Change of levothyroxine suppliers

[AHPH1]

Hi my pharmacist has managed to get supplies of mercury 50mg levothyroxine. I had been on these for 5 years. But recently they had not been available, so had to change to accord. Have been taking accord now for fours months. And doing ok. My pharmacy now has the mercury and I changed back. But started feeling really off after changing back. With headaches and dizzyness. Has anyone ever experienced this with swopping suppliers. Thankyou

[helvella Administrator]

Many of us notice differences between makes. At one point, I was in a similar position to you and decided to go with Accord rather than Mercury Pharma. There wasn't a huge difference for me, but definitely something.

Also, Accord has been more reliably available in the years since.

Relatively few of us do well on a dose as low as 50 micrograms.

I suggest that the change of make might be revealing a continuing under-dosing. Would very much like to see you getting re-rested - TSH and FT4 and FT3 (if possible).

[AHPH1 in reply to helvella]

Thank you, doctor phoning me today. Going to ask for blood test to be done. Did seem alot better with accord

[helvella Administrator in reply to AHPH1]

The cost of another prescription, so you can switch back to Accord is trivial (the GP time and dispensing fees being more than the cost of the medicine). So ask for at least that.

All the best.

[AHPH1 in reply to helvella]

Thankyou, yes I will do. I no my pharmacy have accord in stock

[AHPH1 in reply to helvella]

Hi thankyou, got some accord 50mg and having bloods done next week. Am I meant to be taking any vitamin tablets too. Dr never suggested any in 5 years.Thankyou

[helvella Administrator in reply to AHPH1]

I think SlowDragon will be responding - she usually does.

[SlowDragon Administrator]

How long have you been left on just 50mcg levothyroxine

When were thyroid and vitamin levels last tested

ALWAYS test thyroid levels early morning and last dose levothyroxine 24 hours before test

Essential to test vitamin D, folate, ferritin and B12 at least once a year

If under medicated on inadequate dose levothyroxine, vitamin levels tend to drop

Low vitamin levels tend to lower TSH

Essential to test Ft4 and Ft3 ….not just TSH

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

[AHPH1 in reply to SlowDragon]

Hi thank you. Having my bloods checked next week

[AHPH1 in reply to SlowDragon]

Hi have been on 50mg levothyroxine for about 5years. I have my bloods done if I feel a bit off. They were done about 3month ago. And came back satisfactory. Just a week after having supplier change. I have been having dizzyness in the morning since changing suppliers. GP thought I may had labyrinthitist. But my ear checked out fine. Wondered if the levo meds could cause this. Thankyou

[SlowDragon Administrator in reply to AHPH1]

Guidelines on dose levothyroxine are quite clear

GP should increase dose levothyroxine slowly upwards until Ft4 is near top of range and all symptoms gone

Most important results always Ft3 (at least 50-60% through range)

all four vitamins need testing at least annually and maintain at OPTIMAL levels

Being under medicated for thyroid frequently causes low stomach acid levels and poor nutrient absorption, leading to low vitamin levels

OPTIMAL vitamin levels are

Vitamin D at least over 80nmol

Serum B12 at least over 500

Folate and ferritin at least half way through range

Dizziness is frequently low B12

What vitamin supplements are you currently taking

Typical daily dose levothyroxine is 1.6mcg per kilo per day

So unless very petite, likely to need to increase dose SLOWLY upwards in 25mcg steps until on at least 100mcg levothyroxine per day

[AHPH1]

Hi, which vitamin should I be taking. Having my bloods done next week Thankyou

[1tuppence in reply to AHPH1]

If you're replying to SlowDragon you need to either high-light her name, or use the Reply button underneath her reply to you...otherwise she will not know you have replied to her ...lots of members in this forum

[AHPH1 in reply to 1tuppence]

Thank you will do

[SlowDragon Administrator]

Am I meant to be taking any vitamin tablets too. Dr never suggested any in 5 years.

Yes GP should test vitamin D, folate, ferritin and B12 at least annually

When hypothyroid we frequently develop LOW stomach acid. This leads to poor nutrient absorption and low vitamin levels

Low vitamin levels tend to lower TSH (all a GP often, inappropriately looks at)

On levothyroxine we MUST have GOOD vitamin levels

EXTREMELY Common on levothyroxine to need to supplement vitamin D and vitamin B complex virtually continuously to maintain OPTIMAL vitamin levels

Approx how old are you

Low vitamin levels are more common as we get older

Low vitamin levels very common if left under medicated

Thyroid levels

They were done about 3month ago. And came back satisfactory

please add actual results and ranges

ALWAYS get actual results and ranges on all blood tests

Always test thyroid levels early morning and last dose levothyroxine 24 hours before test

I have been having dizzyness in the morning since changing suppliers.

Many people find different brands of levothyroxine are not interchangeable

But more likely just needing dose increase in levothyroxine

Approx how much do you weigh in kilo

Levothyroxine doesn’t “top up “ failing thyroid…it replaces it. Essential to be on high enough dose

Typically dose levothyroxine is increased slowly upwards in 25mcg steps until on approx 1.6mcg per kilo per day

A few people need less, some need higher dose

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.

[AHPH1 in reply to SlowDragon]

Hi, thank you