Thyroid meds and lactose intolerance

[V3ra]

Lactose and gluten are major triggers for my Hashimotos. My GP has just prescribed me levothyr0xine. However, having just read the information leaflet, this contains lactose - one of my triggers. Anyone know if there are lactose free options and I should push back to my GP for an alternative?

[dizzyarmadillo]

Teva is one of the lactose free ones and the one I currently use (lactose is a major trigger for me too).

I spoke to the pharmacist at my doctor's surgery, as well as the pharmacist I collect my medication from and explained the situation and they've both specified on their systems that I need lactose free prescriptions - maybe it's worth trying this too?

[V3ra in reply to dizzyarmadillo]

that’s a great idea, thanks!

[SlowDragon Administrator]

Yes there are two lactose free brands levothyroxine in U.K.

How much levothyroxine are you starting on

Standard starter dose is 50mcg.

Many people find Levothyroxine brands are not interchangeable.

Lactose free are

Teva, available as 25mcg, 50mcg, 75mcg and 100mcg

Aristo, currently only available in 100mcg tablets

Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome 

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

Aristo (currently 100mcg only) is lactose free and mannitol free. 

March 2023 - Aristo now called Vencamil

healthunlocked.com/thyroidu...

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

Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets 

 

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.

Government guidelines for GP in support of patients if you find it difficult/impossible to change brands 

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching 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).

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

[V3ra in reply to SlowDragon]

thanks so much for this comprehensive reply. I’m starting on 25mg as I’ve managed to get my TSH down to 3.9 with cutting out gluten and dairy but my TPOs are still super high 1018. I’m also starting on LDN with a functional medicine pharmacist. (My GP isn’t really very supportive of trying to address the autoimmune element and as they considered my TSH to be within normal levels didn’t really think any thyroid meds were necessary. I’ve read that taking thyroid meds can also help lower antibodies and that my TSH needs to be under 2 anyway. So I’m not sure how supportive the GP will be in changing but I’ll give it a go as I don’t want to take something with one of my triggers in, just seems counter productive).

[SlowDragon Administrator in reply to V3ra]

You need note added to your medical records that you’re lactose and gluten intolerant

Request new prescription from GP for lactose free levothyroxine. This will be Teva

You need to be aware levothyroxine doesn’t “top up” failing thyroid, you will almost certainly need several dose increases over coming months

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.

[helvella Administrator Thyroid UK]

My document has a chart of which products and dosages are available and whether they contain lactose.

helvella's medicines document can be found here:

helvella - Thyroid Hormone Medicines

helvella has created, and tries to maintain, a document containing details of all thyroid hormone medicines in the UK and, in less detail, many others around the world.

This link takes you to a page which has direct links to the document from Dropbox and Google Drive, and QR codes to make it easy to access from phones.

helvella.blogspot.com/p/hel...

[V3ra in reply to helvella]

thanks for this, I’ll have a look

[Auntyp62]

I insist on Teva, no side effect and keeps me awake all day. Nothing else seems to work the same for me.

[Ratherbegardening]

After many years of being fine on levo, I became dairy intolerant. When I realised this, I was staggered by the amount of tablets generally that contain lactose - eg all antihistamines. I went to loads of bother to find a chemist that dispense Teva. Took it for 6 months, it didn't do anything for me, think it gave me more stomach pains and thyroid symptoms were definitely worse. Went back on usual lactose containing levo and I seem to manage with that small amount daily, with no other dairy in my diet at all. For antihistamines, I now use the liquid stuff that is meant for kids, expensive way of taking it!

[helvella Administrator Thyroid UK in reply to Ratherbegardening]

You have not said which active ingredient you take - but for Cetirizine, there are at least two lactose-free products - Somex and Manx. Price and availability of another matter! And there could be others.

mhraproducts4853.blob.core....

mhraproducts4853.blob.core....

[Ratherbegardening in reply to helvella]

Ooh thanks Helvella. I think at the time I checked the usual ones I had been buying (cheapest) and they all contained lactose. I asked the pharmacist and he said the only one was the piriton liquid so didn't look further. Will check these out.

[helvella Administrator Thyroid UK in reply to Ratherbegardening]

Much as many pharmacists know, and helpful though they might want to be, they don't know everything. And things do change over the years!

It is a rubbish search mechanism, but put in the active ingredients, and choose only PIL (Patient Information Leaflets) and look for section 6.

Tedious, plodding and easy to make a mistake. Also seems to have lots of near-identical products!

products.mhra.gov.uk/

[helvella Administrator Thyroid UK in reply to Ratherbegardening]

You might care to read my speculation on lactose intolerance:

helvella.blogspot.com/p/hel...

[SecondAngel]

I'm the same and take Teva. My pharmacy just asked that the GP specified gf/df in the prescription. From experience, always check what brand you've been given before you leave the pharmacy to save hassle in case of mistakes.

[Tintin0202]

I too am gluten and lactose intolerant. Teva did not suit me at all and could not find any tablet that made me feel well. I am now taking Zentiva liquid thyroxine which has made all the difference and am at last feeling so much better. But it is very expensive compared to the tablets (around £150 a bottle) and at the moment in short supply.