Levothyroxine Solution/Liquid

[Lavender-Blue]

Hi All

Does anyone know how the liquid levothyroxine behaves in the body as compared to the tablets?

[helvella Administrator]

Once the active ingredient, levothyroxine gets into your blood stream, exactly the same.

But I suspect there is more to your question?

[Lavender-Blue in reply to helvella]

Yes, I feel dreadful on levothyroxine. I have had days where I haven't taken my medication and all the symptoms disappear!

I have been prescribed liquid levothyroxine and wandering about liquid being absorbed straight into the bloodstream?

I understand that the tablet form sits in the intestines?

[SlowDragon Administrator in reply to Lavender-Blue]

When on tablets did you always get same brand levothyroxine at each prescription

How much levothyroxine

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient. If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.

There are a few members who are prescribed liquid levothyroxine and find it much better

You can split dose, taking half waking and half late afternoon or bedtime

Bloods should be retested 6-8 weeks after any dose change or brand change in levothyroxine

Always test as early as possible in morning before eating or drinking anything other than water

Make sure last dose liquid levothyroxine is 24 hours before test

When were vitamin D, folate, ferritin and B12 last tested

On any replacement thyroid hormones it’s extremely important to have GOOD Vitamin d, folate, ferritin and B12

What vitamin supplements are you currently taking

[helvella Administrator in reply to Lavender-Blue]

Levothyroxine oral solution does appear to absorb better.

On what appears the same dose (for example, 100 micrograms a day), you'd expect to absorb maybe 60 to 80% of the tablet. But a few percent more of a liquid.

This paper has a few interestoing observations - though I am not suggesting you have the same issues as the subject of the paper. At the right there are lists of similar papers and other papers which cite this one.

Both tablets and liquids have excipients which affect people differently. Some don't do well on the high glycerol content of liquids. If that isn't an issue, you might do well.

Note in particular the way they increased the dosing regime, then dropped it back down.

Switch from tablet levothyroxine to oral solution resolved reduced absorption by intestinal parasitosis

ncbi.nlm.nih.gov/pmc/articl...

If you do not do well on the liquid products, you might find you'd do better with some liothyronine.

[Lavender-Blue in reply to helvella]

Thank Helvella, I will take a look at that!

[Lavender-Blue in reply to helvella]

Just read this Helvella it's interesting too that dosages on tablet and solution that the patient was prescribed prior and during investigation were 1.2 mcg/1.4mcg per kg body weight as opposed to the 1.6/1.7.

Thanks.

[helvella Administrator in reply to Lavender-Blue]

These figures (like 1.6 or 1.7) are talked about as if some sort of gospel truth. At best they are estimates. More often they are guesses.

[SlowDragon Administrator]

Looking at previous posts

Couldn’t see any recent vitamin results or if you have autoimmune thyroid disease also called Hashimoto’s diagnosed by high thyroid antibodies

Are you on strictly gluten free diet or dairy free diet

Long article about malabsorption issues

academic.oup.com/edrv/artic...

[Lavender-Blue in reply to SlowDragon]

I take Vitamin D, Myo-Inositol and Selenium. Selenium recommended by SeasideSusie. I eat a low carbo diet, goats yogurt, almond milk and no bread. I do eat butter, cheese, this doesn't seem to cause me the thick throat, and weeping, eyes like milk can in its excess and cough.

My fasting tests on 21.9.21 taken 8.30am were TSH 0.83 and T4 19.3. I felt dreadful! Gowd only knows what they would have been adding the meds before the tests!

I am suspecting I have been overmedicated on levo for years!

Back in 2010 my TSH was 0.08 and T4 24.8.

2012 TSH was 1.35 snd T4 21.9.

Always felt s**t!

I have chest pain, which has got better since I have reduced my meds.

I am on 75mcg now and suspect still too much. (After self medicating on ndt, I tend to go on feelings in my body as opposed to numbers)!

My areola is inflammed too and looks bulbous. My stomach is reducing and feeling better with the reduction in medication.

I am suspecting overmedication as opposed to which type of meds too.

I woke this morning feeling terrible, like a hypo feeling. I waited and waited to see how if I would improve. At 12 midday, I began to 'lift' my eyes 'opened ' from being puffy as did my face, the bone pain in my head and face eased off as did my facial muscles (they relaxed) my jaw did too.

Phew....I did have antibody tests done years ago but uncertain about them all.

Had sycanthen tests and assays too under hospital, all fine, thank goodness.

I seemed to be OK on levothyroxine from diagnosis to about 2010/11 when all symptoms raged.

I have taken the liquid at 3.45pm and am already feeling a heat in my breasts and they look reddened again after easing off earlier.

Thank you for reaching out to my post and reading it. X

[SlowDragon Administrator in reply to Lavender-Blue]

So it’s essential to test vitamin D, folate, ferritin and B12 at least annually minimum

When were these last tested

How much vitamin D are you currently taking …..how long at this dose

Come back with new post once you get FULL thyroid and vitamin testing done 6-8 weeks after starting on liquid levothyroxine

The fact you improve as day goes suggests cortisol issues (common if thyroid Management is poor

Approx how old are you

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

by DIY fingerprick test or pay extra for private blood draw

bluehorizonbloodtests.co.uk...

High Ft4 often doesn’t mean over medicated…..but poor conversion of levothyroxine (Ft4) to active hormone (Ft3)

Reducing levothyroxine reduces Ft4…..but also lowers Ft3

Low Ft3 leads to low vitamin levels

Low vitamin levels leads to poor conversion

Poor conversion results in high Ft4 and low Ft3

You could test vitamin D now

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

[Lavender-Blue in reply to SlowDragon]

Not sure what Dr's last tested. I take 1000 vitabiotics vitamin D, I have took Better You brand in the past too.

Yes, I have been looking into private testing.

I do have a test booked in at Dr's, in a few weeks; I will see what comes back.

Thank you for replying, greatly appreciated to all.

[gabkad]

I posted about this a week or so ago. A study done indicated that people prefer the liquid because they can eat breakfast right away. Food doesn't interfere with absorption.The concentration is 100 mcg thyroxine per 5 ml (a teaspoon).

[helvella Administrator in reply to gabkad]

The concentration is 100 mcg thyroxine per 5 ml (a teaspoon).

Not always - there is a variety of concentrations. At least from 25 to 125 micrograms/mL.

helvella - Thyroid Hormone Medicines

I have created, and try to maintain, a document containing details of all thyroid hormone medicines in the UK and, in less detail, many others around the world.

dropbox.com/s/shcwdwpedzr93...

Food doesn't interfere with absorption.

I think that is an overclaim. There is evidence that, in some cases, there is much less interference. But they simply have not performed sufficient research to demonstrate that this is a general rule across all foods.

Even if we restrict ourselves to foods commonly eaten at breakfast, that encompasses a huge range of breakfast cereals (some fortified with iron), bakery goods, fruits and juices, eggs, dairy products, etc. And the work just doesn't appear to have been done - they have picked a few (like coffee).

[gabkad in reply to helvella]

I know that coffee reduces absorption by 30%. But it's weird because coffee is acidic and the pill needs acid to break down. It must be something else in the coffee. There was a study I read years ago done in Italy about this.

[helvella Administrator in reply to gabkad]

The papers tend to be as clear as mud about what coffee (strength, with/without milk and sugar, etc.) A few say "espresso" but even that is open to question.

Levothyroxine actually hardly dissolves in neutral or acidic water. It dissolves much more readily in alkaline solutions.

Thus, it isn't the acid level of the stomach that is critical. It is the bicarbonate in the intestine.

Usually when the gastric parietal cells secrete hydrochloric acid, bicarbonate gets whipped away into the bloodstream, eventually getting to the pancreas. And from there to the intestine when the stomach empties.

Acidity of food itself does not help to produce bicarbonate. Yes, acidity of food might be of significance to the dispersal of some tablets. But not the dissolving of levothyroxine itself.

And we are still speculating as to why coffee has an impact.

[gabkad in reply to helvella]

So, hm, just wondering out loud, if someone takes their T4 with bicarb of soda,what would happen besides burping?

[helvella Administrator in reply to gabkad]

I don't know but I wouldn't recommend trying.

I'd much rather a lab tried first. After all, the stomach will attempt to achieve a particular acidity regardless the food that comes in.

[gabkad in reply to helvella]

Because it doesn't really matter, I'll put a Synthroid tabletin a bit of water to which I've add bicarb and see what happens. If I lose a pill,

no big deal. Tomorrow morning.

[helvella Administrator in reply to gabkad]

You won't be able to see anything from that. The amount of levothyroxine in a tablet is of the order of a tenth of a percent of the whole tablet.

I weighed a UK (Accord) 100 microgram tablet - it was 100 milligrams.

That is 100,000 micrograms. So 100 micrograms is one thousandth of that! The excipients would dominate anything you could see or detect.

[gabkad in reply to helvella]

Synthroid has a lot of lactose. That dissolves. I am just curous thasall. Never fooled with pills before.

[janeroar in reply to helvella]

Clever! 😊

[McPammy]

Your symptoms sound like you’re struggling to convert Levothyroxine to active T3. Have you had all three tested together T4, TSH and T3. You’ll need to find out if you’re converting Levothyroxine ok. I was on Levothyroxine alone any really struggling to take it as I would feel awful about an hour after ingesting. As soon as I stopped Levothyroxine I had no symptoms but very soon I became under medicated. So don’t stop your Levothyroxine or it’ll get worse. Get a private test if your GP won’t test T3 snd/or do the DIO2 gene test through Regenerus Laboratories to check if you have this faulty gene too. I have this faulty DIO2 gene which is the reason why I never did good on Levothyroxine. Once I started a combination of Levothyroxine plus T3 Liothyronine I felt 100% better.

I did a 6 week trial on liquid Levothyroxine and it made no difference as it was the conversion issue. I still take liquid Levothyroxine as I find it much easier to use than tablets. I’d recommend the Wockhardt brand also after trying others.

[Lavender-Blue in reply to McPammy]

Hi

Strangely, I am not low on energy, I would have thought this to be the case...unsure?

The constant face pain, facial bone pain and heaaches are what hinders me. I feel this coming on upon taking the tablets.

Thanks for your reply to me.

[Audley1013]

Hi Lavender-Blue,

Might you elaborate on your face pain and facial bone pain? Is the pain say in your cheekbones? Or would you say right under your mandible, maybe also your salivary glands?

[Lavender-Blue in reply to Audley1013]

Yes, pain in skull, jaw, cheek bones and in facial muscles too.

Upon easing off medication it alleviates, I can actually feel the tingling in the muscles, like a releasing.

Does this resonate with your experience?

[Triciatextiles in reply to Lavender-Blue]

I have these symptoms and many others, they start twenty minutes after taking Levothyroxine. I believe i have developed an allergy to Levothyroxine or the fillers. I have tried all the brands and i have tried adding some T3, but the symptoms remain. Like you they all disappear if i don’t take the Levothyroxine and I feel well for a few days then the hypothyroid symptoms kick back in so I have to resort to taking it again. I have an appointment to see an endocrinologist at the centre of excellence at Addenbrookes hospital in a few weeks and I am hoping to be offered an alternative formula to try.

[Lavender-Blue in reply to Triciatextiles]

Ask for the liquid levothyroxine. If you scroll further back in this thread to see what SlowDragon has posted.

[Lavender-Blue in reply to Triciatextiles]

Here it is...

How much levothyroxine

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient. If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.

[Triciatextiles in reply to Lavender-Blue]

Thank you

[Lavender-Blue in reply to Triciatextiles]

I spoke to Endocrinology before I approached my GP for the liquid.

The advice was that a GP can prescribe it! Good luck. X

[Triciatextiles in reply to Lavender-Blue]

Thanks for suggesting this but i have already been down this route. My GP practice refused my request for tirosint on the basis of cost (although my GP supportive) and that I didn't have any evidence that it was the levo causing me the problems because I take other meds, although I had gradually stopped taking other medication to see if it was indeed the levo. My GP then agreed to refer me to addenbrookes hospital as they are a centre of excellence in endocrinology.

[Lavender-Blue in reply to Triciatextiles]

I believe Tirosant is unlicensed here, that's maybe why. (My surgery refused to fund ndt due it being unlicensed here.

If you look on Thyroid UK's list of medications, listed are what are licensed here in the UK

Teva is what I have been prescribed and lactose free.

[helvella Administrator in reply to Lavender-Blue]

You are correct that Tirosint is not licensed in the UK. However a number of levothyroxine oral solutions are licensed.

helvella - Thyroid Hormone Medicines

I have created, and try to maintain, a document containing details of all thyroid hormone medicines in the UK and, in less detail, many others around the world.

dropbox.com/s/shcwdwpedzr93...

[Lavender-Blue in reply to helvella]

Yes thanks Helvella, I consulted your list prior to my engagement with services. Very useful and informative.

[Audley1013]

Hello Again, My pain is bilateral under my jaw line. It is intermitant but "sharp and stabby". Like ear infection ear ache pain but under my jawline. It got worse after my thyroid was removed for PTC. I can't explain to my care team in a way they understand. But thank you all. I now know I'm not the only one:). It seems like its worse for me on the Synthroid. I'll report back my experince when we switch me to NDT.

[Lavender-Blue in reply to Audley1013]

I notice ear pain too. I sincerely hope you can find respite, its so debilitating!

[abitsad]

I've been taking Tirosint capsules for a few years and recently tried the liquid version for a few weeks. I disliked it so much. Personally I didn't notice that it absorbed any better and it made me cough a lot and gave me a sore throat . I like Tirosint capsules and hope they don't replace it with the liquid version. Just my personal experience of a specific brand.

[Lavender-Blue in reply to abitsad]

I feel very concerned about the Parahydroxybenzoate (E219), I have discovered that it may be an Eastrogen disrupter.

Please, if anyone knows anything about this chemical, can you inform?

[helvella Administrator in reply to Lavender-Blue]

You might find this of some interest:

dermnetnz.org/topics/allerg...

[Lavender-Blue in reply to helvella]

Thank you Helvella!

I very much eat 'cleanly' and buy natural products where possible.

Ingestion of this stuff frightens me!

Really having to think again.

[helvella Administrator in reply to Lavender-Blue]

I was fairly sure at least one levothyroxine oral solution did not contain any E219 but when I checked through the documents, it looks like they all now contain it. Could well be my memory playing up.

Tirosint doesn't.

[Lavender-Blue in reply to helvella]

It's like trying to get blood out of a stone trying to get unlicensed meds!

Yes, it's the Roseway compounded stuff, they wouldn't give me the costing when I contacted them; they said I would need a prescription first!

I explained I need to know costing first in order to see if I could afford the meds.

There is no point trying to convince GP to write a private prescription to learn I cannot afford it!

Thanks Helvella.