Hi everyone, just wondering if anybody has suffered with digestive problems on Teva brand Levothyroxine? It has suddenly come out of the blue for me, lots of stomach pressure, bloating, nausea, discomfort, bubbling feeling. Doc has suggested I try omeprazole but just wondering if it could be related to Teva fillers? I’m thinking a brand change may be wise to rule it out. Thanks x
Digestive issues with Teva?: Hi everyone, just... - Thyroid UK
Digestive issues with Teva?
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jm2450
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SlowDragonAdministrator
How much levothyroxine are you now taking
How long on this dose
You could simply be on too low a dose
Or Teva brand upsets many people
How long have you been taking Teva
When were thyroid and vitamin levels last tested
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis) and especially if under medicated
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Recommended on here that all thyroid blood tests early morning, ideally before 9am last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
List of private testing options and money off codes
thyroiduk.org/getting-a-dia...
Medichecks Thyroid plus antibodies and vitamins
medichecks.com/products/adv...
Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test
bluehorizonbloodtests.co.uk...
If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code
thyroiduk.org/getting-a-dia...
NHS easy postal kit vitamin D test £29 via
I’ve been on 50mcg since last July. Got my blood tested yesterday as they kept me on 50 even though my TSH was 3. Awaiting results today. Since last Friday though, a lot of abdominal discomfort and not sure why.
Because you are under medicated
50mcg is only a starter dose
Request/insist on 25mcg dose increase in levothyroxine
Levothyroxine should be increased slowly upwards in 25mcg steps until TSH is always below 2
Many people, when adequately treated will have TSH around or under one
Most important results are always Ft3 followed by Ft4, aiming for Ft3 at least 50% through range
All four vitamins need testing, likely low as been left under medicated thyroid wise
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 median TSH in healthy population is 1-1.5
web.archive.org/web/2004060...
Aim is to bring a TSH under 2.5
UK guidance suggests aiming for a TSH of 0.5–2.5
gp-update.co.uk/SM4/Mutable...
Persevere - have all guidelines printed and be ready to quote them
healthunlocked.com/thyroidu...
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
Thanks dragon. I will be talking to my doctor today about increasing regardless of my TSH result. I do also want to switch brands of Levo and try accord (mannitol and acacia free) but how would I request this in prescription form if I go up to 75 as don’t they only make 50 and 100?
Hi
I was on Accord as a named brand as I was having issues with itching, there are two ways, either they can issue 42 tablets a month of Levo 50mcg and you use half of one with a full one. Or the other way is alternate day dosing, so one day 100mcg, the next 50mcg. Averaging 75mcg. It doesn't suit everyone, some feel better on a steady continuous dose. It's trial and error 😃.
Thank you sunshine, I feel like I’m being a bit optimistic in them listening to me anyway at this point but I’m just not right!
Levothyroxine doesn’t top up failing thyroid, it replaces it
50mcg is only a starter dose
Have you had Ft4, Ft3 and vitamin D, folate, ferritin and B12 tested this time
ALWAYS test thyroid levels early morning, ideally before 9am and last dose levothyroxine 24 hours before test
GP told me not to fast or not take tablet beforehand as it’s a storage dose so won’t make any difference? Is this correct? I didn’t fast or not take my tablet before my blood test for this reason. There’s so much conflicting information, I am just at a loss as to what to listen to! I’m having my vitamin levels taken next week!
GP is incorrect
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...
So you book an early morning appointment and only have water between getting up and blood test. (As you need empty stomach to take levothyroxine)
Then take levothyroxine immediately after blood test done
Median TSH graph in healthy population is 1-1.5
healthunlocked.com/thyroidu...
TSH daily variation. Highest early morning
healthunlocked.com/thyroidu...
So it’s important when you test TSH ....
researchgate.net/publicatio...
“According to the current TSH reference interval, hypothyroidism was not diagnosed in about 50% of the cases in the afternoon.”
“Further analysis demonstrated inadequate compensation of hypothyroidism, which was defined in 45.5% of the morning samples and in 9% of the afternoon samples”
If delaying taking levothyroxine until after blood test, you likely want to not eat or drink anything apart from water before taking levothyroxine
It may (or may not) make a difference to TSH if fasting ….opinions differ
ncbi.nlm.nih.gov/labs/pmc/a...
ncbi.nlm.nih.gov/pubmed/252...
Ok so my TSH result has come back today at 3.0 (0.35 - 4.94 normal range). So basically my GP won’t do anything with that, so I am going to have to insist that I am put up?
What time was test done
A) if TSH is over 2.5 dose levothyroxine should be increased by 25mcg and bloods retested 8 weeks time.
B) just testing TSH is completely inadequate.
What were Ft4 and Ft3 results
C) if vitamin D, folate, ferritin or B12 are low this tends to lower TSH
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.
Aim is to bring a TSH under 2.5
UK guidance suggests aiming for a TSH of 0.5–2.5
gp-update.co.uk/SM4/Mutable...
They only test my TSH, I have a private test next week for vitamins and FT4 + FT3. The test was done at 8:45 am
I’ve just had a long conversation with GP and she had point blank refused to up my dose!
Suggest you wait until you get private test results back
And vitamin results
Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works
Then Email/post GP copies of FULL thyroid test results and copies of all those official NHS guidelines that state that on levothyroxine TSH should be below 2-2.5 as maximum.
Outline politely that you wish to have trial increase in levothyroxine to 75mcg
or a referral to endocrinologist of your choice
In reality, it needs to be a private consultation with endocrinologist.
A) NHS waiting list is 9-18months
B) very difficult to see named NHS endocrinologist. Frequently you just get junior assistant
Vast majority of endocrinologists are diabetes specialists
Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors
tukadmin@thyroiduk.org
Roughly where in U.K. are you
Some private endocrinologist are still doing consultations on zoom. Distance no object
Initial consultation is £250
Endocrinologist then writes to GP and instructs them to increase dose levothyroxine and maintain TSH around, or under one
(Many people when adequately treated will have TSH well below one)
Thank you dragon, I’m going to wait until I get all my private results back and go from there. GP will at least allow me to request a new brand to try, but I’m doubtful it will sort all my issues out. So next step is my full bloods and vitamins done next week. I will post results here and see if anybody can help me interpret them? After that if anything is indicated, I will get a celiac test.
Suggest you change brand immediately after private blood test next week
Advice on here is only make one change at a time otherwise you can’t tell what’s helping
So change brand, before increasing your dose
Yes come back with new post once you get results
Remember it’s Bank holiday Monday
Only do test early Tuesday (or at a push) Wednesday morning
I will definitely do that and come back with results. Tests, change brand, will order it this week, then I will go about speaking to another GP about dose increase. Cannot believe how awful she was. Told me that it doesn’t matter what I said my results were in range so there is nothing wrong with my thyroid at present and I didn’t need a dose increase. I really tried to argue the point but she wasn’t interested. I never knew how hard it was to get listened to by these people.
I was left extremely under medicated 5 years…..more on my profile
Guidelines are quite clear for GP’s
Levothyroxine “replaces” failing thyroid, autoimmune thyroid disease means your thyroid is being destroyed
So majority of autoimmune thyroid patients patients will eventually end up on approx 1.6mcg levothyroxine per kilo of your weight per day
See also at approx 16 mins into this YouTube clear info of dose levothyroxine
Unfortunately your GP obviously not read the guidelines
Sorry to hear that dragon. Thank you for all your hard work in trying to help us and educate people. It is very difficult. I have spoke to my pharmacy and managed to get prescription to try Accord so will start with baby steps here and work up to sorting this out properly. It’s astounding how little GPs know about the thyroid! Quite worrying that I’ve learned more here about everything than I have ever learned from a GP!
Especially as there’s 2 million people in U.K. on replacement thyroid hormones…..vast majority are female
Levothyroxine is 2nd or 3rd most prescribed medication……so it’s not like it’s rare
Exactly, it is crazy to think that there are so many people probably needlessly suffering.
You might find my medicines document of some help.
It has a table of UK brands which identifies which contain lactose, mannitol and acacia.
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.
From Dropbox:
dropbox.com/s/shcwdwpedzr93...
From Google Drive:
I was switched to Teva and had such bad nausea and felt so unwell. The fillers in the tablets can really effect some people and the absorption of the T4. I would suggest asking your doctor to try you on a different brand or put a named brand on your prescription if there is one you feel well on. I now take almus/accord....would never accept Teva again!
SlowDragonAdministrator
You might find this post interesting and her results
Teva made me very unwell, due to the acacia filler. I went on to Accord/Actavis/ Almus and never had any more problems. My prescription specifies NO TEVA and requests the above. Same for T3. A TSH of 3 is not acceptable when you are being treated with levo, it should be one or less. Hope you can find a more competent GP, especially one that doesn't patronise their patients!
Thanks crimple. I’m going to switch to accord and see if it helps, but I’m also going to get back on and request different GP to speak to re my results. It’s so frustrating. They see my range goes up to 4.94 and say well because you’re in normal range you’re absolutely fine, it’s all in your head. That extra .25mcg isn’t going to push me too far down is it? Is that what they’re worried about?
Such idiot GPs, the range is only for diagnosis, once you are on Levothyroxine TSH should be below 2 and better if below one. They are all obsessed with TSH, few of them know that T4 is a storage hormone which has to be converted by the body to T3 so that every cell in the body can use it.
Most have never heard of the issue with DIO2 gene which determines whether or not you can convert T4 to T3. I always had low T3 but they wouldn't let me have any because my TSH was suppressed.
Now on 15 mcgm T3 with 100mcgm T4, finally feel human, no brain fog and my TSH is well below the bottom of the range. As I have said on here before, I told the GP that I preferred a life to an existence. They don't mess with me now just ask me to attend for annual blood test. I remind them that they must test TSH, T4 and T3 and I am not interested in TSH result! Good luck getting "through" to your GPs. Keep coming back here for proper info and advice.
Thanks so much for your advice crimple. It’s very hard when starting out on this kind of journey, not knowing anything about it all and GPs constantly saying everything’s fine when it’s clearly not otherwise why would I be feeling this way! Currently at work trying to plod through and use my brain, but it just isn’t functioning like it used to. I’m just tired and foggy! And it is not normal. 8 hours sleep and no idea what I’m doing!
jm2450 I learned everything from this site and it gave me the courage to fight my corner. For 5 years I had meekly accepted the advice that I was over medicated, I wasn't. It was my TSH being low, but so were T4 and T3. I bought lots of books and read as much as I could on this site. Due to brain fog it took a while to filter into my brain.
Finally 5 years ago I dared to go it alone and obtained some T3. I went very, very slowly, but have been on my current dose about 3 years.(GP sent me to an endo, I am lucky to live in the area where T3 is available.)
I rate my health about 8/10 compared to 4-5/10. Having Hash's does complicate things a bit, but I have been Gluten free a long time and it does help, also dairy free. My quality of sleep has improved too and the palpitations and pulsatile tinnitus went away. Patience is the thing and also perseverance. good luck
Hi jm2450.
An increase of 25mcg is highly unlikely to lower your TSH of 3 so much it goes below range , but to help an 'overcautious' (under educated) GP feel more comfortable with the idea, ask for " a trail increase to see if it will improve your symptoms " and use the references below to support you request .
If they still refuse to even try it , then write a letter ( ? to the practice manager) saying something like this;
~ After seeing Dr .... on .... , i was refused a trial increase of my dose of levothyroxine.
I would like to trial an increase of 25mcg to see if it improves my symptoms of ...... .
I am aware of several recommendations for GP's treating patients on Levothyroxine to keep TSH below 2.5 , and i am aware that the most common level for TSH in people without thyroid disease is under 2 , usually around 1. (references enclosed )
I do not think it likely that a small increase of 25mcg would cause me to become overmedicated or take my TSH below range, since it is currently near the top of the reference range at 3 .
I am aware of the signs and symptoms of overmedication , (fast heart rate , feeling hot . sweating, increased frequency of bowel movements , fine tremor in fingers of outstretched hand )and i would of course let my GP know if i experienced any of these .
TSH and fT4 can be retested after 6/8 weeks on increased dose to re-asses blood levels and symptom response , so if 25mcg increase did result in overmedication it could be reduced slightly.
If you are not prepared to allow me to trial an increase of 25mcg, please provide a written explanation of the reasons why you think it is inappropriate for me to have a TSH of 1 or 2 which is in line with the majority of healthy people ~
References:
1) GPonline.com 15th April 2010.
gponline.com/endocrinology-...
"Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L." Written for GP's by "Dr Iqbal is a specialist registrar in endocrinology and Dr Krishnan is a specialist registrar in cardiology, Liverpool".
2) GP-update.co .uk
gp-update.co.uk/files/docs/...
"The goal of treatment is to make the patient feel better and this tends to correspond with a TSH in the lower half of the reference range (0.4–2.5 mU/l).
If a patient feels perfectly well with TSH between 2.5 and 5 mU/l there is no need to adjust the dosage" .
3) Pitfalls in the measurement and interpretation of thyroid function tests.
Olympia Koulouri, MRCP, NIHR Academic Clinical Fellow, Carla Moran, MRCPI, Senior Clinical Fellow, David Halsall, PhD, FRCPath, Consultant Clinical Scientist, Krishna Chatterjee, FRCP, Professor of Endocrinology, and Mark Gurnell, PhD, FRCP, Senior Lecturer in Endocrinology & Associate Clinical Dean ncbi.nlm.nih.gov/pmc/articl...
" ....optimal thyroid function tests (e.g. normal T4 and T3 with TSH <2 mU/L in primary hypothyroidism). "
4) page 13 in the liothyronine (T3) guidance... sps.nhs.uk/wp-content/uploa...
" ... optimal dosage with levothyroxine TSH 0.4-1.5mU/L "
5) Graph showing TSH distribution in healthy population .... web.archive.org/web/2004060... (TSH is most commonly around 1 or 2)
Wow. Thank you for all of that tatty! That’s a great wealth of information that I shall be using!
Just seen your post as am trying to find this out due to similar issue. My levothyroxine has been changed to Teva and after taking it for a couple of days my indigestion has increased ten fold. I do suffer with it anyway but also find PPI’s don’t work so struggle along. Maybe a coincidence but it’s making me SOB the symptoms are so bad. Did you manage to find a solution to your question?
I didn’t find the answer, although I took omeprazole for a week and then I switched to the Accord brand pill and so far I haven’t experienced anything quite as bad as I was experiencing but I am giving it a few weeks before I make the assumption that it may have been the Teva. I had been on Teva for 10 months with no digestive issues so it could just be a coincidence. It also appears that I am currently under medicated which could be a contributing factor, and recently found out I am vitamin D deficient and low in folate so it could be a number of factors sadly. It’s all trial and error isn’t it, which is really frustrating! I hope you find some answers!
Could I ask if you felt the Omperazole worked for you? I have read conflicting information that suggests having hypothyroidism means you have low stomach acid so taking a PPI can make it worse. I’m at the stage now though where I’m willing to try it I think.
The omeprazole has done something but I still have something going on digestively. It’s not 100% normal, but I haven’t had it as severe as before I took the omeprazole. I think re: the omeprazole and hypothyroidism, short term it’s alright, I definitely won’t be taking it long term though. If I’m honest my stomach hasn’t been right since having covid in January, so with me it could just be so many different things!
I take digestive enzymes which work really well.
I experienced the same plus extreme diarrhoea. I already suffer from IBS so mannitol - a known laxative - just made everything worse. I didn't realise it was a new brand, just picked them up from a different pharmacy, started taking them and the symptoms began. 'Then' I looked at the prescription boxes as it was the only different thing in my life and noticed TEVA brand and mannitol. Up till then I was taking mercury pharma with lactose, which I am perfectly okay with. Incidentally, this also happened to my 'then' husband.
Hiya, thanks for the response! I switched to Accord five weeks ago and sadly I’ve still had a couple of stomach flare ups so I’m not sure that the Teva was the issue! I’ve also had some other things develop like tingling and numbness in legs which are brand new for me! So I honestly have no idea whether it’s the hypo or the thyroxine brands. I am in the middle of upping my dose so maybe things will get better….. I hope anyway…..
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