Allergic to Levothyroxine

[Kazzyloulou]

I just wondered what it feels like to be allergic to Levothyroxine or have it not agree with you. I'm increasing slowly from 50 to 75mcg of Levothyroxine (Accord), doing alternate days before a blood test again in 3 weeks. But I feel awful, very low mood, exhausted and itchy. Not sure if to wait it out or get an appt sooner. Should I be feeling better? I did post my results on here before but I can't find them?

[SeasideSusie Remembering]

Kazzyloulou

To find your previous posts click on your user name or your avatar, this takes you to your profile page where you will see POSTS and REPLIES that you have made.

This is your previous post:

healthunlocked.com/thyroidu...

I'm increasing slowly from 50 to 75mcg of Levothyroxine (Accord)

How are you achieving 75mcg, are you cutting a 50mcg Accord tablet in half and adding 50 plus 25mcg?

[Kazzyloulou in reply to SeasideSusie]

Thank you re the previous post...I found it! I'm taking 50 and 75 on alternate days.

[SeasideSusie Remembering in reply to Kazzyloulou]

Is it a 75mcg tablet? Accord don't make a 75mcg one, only Teva do.

[Kazzyloulou]

Sorry, yes the 75 is Teva.....I didn't realise they were different.

[SlowDragon Administrator in reply to Kazzyloulou]

How long have you been on just 50mcg levothyroxine

Did you always get Accord brand for 50mcg tablets

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 extra 50mcg Accord tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Glenmark or Aristo (100mcg only) are lactose free and mannitol free. May be difficult to track down Glenmark, not been available very long 

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.

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).

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

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...

markvanderpump.co.uk/blog/p...

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)

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

[SeasideSusie Remembering in reply to Kazzyloulou]

Kazzyloulou

So it's likely the Teva brand is causing you problems, quite common with some members to have adverse reaction to Teva. So on your 75mcg days try taking 1 and a 1/2 of the 50mcg Accord tablets and see if those symptoms disappear. If so refuse Teva in future and put in a yellow card report about your adverse reaction to it. See this post on how to do a yellow card report:

healthunlocked.com/thyroidu...

[Kazzyloulou in reply to SeasideSusie]

Thank you for your help, its much appreciated.

[Kazzyloulou]

I've been on 50mcg accord for 15 years plus. Latest T4 was 12.6 (9-19.10 range). TSH was 3.19 (0.35-4.94 range). Ferritin 67, I take 2 x Ferrous Fumarate a day. Vit D 84. Cholesterol 6.1. Not had Folate and B12 recently. Last one was B12 856, Folate 5.4. Shall I go back to taking Accord only but still do alternate, same dose until next blood test? Or take 50 plus 1 quarter a day?

[Jazzw in reply to Kazzyloulou]

Hi Kazzyloulou.

As you didn’t reply directly to SeasideSusie and SlowDragon they probably won’t see you reply, so I’ve tagged them in to this.

Given your most recent TSH and FT4 you’d almost certainly be ok on 75mcg levothyroxine daily—you were clearly under medicated on just 50mcg! But I realise there may be a reason you’re going more slowly with a dose increase? 50mcg is a starter dose and you almost certainly shouldn’t have been left on that dosage for 15 years! Was it your doctor’s idea to only increase by 12.5mcg a day??

If it were me, I’d want to be taking the same amount every day (not least so I didn’t accidentally lose track of which days I was supposed to take extra 🙂). So I’d do the 50mcg plus a quarter (well, being honest and given your ongoing symptoms I’d do 50mcg plus a half and make it 75mcg a day but you probably don’t have enough spare pills to do that).

Your folate is quite low. Would be well worth taking a folate supplement to bump that up a bit—or a Vit B complex with a decent amount of folate in it.

[SeasideSusie Remembering in reply to Kazzyloulou]

Kazzyloulou

Shall I go back to taking Accord only

That's the only way to find out if Teva is causing the problem.

but still do alternate, same dose until next blood test? Or take 50 plus 1 quarter a day?

That's up to you, either would be fine. Whichever you are comfortable with.

[SlowDragon Administrator in reply to Kazzyloulou]

Yes ….1 Accord plus 1/4 tablet every day

After 6-8 weeks…get retested and increase dose to 1 Accord plus half a tablet

Meanwhile request new prescription for extra 50mcg tablets (Accord brand only)

You have been left woefully under medicated for far too long

Need to take increasing dose levothyroxine very slowly after such a long time left hypothyroid