Stomach issues on Teva Liothyronine

[Cookerybookaddict86]

Has anyone experienced stomach issues with Teva Liothyronine?

My 18 year old daughter, who has secondary hypothyroidism, recently had her prescription changed from 75 mcg of Levo to 50mcg of Levo plus 20mcg of Liothyronine. The endo specified on the prescription that the Liothyronine should be Thybon Henning, however the pharmacist gave her Teva instead and with hindsight we really should have queried this.

She's been on Liothyronine now for just over a week and her stomach feels very bloated, painful and she's also constipated. She had very bad digestive problems before going on to Levo several months ago, however everything seemed to improve quite a bit on the Levo and we were hoping that a small amount of T3 would improve things even more, however it seems to have had the opposite effect! Other than these stomach issues she hasn't experienced any side effects at all from the Liothyronine , although from reading other posts it seems as though she's been given a very high starting dose. We would love to know whether anyone experienced anything similar to this?

[Jazzw]

Oof, going straight in at 20mcg is a big change.

Generally here we advise introducing liothyronine much more slowly—say 5mcg at a time.

I wouldn’t reject the prescription—it’s fab that she’s been prescribed a half decent amount of liothyronine—but it would be well worth trying a lower dose of liothyronine and working up to a higher dose.

[Jazzw]

Don’t worry about it being Teva by the way. It’s a different formulation to Teva T4.

Although as you say, the Thybon Henning should have been honoured.

What brand of levo is the 50mcg??

[Cookerybookaddict86 in reply to Jazzw]

Thank you for your reply. The levo she's on at the moment is Accord. Weirdly enough when she was on 75mcg of Levo, it was actually Teva and her stomach felt fine, although as you've pointed out it's a different formulation to the T3.

[Lalatoot]

Starting lio like that is quite a shock to the system.

The gentler way is to reduce levo dose for the first week to give ft4 time to reduce.

The next week add in 5mcg lio.

If all well add in another 5mcg lio and then add in 5mcg lio every 2 weeks until you reach a total daily dose of 20mcg.

Doctors seem to consider 20mcg as a typical dose for lio. Some folks don't need that much.

My prescribed dose was 50mcg levo and 20mcg lio. After 2 years of slowly and methodically altering doses I found that I was much better on 100mcg levo and 7.5 lio both split into 2 doses.

Doctors can't really gauge what an individual's combo dose will be - it something the person has to work out by trial and error.

[Cookerybookaddict86 in reply to Lalatoot]

Hi Lalatoot, that's very interesting, thank you! Did you have any side-effects from taking 20mcg of Lio? It sounds as though you're actually doing a lot better on much less. My daughter hasn't had any side-effects other than these stomach issues which came on two days after she started taking it so we're pretty sure there must be a connection.

[Lalatoot]

I started as I described by reducing my levo week 1 and then building up to the 20mcg dose (Teva) every 2 weeks. Once established on the 50/20 dose my ft4 was 0% and my ft3 76% and I did not feel well. Some folks need both ft4 and ft3 at least around 50% through range while others are well with low ft4 if ft3 is high. So I set about increasing my ft4 levels. On 50/7.5 my ft4 is 50%through range and my ft4 72% through its range.

[Aurealis]

I started on 20mcg and it only gradually had an effect. 20mcg Lio is equivalent to about 100mcg Levo so she’s on double the dose of hormone in total as she was before, a big increase. Isn’t thybon henning Liothyronine hydrochloride not Liothyronine sodium? I wouldn’t have thought they could substitute in that case. What is endo aiming for - T3 only?

Once her body gets used to T3 she might need to reduce Lio or Levo quite quickly. A too high dose can cause constipation in initial stages

[Cookerybookaddict86 in reply to Aurealis]

Thank you for your reply, it's very helpful.

I'm not entirely sure what the long term aim is although there hasn't been any suggestion from her endo of aiming for T3 only. We had assumed that if her T3 dosage was too high, she would end up with loose bowels but it seems to be having the opposite effect and she's gone back to where she was before she started on Levo (ie very constipated!)

[Aurealis in reply to Cookerybookaddict86]

a lot of thyroid symptoms occur if levels are not optimal, so too much or too little sometimes cause similar symptoms. If she can bear it, it’s best to let it settle down. Pay attention to a healthy diet, avoid white bread, eat plenty of veg, fruit, granary bread, soup, etc (and I would eat chocolate too)

[SlowDragon Administrator]

T3 was almost certainly started too quickly

Adding T3 should be done SLOWLY ……usually only 5mcg …..wait at least a week before adding 2nd 5mcg dose mid-late afternoon

Often hold at this dose for 6-8 weeks and retest before considering increasing

However…..she is where she is …..probably worse to reduce

Stick with 20mcg …..but she will likely need to split dose…..if not doing so already

Is she cutting T3 into 3 doses (with craft scalpel or pill cutter)

Many people on T3, certainly initially, need to split the dose and spread across the day

So cut into 3 and taking T3 at approx 7am, 3pm and 11pm

Many people find SMALL 5mcg dose T3 at bedtime improves sleep

Or ….if last dose keeps her awake…..6am, noon and 6pm

ESSENTIAL to test vitamin D, folate and B12 too at next test if not tested recently

[Cookerybookaddict86 in reply to SlowDragon]

Thank you SlowDragon. She is splitting the dose in two (6am and 11.30am) but perhaps 3 doses would be better and thanks for the reminder about vitamins - it's been several months since these were last tested, so we probably need to retest quite soon.

[SlowDragon Administrator in reply to Cookerybookaddict86]

what vitamin supplements is she currently taking

[DandyThyro]

I see your post is fairly old and had lots of replies, so you're probably sorted. However, if not, I suggest you check the ingredients of your Teva Liothyronine. I can't take Teva Levothyroxine due to one filler, mannitol, used instead of lactose. That filler doesn't seem to show up in any other levothyroxine nor any other Teva product I take. It's great for people with a lactose intolerance, but awful for people who can't take mannitol, and shows up as digestive issues. For me it was constant nausea and biliousness. Later I found out that people with a northern European DNA dominance are more likely to have that intolerance. Good to know.