Liquid levothyroxine

[Harlech]

Hi, In previous post I mentioned that I had been prescribed liquid levo, brand was zentiva, resently received brand mercury, have suffered spinning fuzzy head, burning mouth, diarrhoea & stomach pains, could this be a reaction, as anyone else had a problem. Phoned dr's to speak to their phamacist, , who isn't available until 20th Dec, so receptionist made dr's app. for 15 Dec. (dose 5ml).

[helvella Administrator]

Regardless anything else you do, I urge you to put in a Yellow Card report:

healthunlocked.com/thyroidu...

Zentiva:

It also contains the following inactive ingredients:

glycerol, citric acid anhydrous, sodium methyl parahydroxybenzoate (E219), citric acid 10% and purified water.

Advanz Mercury Pharma:

It also contains the following inactive ingredients:

glycerol, citric acid monohydrate, sodium methyl parahydroxybenzoate (E219), sodium hydroxide and purified water

Not entirely clear, did you get this dispensed by the surgery?

I think you absolutely must get in touch with whoever dispensed it and request, nay, even demand a replacement.

But make sure you retain some of both products (if feasible) for future analysis.

[Harlech in reply to helvella]

Firstly i thank you for your reply. The medication came from boot's pharmacy, Zentiva & mercury. I do have a small amount of zentiva, as when I received the mercury I checked the ingredients & as they contain the same I started the mercury 1.Does liquid absorb better,? Should I have tried a lower dose?.

I have tried tablets, teva, mercury, accord, which caused coughing with a white frothy mucus though out 2020 until Sept 2021 took 14 courses of antibiotics , gp said tablets wouldn't do that, had chest X-ray clear stopped tablets cough gone, then started the liquid, now incurring issues with that too. At the moment I feel dreadful.

I do have high b12 levels total>2000 done nhs b/test & active >150 done medichecks as nhs don't do them

Which the dr's are aware of, as yet I haven't had an answer, it's been referred to endrorinlogist could this cause issue ref. to me with levothyroxine?

Tablet doses. 25mg then 50mg liquid 5ml.

[helvella Administrator in reply to Harlech]

Liquid is usually thought to absorb better than tablets.

That is a small difference - that Advanz has sodium hydroxide where the Zentiva has citric acid 10%.

In itself, high B12 wouldn't be expected to cause anything. You should see how high B12 can get on those who have injections of B12!

But high B12 without supplementing could indicate other issues - e.g. with your liver.

Your dose is still very low - most people end up needing around 100 micrograms - or higher - when they reach a stable, long-term dose.

[Harlech in reply to helvella]

Helvella, I only checked the box ingredients & sodium hydroxide not listed ,on mercury, I now have checked the leaflet, & yes. Thank you. I have to contact boot's & see if they will replace mercury 1.Ref. To B12 its been going up for appox 3yrs no supplements, had b/test for liver & FBC done

29/9/2021 all OK.

My gp will not increase the dose she gave me 25mg on alternative days for 5months until a referral to endocrinologist March 2020 1 week before lockdown) said I could take them each day, I then asked my gp it increase 3days a week in June 2020 answer no did another referral that was phone call Oct 2020 when I got 50mg, & that endrorinlogist put me back in the hands of my gp.

(my gp in her referral letters as never included b/test results but endro 's accepted b/Horizon)

I have sent my gp 3 b/Horizon b/test as I was able to get them done in lockdown, I also included their dr' s comment about tsh being 1 she completely ignores them.

Last 1 I had done at the surgery was 1/9/2021

Tsh 2.36. (01 5.0). Ft4. 15. (12.-23)

The only thing I can do now is get boot's to give me zentiva & have b/Horizon bloods done mid January, see what the results are, & see if I can get an increase if needed.

[SlowDragon Administrator in reply to Harlech]

Clearly you are under medicated

Ft4 is only 27% through range

What vitamin supplements are you currently taking

Can you increase dose levothyroxine up yourself ?

[Harlech in reply to SlowDragon]

Levo tablets were causing a cough with clear frothy mucus, in 21 months I had 14 courses of antibiotics. Spoke to a pharmacist who said this could be levo needed increasing also mentioned trying liquid levo.Spoke to my Gp who said its nothing to do with the tablets, & I needed an chest x-ray had it done result clear. So she wouldn't increase the dosage, so it was my suggestion ref. Levo liquid unfortunately that too hasn't gone well at present. Think due to mercury 1, causing side affects.

*within days of stopping the levo tablets coughing stopped *

Other liquid brand was ventiva.

[SlowDragon Administrator in reply to Harlech]

Your GP clueless

Can you see a different GP

Levothyroxine doesn’t “top up” failing thyroid…it replaces it

Starting on 50mcg and increasing upwards as fast as tolerated until on, or near 1.6mcg levothyroxine per kilo per day

How much do you weigh approx in kilo or stone and pounds

tattybogle has good suggestions on how to “accidentally” loose a packet (or bottle) of levothyroxine so you need an extra prescription

That enables you to get enough extra to increase the dose ….up to 7.5ml per day (as split dose perhaps)

When under medicated we develop low stomach acid….this can cause cough…..SIBO ….H pylori etc

[tattybogle in reply to SlowDragon]

indeed . it's well known that hypothyroid patients are a bit brain fogged sometimes .. i've left a whole months packet on holiday and had to go and ask GP to replace it .. What can they say .... these things happen sometimes

[SlowDragon Administrator in reply to tattybogle]

😀👍

[Harlech in reply to SlowDragon]

SlowDragon I changed to this surgery July 2019 to date I have seen only 2 gp's. I tried to book an appointment with the gp who gave me the levo. First I phoned to book an appointment face to face 1, no can't do that, the gp phones you first and if they agree then an appointment is made. I phoned it was almost a month when I received her phone call never had the face to face appointment.All the antibiotics I have been given I know I mentioned 14 it's 15 really but I have never taken 15th 1, all done my different Dr via phone calls, think they use locums. My last blood tests at the surgery done by a paramedic. (that didn't bother me).

With Christmas & New year upon soon, all I can do hopefully get another liquid replacement boot's will not do that without new prescription due to cost as it expensive. (Told £100. bottle must check)

Have b/tests sometime in January.

[SlowDragon Administrator in reply to Harlech]

Yes 50mcg liquid levothyroxine 100ml bottle is £89.92

[Batty1 in reply to Harlech]

I had a horrible cough with a particular levo manufacture it contained Acacia which also caused blistering hives once I stopped within a couple of weeks I stopped coughing and haven’t had blistering hives …. It’s possible your allergic to something in the liquid pills.

[SlowDragon Administrator in reply to Harlech]

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Graph showing TSH in healthy population

web.archive.org/web/2004060...

[SlowDragon Administrator in reply to Harlech]

Have you tried taking half liquid waking and half later in day or at bedtime

Often members on liquid find it better to split the dose

You could just be very under medicated

Cough suggests lactose intolerant

Are you on lactose free diet

Cough can also be acid reflux…..extremely common when under medicated….due to LOW stomach acid

How old are you

50mcg is only a starter dose levothyroxine

(25mcg is starter dose if over 65)

Typically dose levothyroxine is increased slowly upwards in 25mcg steps retesting 6-8 weeks after each dose increase

This continues until TSH is around one

Levothyroxine doesn’t top up failing thyroid, it replaces it. Essential to be on high enough dose

How much do you weigh in kilo

Typically eventual dose is approx 1.6mcg levothyroxine per kilo per day

Unless very petite, that’s likely at least 100mcg

[Harlech in reply to SlowDragon]

Thank you for your reply. I just done a reply to Helvella

[McPammy]

I take liquid Levothyroxine. The brand I always use is Wockhardt which is distributed from its Wrexham site. I’ve tried a few but much prefer Wockhardt. My pharmacist orders my prescription direct from Wockhardt at Wrexham who deliver free of charge to the pharmacist. I split my dose. Half at noon and half late afternoon. I did this as I have trouble taking Levothyroxine in one dose for reasons I don’t understand. What I find really good about liquid over tablets is that you can tailor your dose to whatever is correct for you. Tablets usually come in no less than 25mcg sizes although there is one 12.5mcg size out there. But with liquid you can reduce or increase by 10mcg or even smaller amounts which certainly helps getting the correct dose.

[Star13]

I also take liquid levo. First Teva, then Mercury then zentiva. I also think I’ve had other brands too but they are the main ones I seem to get. Personally I don’t like the taste of zentiva. When I first started taking the liquid I had similar problems, burning mouth and throat, coughing in fact I thought I was having a full on allergic reaction. I had to start by taking very small amounts and build up, which has been said is very easy with the liquid.

I dose myself with it and find my own level as I’m having Endo issues. I just say I’m taking 65mg along with my 40mcg of T3 if asked. I also split the dose of both. As I’m still not even in range on my T4, within range on T3 but always have depressed TSH I have to go on symptoms.

I also found excuses to get extra T4 slipped in on prescriptions!!

The side effects gradually wore off. I do find having a sip of water after helps which is fine according to the PIL.