Mercury Pharma brand

[KIMBO1964]

Hi, does anyone else get headaches when they use this brand? I stopped taking it for a week and the migraines disappeared, but the day after starting the tablets again I got a 2 day migraine again. I've stopped taking the tablets and and no headache/migraine.

[SlowDragon Administrator]

Headaches more likely due to being under medicated and only on 50mcg levothyroxine

Which other brands of levothyroxine have you tried

Many people find different brands are not interchangeable

Dose levothyroxine should be increased upwards in 25mcg steps until TSH is always below 2

Most people when adequately treated will have TSH around or under one. Ft3 at least 60% through range and Ft4 at least 60-70% through range

Push for increase to 75mcg levothyroxine

Teva is only brand that makes 75mcg tablets

So if avoiding Teva request 50mcg and 25mcg or just extra 50mcg and cut in half

[KIMBO1964 in reply to SlowDragon]

Hi, thankyou I'm currently on 75mcg now after harassing my GP as my TSH is still at 2.74 and I continue to have symptoms, but both my endo and GP are insisting I'm "in range" so will not increase my dose despite my symptoms, and massive weight gain.

[SlowDragon Administrator in reply to KIMBO1964]

How long have you been on 75mcg

Bloods should be retested 6-8 weeks after constant unchanging dose and brand of levothyroxine

Presumably endocrinologist is diabetic specialist

Print out guidelines on dose by weight and ask them to explain why they aren’t following guidelines

[KIMBO1964 in reply to SlowDragon]

I've been on this dose for a year. Bloods haven't been checked since last November. Yes, you are correct - endo is a diabetes specialist.

[fuchsia-pink in reply to KIMBO1964]

TSH of 2.74 is still too high - you want this less than 2 and probably less than 1 - AND for freeT4 and free T3 to be nice and high in range ( I, for one, can't lose weight unless they are).

Just being "in range" is no use to anyone. For instance, if the free T4 range is 12 - 22 you will feel dreadful (and be demonstrably under-medicated) if you are at 12.5 - and feel much better if it's 19.5 ... but both are "in range" and therefore acceptable to a lazy bored GP

This is why it's so important to get your actual results each time x

[KIMBO1964 in reply to fuchsia-pink]

My T4 is at 15.7, and yes I do feel dreadful, have put on loads of weight, have acid reflux, developed eczema, feel fatigued, brain fog, hair thinning and not growing ( I haven't had a haircut for over 4 years) etc etc, but have a doctor and endo who are both refusing to give me a higher dose, although I know from experience that when I'm on a higher dose and my TSH is at 1.0, I feel like a new person.

[SlowDragon Administrator in reply to KIMBO1964]

All these symptoms are due to being under medicated

Acid reflux - low stomach acid

Low stomach acid leads to low vitamin levels

Low vitamin levels tend to lower TSH

[SlowDragon Administrator in reply to KIMBO1964]

How much do you weigh in kilo approx

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...

[SeasideSusie Remembering]

Ask the pharmacy for a different brand if you are having side effects from MP brand.

If another brand doesn't give you migraines, tell you GP you have an adverse reaction to the MP brand and will he stipulate XXX brand on your prescription, or ask the pharmacy to ensure you are only given XXX brand in future.

If you find it's definitely the MP brand giving you migraines, do a yellow cards report:

yellowcard.mhra.gov.uk/

[KIMBO1964 in reply to SeasideSusie]

Thankyou, will give that a try

[Gingernut44]

In a word, yes. I now take Wockhardt only as it’s the only brand I can tolerate. I think it could be the acacia in the MP brand.