Side effects of starting levothyroxine?

[Mrs_Tumnus]

I took my first levothyroxine 25 this morning and this evening I'm feeling super nauseous. Coincidence?

[DippyDame]

Difficult to say for certain. however....

It's not unusual to feel worse for a few days after introducing/changing your dose.It used to happen to me and at the time I didn't understand why.....it's disconcerting.

However, it's usually only the body adjusting to the added hormones... not that you won't be able to tolerate the levo

Chances are this is what has happened ...

particularly If you felt OK before taking the levo.

Hopefully it settles soon.

Meantime monitor how you feel and stay hydrated.

[SlowDragon Administrator]

Could be coincidence

25mcg is very small dose. Standard starter dose of levothyroxine is 50mcg. Starting on too small a dose can exacerbate hypothyroid symptoms. See how you get on

Which brand of levothyroxine have you started with

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, Glenmark 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

[Recon]

Adding my two cents - I occassionaly get nauseous when taking levo - if I wasn't drinking enough water. On those occasions I literally threw up an hour or two later. I don't have issues if I drink a full 8-10 ounces of water. Just something else to keep an eye on...

[Nineby]

I started taking my first ever lot of tablets (Amlus at 50mg), on Friday last week - so 9 days ago now. At first I seemed ok but since Wednesday I have had diarrhoea (now gone thankfully!), nausea, loss of appetite, bit of dizziness. I'm also very bloated and have an uncomfortable tummy. At first I thought it was a tummy bug, but now I'm concerned these are side effects. It's hard to know for sure though, like you, I do wonder if it is just a coincidence...I'm hoping my body will settle down very soon!

[helvella Administrator Thyroid UK]

Are you taking it with a glass of water?

[Nineby in reply to helvella]

Hi helvella, is that a question for me? If so, thanks for replying. I have only had a very small amount of water with my tablets - I normally drink water when taking tablets to help them go by but these ones are so small I haven't had more than a couple of sips. Do you think that would help?

[helvella Administrator Thyroid UK in reply to Nineby]

Well, I'm not going to promise anything, but it is worth a go.

[Nineby in reply to helvella]

Thanks, took your advice and I appear to be feeling more normal today, not sure if it is connected but it definitely doesn't hurt anything

[helvella Administrator Thyroid UK in reply to Nineby]

Pleased to read that.