Could it be from Levothyroxine Teva & Accord - Thyroid UK

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Could it be from Levothyroxine Teva & Accord

Vrboska profile image

Hi there

It's hand dermatitis diagnose I've been suffering for 7-8 years. Started only on left hand between fingers and since recently spread on right hand, now mainly on top of hands. Red patches, painful as burnt feeling or nettle stings. Itchy, mostly in the morning after waking up. Red, inflamed, painful after going out, working, cooking any activity. Better when sleeping and rest. Wear cotton gloves and latex free on top for housework. Used all ointments, creams, steroid creams prescribed in London's Guy's Hospital. In desperation now applying manuka honey that helps a bit. Started doing tests, now waitting for gluten intolerance results and waitting to see dermatologyst in february to do other allergy tests. Only known condition I have is undeructive thyroide for 17 years, taking Levothyroxine 75 mcg. Will check if dermatologyst could reffer to endo to get me a replacment for Levotaroxine to exclude allergy on it. I spent days and days on google, reading, watching diet, excluding that and that and nothing works. I am 62, no other known health issues. Any similar experiances or ideas what it could be? Thanks.

66 Replies

Nothing useful to say, you might talk to the dermatologist about whether there is a link. I'm sorry you are going through this, it must be maddening.

Vrboska profile image
Vrboska in reply to SecondAngel

Many thanks for your understanding. It looks terrible but I am used to it as I understand it's beyond help.

A few years ago I cleared up pompholyx eczema covering my whole right hand after it started with dermatitis then went on to eczema and finally these huge unsightly blisters all over. I had tried everything, even stuff from the doctor but nothing worked. Then I came across B12 cream online and thought I would try that. So I rubbed it all over my hands before bedtime and hoped for the best, it did take the itching off.

Anyhow, my hand started to clear up and my skin was back to normal once more.

All I get now but only occasionally is a tiny patch of eczema on the side of my middle finger.

I actually have had it on my finger again this week, but a tiny bit of cream applied is healing it and today it is just a dried patch.

B12 cream really keeps it at bay.

Vrboska profile image
Vrboska in reply to Ellie-Louise

MAny thanks. Will try it asap and add it to my huge box full of different creams. I noticed it's made by few manufacturers, is yours by Dr Weil?

Ellie-Louise profile image
Ellie-Louise in reply to Vrboska

No, mine is this one. Life Flo Vitamin B-12 Cream For Sensitive Skin 4 oz (113.4g) Paraben Free

I originally bought it on Amazon but they didn't have any when I needed more so then I found it on eBay.

Vrboska profile image
Vrboska in reply to Ellie-Louise

Thanks Ellie-Louise, I will try it.

Ellie-Louise profile image
Ellie-Louise in reply to Vrboska

Let me know if it helps. x

Two years ago SeasideSusie suggested posting your test results - which I cannot find. I am thinking you may have low VitD levels .... VitD is an anti-inflammatory steroidal pro-hormone - so much more than a vitamin. Do you supplement ?

Vrboska profile image
Vrboska in reply to Marz

Thank you for mentioning 2 years ago...can't remember why I didn't put results but most likely was that between 2019 and earlier this year when she died I was caring for my mum who was fighting breast cancer so I left all my health problems behind. I have been taking strong dosage of D3 vitamins daily.

Marz profile image
Marz in reply to Vrboska

Sorry to read about your Mum.

So which VitD are you taking and how much ? What was your last test result ? Dosing is guided by results in many cases. VITD is fat soluble ...

Are you taking the co-factors - magnesium and K2-MK7 ?

Vrboska profile image
Vrboska in reply to Marz

Thanks Marz. I have been taking D3 50 Plus HEALTHSPAN Capsules, selprescribed and I don't know abt co-factor-magnesium K2-MK7. Grateful for your advice on this. I have to admit I had a Medicheck test last year in February and after that had 6 months TSH check with GP and it was withing normal range, hence the 75 mcg prescription. Do advise Medicheck test and which one pls?

Marz profile image
Marz in reply to Vrboska

healthunlocked.com/thyroidu...

The above link takes you to an earlier post of yours concerning tests - with helpful Replies.

Do keep copies of your test results with ranges. Saying your TSH was in 'normal' range does not help members understand. Normal/Fine/OK is not a result - it's an opinion ! Your TSH would be good around 1.

Am off to check your VitD supplement !!

Edit: Have checked your VitD supplement and each capsule is 2000 iu's. I would double that in winter and test again in the Spring.

Maybe some research on K2-MK7 and Magnesium would help - lots of info on this forum.

Vrboska profile image
Vrboska in reply to Marz

Thanks Marz, I did neglect my thyroid state, I agree I should have done more check ups and records. It's only when one comes on this place you realize how much other people know and do with our condition. Will comb through the previous post replies and will be free to double check with you before doing next tests with Medicheck.

Marz profile image
Marz in reply to Vrboska

I posted the link above giving you information about the testing required from your earlier post.

Vrboska profile image
Vrboska in reply to Marz

Thanks Marz, I have copied it and will arrange test asap. Best wishes.

Vrboska profile image
Vrboska in reply to Marz

Sorry to bother you; couldn't find this co-factors magnesium and K2-MK7, only D3 and K2 MK7. Where and what do you buy pls? Thanks

Marz profile image
Marz in reply to Vrboska

Magnesium is one product and VitK2 MK7 is another ! If you read through the excellent Replies by SeasideSusie you can read her detailed advice given daily. Sorry in a rush !

Vrboska profile image
Vrboska in reply to Marz

Thanks a lot.

SeasideSusie profile image
SeasideSusieAdministrator in reply to Vrboska

Vrboska

couldn't find this co-factors magnesium and K2-MK7,

They are two separate supplements.

D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.

For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.

For Vit K2-MK7 I like Vitabay or Vegavero brands which contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.

You can get D3/K2-MK7 combined in one supplement but you have to be careful of the amount of K2-MK7, you don't need more than 100mcg for any amount of D3 up to 10,000iu. If looking for a combined D3/K2 supplement, this one has 3,000iu D3 and 50mcg K2-MK7. The company has told me the K2-MK7 is the Trans form

natureprovides.com/collecti...

It may also be available on Amazon

Magnesium helps D3 to work. We need magnesium so that the body utilises D3, it's required to convert Vit D into it's active form, and large doses of D3 can induce depletion of magnesium. So it's important we ensure we take magnesium when supplementing with D3.

Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

Vrboska profile image
Vrboska in reply to SeasideSusie

Thank you so much for this helpful info. Happy and peacefull Christmas and best wishes. Neri

I have struggled with eczema for 50 years. It tends to come and go and moves around affecting different areas, but hands are always worse. GPS are generally very limited help. Over the years i have experienced a couple of serious skin infections caused by eczema damaged skin so it should be taken seriously. Over the last few years I have found a product called dermol 500 to be the best treatment and better long term than hydrocortisone cream or ointment which seems to cause long term dependence but which GPS are fond to prescribe. Dermol 500 is available off prescription although some GPS prescribe it. It's basically an antimicrobial emollient. There is mounting evidence that eczema is linked with high levels of skin bacteria that affects susceptible individuals. It has been a game changer for me. I hope this helps.

Vrboska profile image
Vrboska in reply to DavePhoto

Thank you Dave. Dermol, both cream and shampoo is sitting in my cupboard, several years ago was prescribed by my GP. Didn't make any difference in my case unfortunatelly.

I was given Dermol but it didn't help mine.

Hi Vrboska... Just like DavePhoto .. i find Dermol 500 lotion (in big green box from chemist, about £12 ) works to soothe the itch and heal my skin condition in a way that nothing else ever has. Mine is possibly not same as yours, but i recommend you try it anyway .. it "shouldn't" work for mine , but it does :)

.. i have Pompholyx ... very tiny , VERY itchy blisters form under skin , (you can feel the itch days before you feel the little bump) they fill with clear liquid, then dry out and flake off leaving my skin a thin papery mess that bleeds easily... Pompholyx happens specifically on the skin on the SIDES of fingers / toes. usually becomes symmetrical on each hand /foot ..... it also happens on palms /soles, occasionally it spreads a little towards top of fingers , but i never had it all on the top of the hand like yours is. I discovered lots of other people on here have Pompholyx .. some mentioned B12 cream... see half way down this post healthunlocked.com/thyroidu... )

GP gave me some strong steroid cream , but thanks to Dermol 500 lotion i've never had to use it yet.

Vrboska profile image
Vrboska in reply to tattybogle

Thank you, I will try Dermol again.

Vrboska profile image
Vrboska in reply to tattybogle

Many thanks. All these years in my diagnose is "contact dermatitis", but it seems to me it is Pompholyx exactly in a way you describe. But with now clearly formed red patches it seems that is something more on top of that. Dermol didn't work for me.

tattybogle profile image
tattybogle in reply to Vrboska

shame .. clutching at straws here , but was it the lotion in a pump bottle you tried, or the cream ?

I was using the thinner lotion and putting it on very frequently .

Vrboska profile image
Vrboska in reply to tattybogle

Thank you Tatybogle. I couldn't find today my old Dermol lotion with pump, I might have given it to my neigbour after it didn't help. But I still have a Dermol 200 shower emollient that can be used a cream too. So I am applying today after few of you prized Dermol. I have noticed that some of the creams work for some times and it stops after while.

Yes, that was my own reply, the one halfway down on your linked post.

My blisters were big ones, wet leaky and horrible. I was ashamed to show my hands.

Good luck getting to the bottom of it. I just thought I would mention certain shampoos gives me eczema on my eyelids even though it never goes near them. It took me absolutely years to work out.

My husband (who has no thyroid problem) has trouble with his hands with lots of soaps and dish detergent. I know you are wearing gloves, so I expect this is not your problem, but he got tested, and it turned out he should be avoiding a thing called polyquaternium - if you look, that is in very many shampoos and soaps. Perhaps another thing to look out for? For all I know that could also be the thing that sets my eye off too.

Vrboska profile image
Vrboska in reply to Ruby1

Thank you so much. I have been using on prescription for years Gentle wash for washing hands, but recently got myself: Dr bronner all - one 18 in 1 hemp lavender pure castile soap, I just started using it for shower and hair, hands but will try for cleaning too. It is hard to isolate yourself completly but if I can reduce it and manage I would be gratafull. My neice whose child has allergies recommended this shampoo and it helped to her girl.

Many thanks to you all for trying to help. As from this morning I decided to take only 50 mcg Levo by Accord and see results. The next week I will try 2 tablets 25 mcg of Teva and see if a mix of these 2 could cause it or one of these. Will ask Dr to try an alternative for Levo to exclude it as a cause. Will also try anything else. Best regards to you all.

tattybogle profile image
tattybogle in reply to Vrboska

The penny just dropped that you were asking about a possible connection to Levo formulations. Well ... now i come to think about it .... i did stopped accepting any Teva last year .... and this year my pompholyx has not returned at all ( temptin fate .. as it no doubt will do now i've said that !)

this is far from conclusive proof of any connection.. because my pompholyx has been around on and off for at least 15 yrs coming and going for prolonged periods of time., so it's most likely just a coincidence .

I could take Teva again see if it comes back :) but i'm not going to, (i only stopped it cos i found it makes me fee a bit 'flat' compared to others )

but you've got me wondering now .. wish i'd kept 15 yrs of records for when my skin went wrong and what brand of Levo i had at the time .... Hmmm.

Vrboska profile image
Vrboska in reply to tattybogle

Thanks for sahring this usuful thought about Teva. I never used to pay any attention what I was given in pharmacy, but reading other people posts here made me check if different manufacturer's Levo have different effect. It's learning path for every one of us, a detective work! What exactly made you stop taking Teva and what are you taking now pls?

tattybogle profile image
tattybogle in reply to Vrboska

I never paid much attention to brands for the first 15 yrs , but i was usually given the same ones , i might have had Teva once or twice in all that time. I had 3 month prescriptions. Then i moved and the new GP/ Chemist gave me a different brand every time , and Teva became very common, and 2 month prescriptions .

I went down hill around this time , which i thought was just 'my age' and unrelated to Levo.... but i did notice a bit of difference whenever i started a Teva prescription . I do remember thinking "this stuff seems cheap and nasty, and it feels a bit 'slower' "

A few years later it became more obvious because i'd had a few months of feeling quite well for me, and then got Teva again and within a week and a half i felt rubbish again.

Nothing specific .. not like an allergy or anything ... i just went from feeling "good and where shall i go next ? :) " to feeling "bleurgh' and can i go home yet ? :( "

So i moved chemists to one who was happy to be more helpful and didn't patronise me for suggesting i could tell the difference.

I currently have "anything but Teva" , so it's usually Wockhardt 25's with Mercury 50's , or sometimes they give me Mercury 25's with Accord 50's

( if trying to avoid Teva remember that 'Northstar' 25mcg's are actually Teva tablets inside ... Northstar 50's /100's have Accord tablets inside )

Vrboska profile image
Vrboska in reply to tattybogle

Many thanks. How interesting is that 'Northstar' 25mcg's are actually Teva tablets inside ... Northstar 50's /100's have Accord tablets inside. Over all these years I never had Accord before, never heard abt it. I'll take your advice, very helpful. Best wishes.

I have had exactly that on my hands- couple of bad flair ups. I can’t use soaps but wash with epaderm. I’m underactive and on Levo thyroxine. I think my first bad case was prior to being treated (it must have been bad as I remember taking pictures of it so track it’s spread!!) but all been well since, unless I’m out and about and use soap there. Then I can feel it flair up. I totally get the burning feel. It’s like your skin is raw there. I think not rinsing and drying my hands properly seemed to make it worse.

Hope you find a solution!! Don’t know if you’ve given epaderm a go yet?

Thanks Butterfly. You were lucky that you managed to stop it in time. I haven't used Epaderm but many similar ointments, creams, emollients. I feel embarrassed asking GP for new prescriptions all the time and I have really lost hope that there will be a cure for this. I am now concentrated on finding a cause for this inside my body, seems that I can't help it with treating hands. So, trying to exclude medicine, food, any other health issues.

Absolutely it’s awful. I think my thing is I need to keep on top of it. Force myself to take my epaderm with me in my bag etc as the minute I use something else ( even things described as for sensitive skin) I can feel skin tightening. Worse in cold weather as well. I’ll keep my fingers crossed for you, but do agree- I think lots of this comes from the inside. I had a really bad case of gutate psoriasis twice in adulthood, but looking back was stress related. I’ve eliminated a lot of things as well- alcohol being a big one not that I drank a lot, but I’d become intolerant and am sure this was linked to my thyroid. I felt toxic the day after, even after one glass. And recently started gluten free so here’s hoping you find the culprit 🤞

I had pompholyx eczema for at least 40 years. Mostly, in adulthood, I used steroid scalp ointment (prescription only) as a treatment, not for my scalp (my scalp was never affected) but for all the other affected skin areas. I had few choices for treatment - I can't tolerate lanolin or vaseline and they are in so many creams and ointments.

This is what I got prescribed, and I used it as rarely as possible - it was quite a strong steroid and would have thinned my skin if used too often :

bnf.nice.org.uk/medicinal-f...

But in the end I found my own cure. I started to supplement high dose (5000mcg) methylcobalamin (a type of Vitamin B12 that can be bought online without prescription) Once I got my level of B12 up very high (in excess of 2000 ng/L in a serum vitamin B12 test) I cut back and now I take it only 2 or 3 times a week.

The thing I should warn about is that it actually made my skin worse to begin with then after about 2 - 3 months my skin got better than it had been for decades, and it has stayed that way. I also found the high dose B12 gave me spots - but then I'd had "teenage" spots for 40 years as well as the eczema. The spots got worse just like the eczema too, then they went away completely. I've had one spot in the last five years, which is a miracle as far as I'm concerned.

Vrboska profile image
Vrboska in reply to humanbean

Many thanks. Will give it a go after I get my blood test results. where do you buy it from pls?

humanbean profile image
humanbean in reply to Vrboska

It's easily sourced on most supplement websites including Amazon, and can be bought in various doses.

I've bought these (very high-dose) ones before :

amazon.co.uk/Strength-Methy...

But you might want to try a lower dose first, in case it doesn't agree with you.

SlowDragon profile image
SlowDragonAdministrator

Could simply be under medicated

75mcg is very low dose unless you are extremely petite

What were your most recent thyroid and vitamin results and ranges

TSH, Ft4 and Ft3

Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Especially to retest vitamin D, folate, ferritin and B12 at least annually

Vrboska profile image
Vrboska in reply to SlowDragon

Thanks. I tried to get Medicheck test but there was a message to leave it till 4th January due to Christmas holidays. I am 74 kg. My latest NHS blood test are TSH 0.86 (0.27-4.2), B12 384 (180-999), Ferritin 73 (30-400). I'll increase Levo (Acord) to 100 till I get Medicheck results and will post them here. My last Medicheck test was 2019 and their Dr kindley explained the results as ok, therefore I din't post them here. I have copied and printed all the info and advice from you lovely people here and will take everyone's point. I have also started gluten free diet (have ocassional treat when I can't resist), reduced lactose to min. Best wishes, neri

SlowDragon profile image
SlowDragonAdministrator in reply to Vrboska

B12 is on low side

Are you currently taking any vitamin B complex or B12

No recent vitamin D or folate test results

Ferritin- range suggests you’re male?

Medichecks Dr reviews are often dubious. They are totally TSH obsessed, just like most GP’s

What were Ft4 and Ft3 results

No point re doing Medichecks test until minimum 6-8 weeks on unchanging dose

Vrboska profile image
Vrboska in reply to SlowDragon

Are you suggesting different testing place? The above results are from NHS, so i don't have Ft3, Ft4 and folate. I am woman, not sure what range of ferritin should be? Many thanks for your help.

SlowDragon profile image
SlowDragonAdministrator in reply to Vrboska

Ferritin range usually 15-150 if female

But NHS has odd ranges from time to time

See what ferritin result is via Medichecks

Vrboska profile image
Vrboska in reply to SlowDragon

Thanks a lot!

SlowDragon profile image
SlowDragonAdministrator in reply to Vrboska

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

Vrboska profile image
Vrboska in reply to SlowDragon

OMG this looks complicated. I have never heard abt calculation based on weight over these years. I must read this carefully and see if I get it.

SlowDragon profile image
SlowDragonAdministrator in reply to Vrboska

74 kilo x 1.6mcg suggests you might eventually need approx 118mcg per day

Not everyone does, but can be useful to get trial dose increase from GP

If been on 75mcg years can be difficult to tolerate increasing dose

Some people have to increase dose very slowly eg 75mcg and 100mcg alternate days

Or even slower

Vrboska profile image
Vrboska in reply to SlowDragon

That was very helpful, will try that slowly.Thank you.

SlowDragon profile image
SlowDragonAdministrator

Teva contains mannitol (instead of lactose in most levothyroxine tablets)

Google suggests mannitol may have possible link to dermatitis

Vrboska profile image
Vrboska in reply to SlowDragon

Uau, thanks for this fact, very usuful. Following advice of lovely people above, I have put aside Teva 25 mcg and started taking 2 tablets of 50 by Acord. I meant to restart Teva 75 next week to see what happens, but having read this I will just leave it.

SlowDragon profile image
SlowDragonAdministrator in reply to Vrboska

Are you on lactose free diet that Teva was prescribed?

Or just because you’re on 75mcg dose

(Teva is only brand that makes 75mcg tablets)

Is this recent dose increase

What were most recent thyroid results

Vrboska profile image
Vrboska in reply to SlowDragon

I saw your message after I have already written mine. I simly follow advice of friends to try to reduce/eliminate lactose. Not sure abt your question regarding Teva? I was given in my pharmacy my 75 mcg dosage in two tablets; 50 by Acord and 25 by Teva. i have been on 75 for years (diagnosed 17 years ago). So, few dyas ago I left Teva out and started taking 2 50s.

SlowDragon profile image
SlowDragonAdministrator in reply to Vrboska

Ok so only been on 75mcg long time …..

75mcg is low dose…only one step up from starter dose

Always test thyroid levels as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

SlowDragon profile image
SlowDragonAdministrator in reply to Vrboska

Aristo levothyroxine is lactose free but doesn’t contain mannitol

But only available as 100mcg tablets

Not widely available - could ask Pharmacy if they can get Aristo

GP can specify brand

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

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.

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).

Vrboska profile image
Vrboska in reply to SlowDragon

I am very grateful for your extremly helpful info in many aspects of my issues. Thanks again for taking time and interest and sharing with me your knowledge. I learnt so much from all of members here. Great community here.

SlowDragon profile image
SlowDragonAdministrator in reply to Vrboska

I would suggest you can’t stop and start different doses

It takes months for body to recover

Just get GP to prescribe more 50mcg tablets and cut Accord tablets in half to get 25mcg

Hold at this 75mcg dose that you have been on for years and retest in 6-8 weeks

Accord is also boxed as Almus via Boots or Northstar via Lloyds

Accord don’t make 25mcg tablets

Vrboska profile image
Vrboska in reply to SlowDragon

Very wise advice, I took early morning 100 and felt heart palpitations when I woke up.My pharmacy always comes up with mixed up brands for 50 and 25 I never had same.I never wondered if 50 and 25 should be same. Should I ask to stick to one same for every prescription or it doesn't make difference as long as it's not Teva. For instance I was given Acord first time in life, never heard of it before. Usualy it was Mercury and Wockhard and Actavis. Tks and have a nice day!

SlowDragon profile image
SlowDragonAdministrator in reply to Vrboska

Many people find Levothyroxine brands are not interchangeable.

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 only make 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

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.

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

Hi Vrboska,

I recently came across a condition called Granuloma Annulare. It was suggested to me by another member of the forum as I was trying to identify a rash that I have over my body.

There are different forms of it. The photo of your rash does look similar to some of the images that I saw when I was searching on the internet. Not sure if you came across it when you were looking for answers?

It can be connected to thyroid problems or diabetes and can be triggered by some other medications too. I'll try to provide a link to some information and photos.

Best wishes.

dermnetnz.org/topics/granul...

mayoclinic.org/diseases-con...

Vrboska profile image
Vrboska in reply to Hedgeree

Hi Hedgerre Thanks for this suggestion. I've read it and it is rather scary. I will have this in mind whilst eliminating possible causes one by one and will check with dermatologyst at my appointment in February. I've spent days and nights studying medicine on internet trying to identify my problem and new things keep coming all the time, like this one, so seems an endless and hopless process. It's now 1.26 in UK, and I've been reading abt this since 8 pm and night after night like this, having seen GP this morning, been in few pharmacies... so tired of this. Best wishes.

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