TSH and Levo increase

[mrskiki]

So another bloodtest and not sure what the results show except that several months in, my TSH is for whatever reason increasing nicely on the starter dose to enable an increase now from 50mg to 75mg, and my FT4 hovers around 30%. So a recommendation to test again in 2-3 months.

I didn't get another finger prick test for T3 as the dose was still low and I didn't feel (or look) much different so thought I'd wait rather than bruise all my fingers again?

Still taking the D3/K2 spray.

I have some DIO2 and 1 gene variants mainly on one side that I'm still working out the implications of, indicating I may eventually need T3 but I'll see where I get with the T4 first.

[SlowDragon Administrator]

No problem getting dose increase with that high TSH

Which brand of levothyroxine are you currently taking

If avoiding Teva (only brand that makes 75mcg tablets) request 50mcg and 25mcg if on Mercury Pharma brand

If on Accord (also boxed as Almus via Boots or Northstar via Lloyds) Accord don’t make 25mcg tablets. Get extra 50mcg tablets and cut in half to get 25mcg

Recommend getting vitamin D, folate, ferritin and B12 tested at next test

[mrskiki in reply to SlowDragon]

Thank you SlowDragon. The nurse reactivated the 25mg prescription to use up the 50mg so I'm getting a 50 and 25 😁 Pharmacy tend to give Merc in 50, and the 25s Wockhardt and Merc. I did once get Teva 25 early on, so thought I'd give it a go as by then had a food intolerance test which annoyingly showed lactose, casein, whey intolerance (I love that whole organic unhomogenised creamy milk .... and tea with oatmilk - well its more of a porridge water). Anyway after a few days my puffy eyes seemed worse and a bit piggy and sore. Can't see anyone else having that specific problem when I had a look through the forum but it put me off a bit as made it even harder to get to work so I didn't finish them. The Teva tablets are small but oddly several times the volume of the others which are tiny.

Oh, and for the vit tests is it worth doing now?

[SlowDragon Administrator in reply to mrskiki]

Many people have note added to all levothyroxine prescriptions “No Teva”

Or note saying “Brand xxxx only”

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.

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).