T3 has gone down and T4 over range now

[PixieElv]

Hello All

I’ve got new blood results, this time not via GP but via BlueHorizons. They give a very different reading to my previous result.

Previously my results on 175mcg daily were

T4 20.1 (12-22)

T3 5 (3.4-6)

I’ve got central hypothyroidism, so TSH is of no relevance.

I still had a lot of hypo symptoms, even on those ‘amazing’ results, so I increased to 200mcg and 175mcg alternatively and the results are below.

My DHEA was low, so my Endo has put me on 25mg of DHEA each day.

Can anyone help me make sense of the results below please?

I don’t want to reduce my dose as 175mcg didn’t do it. I tried T3 but that didn’t work for me either.

I followed the correct testing procedure of last dose 24h before testing and no Biotin products for 1 week before.

Thank you

[SlowDragon Administrator]

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

What vitamin supplements are you currently taking

You may need to reduce levothyroxine slightly

Do you always get same brand levothyroxine at each prescription

What time was test done ….re cortisol result

[PixieElv in reply to SlowDragon]

Hello SlowDragon,Are you well?

Vitamins were last tested about 3 months ago and were good (don’t know the exact levels - need to go and check).

I am taking DHEA 25mg on instruction of my Endo to deal with low DHEA levels.

I was taking Vit D and Omega 3, 6, 7 9 at the time of the test. no Biotin.

The tests were done around 3pm as THS isn’t a concern for me.

I did have a different brand of Levo. normally I have Accord, but I had Teva this time. Do you think that made such a HUGE difference?

thank you

[SlowDragon Administrator in reply to PixieElv]

Likely different brand levothyroxine is an issue

Many people find Levothyroxine brands are not interchangeable.

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).

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.

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)

Always leave 24 hours between last dose levothyroxine and test

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

[PixieElv]

Thank you SlowDragon,Teva doesn’t cause me any issues but clearly my T3 reduced dramatically and my T4 spiked!

Would you suggest going back to Accord and retesting? After 6-8 weeks? Earlier? Later?

Thank you