthunlocked.com/thyroidu...

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

SeasideSusie profile image
SeasideSusieRemembering

My T3 was at the top of the range and T4 low range with a high TSH.

Would it be beneficial to add 0.5 Armour instead of go up 25mgs Levo

Armour contains T3. That will take your FT3 even higher.

MariaStrawCinar profile image
MariaStrawCinar in reply toSeasideSusie

Yes I see so I think I will keep going with Levo so I can see how I respond without T3 added. T4 always low TSH high but T3 top range is a pattern Grey Goose pointed out last time.

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