Insomnia

[Specky1981]

Hi, I just started low doses of Levothyroxine last week, 25mg per day. And since then my insomnia has returned to the point where I only managed 2 hours sleep last night! Could this be the medication? And has anyone else experienced this please?

[Buddy195 Administrator]

Welcome to the forum Specky1981.

Can you please give us some more information so that members can best advise.

Do you have the results of your thyroid blood tests (eg TSH, FT3, FT4)? Please also supply the ranges as these can vary between laboratories, if you don’t have them, do ask your GP surgery for a copy (as you are legally entitled to these).

Apart from insomnia, what other symptoms are you experiencing?

25mcg of Levothyroxine is an extremely small starter dose and it is likely you will need an increase after 6 weeks.

[Specky1981 in reply to Buddy195]

Ok thanks, I will try and get the blood results. It just seems weird that I was sleeping so well and then start the tablets and my sleep goes bad again! It’s awful.

[SlowDragon Administrator]

Try taking your levothyroxine at bedtime

Which brand of levothyroxine have you got

Approx how old are you

Standard starter dose of levothyroxine is 50mcg

Starting on too small a dose can make symptoms worse

[Specky1981 in reply to SlowDragon]

Many thanks.Would taking it at bed time not make it worse?

[Specky1981 in reply to SlowDragon]

I’m 47The brand is North Star

[SlowDragon Administrator in reply to Specky1981]

Insomnia likely because dose is too small …..taking levothyroxine at bedtime can be more effective as it’s better absorbed

Must be minimum 2-3 hours after a meal and no snacks before bed. Nothing apart from water for at least an hour before and after levothyroxine

Northstar 25mcg is Teva brand (just to be confusing)

Teva upsets many people

Request a new prescription from GP

Say you have spoken to Thyroid U.K. and understand many people don’t tolerate Teva brand levothyroxine

That you would like to try a different brand

Try Wockhardt or Mercury Pharma (Advanz) or Eltroxin (also Advanz)

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

Teva contains mannitol as a filler, which seems to be possible cause of problems. It changes the gut biome

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 or Wockhardt

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets

Mercury Pharma brand is often listed as Advanz on pharmacy database

Eltroxin and Mercury Pharma are identical

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

Wockhardt only make 25mcg

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.

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

[Specky1981 in reply to SlowDragon]

Many thanks for the info.

[SlowDragon Administrator]

What were your thyroid results BEFORE starting on levothyroxine

Have you had vitamin D, folate, ferritin and B12 levels tested

Essential to test vitamin levels and thyroid antibodies

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

Approx how much do you weigh in kilo

[Wua13262348 in reply to SlowDragon]

Like you I was started on Northstar 25mcg levothyroxine recently. First 3-4 days I was awakening every 1-2 hours a night and bit of a sore head and nausea during the day for first week. Also felt a bit bloated on it.I have reasons already documented in previous posts to not want to take this brand because of the mannitol it contains.

I felt no benefit from it , and think took it for maybe about 6-8 weeks before managing to get switched to Glenmark, and immediately felt that maybe there is a human being trying to emerge!

Glenmark is the one, in my opinion, least likely to cause you gut problems as it is lactose, mannitol and maltitol free.

You will only get it from an independent chemist as the supplier is Phoenix, and Lloyds and Boots don't deal with them.

Hope this helps.

[Specky1981 in reply to Wua13262348]

Thank you very much. Glad you got a decent brand in the end. I will ask for different as hopefully will be more suitable!