Which T3 brand?

[Geegee777]

I have finally been given a nhs prescription for T3.,which stipulates Thybon Henning, at my request. However ive found only one chemist in my area North Wales, who is willing to try and get some. Can anyone recommend a lactose free form of T3?Now im feeling better, I dont wish to feel rubbish again, so any advice will be most welcome 🌸🌸🌸🌸🌸🌸

[Jaydee1507 Administrator]

Many people use their private prescription to buy by post, so distance is no obstacle, also you can find the cheapest price. Recommendation is to phone several of the pharmacies on this list for a quote prior to posting your prescription to them.

Thybon-Henning cost should be 50-60p per tablet.

thyroiduk.org/if-you-are-hy...

[helvella Administrator]

Details of all UK and many non-UK liothyronine products are in my medicines documents.

You could try the list of pharmacies on the Thyroid UK website:

thyroiduk.org/if-you-are-hy...

helvella's medicines documents (UK and Rest of the World) can be found here:

helvella - Thyroid Hormone Medicines

helvella has created, and tries to maintain, documents 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 documents from Dropbox and Google Drive, and QR codes to make it easy to access from phones.

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

[McPammy]

I’ve tried to obtain Sanofi Thybon Henning 20mcg from the NHS unfortunately the hospital pharmacies I’ve contacted cannot order it as it is not licensed within the NHS. I get Morningside Healthcare from the NHS 5mcg size tablets as I take 5mcg twice a day. When I switched from Thybon to Morningside I found Morningside to give me quite a boost initially but that dropped away quickly. When I got my bloods done after several weeks on Morningside my TSH had raised and T3 was lower. I also put on weight during that period. I switched back to Thybon and felt better. I now only use Thybon and keep my Morningside as a safety net. I also take Liquid Levothyroxine daily. As a side note recently I couldn’t get Liquid Levothyroxine for a while. Eventually some stock came through but it was only 125mcg strength when I normally take 50mcg strength. So the pharmacist advised to reduce my daily dose. I did that precisely. I got my bloods done again a few weeks later. To my surprise my TSH had gone suppressed and my T4 and T3 went very high. Never been that high before. So now I’m wondering if taking a much stronger strength medication can make your levels go much higher, even though I was taking the correct dose. There must be a reason why endocrinologists prescribe certain strengths maybe?

[helvella Administrator in reply to McPammy]

There must be a reason why endocrinologists prescribe certain strengths maybe?

Much of the time, dosing is based on available products rather than patient need!

Think how many have levothyroxine doses adjusted by 25 or 50. Solely because they are standard tablets. With no thought to splitting or alternate day dosing, or any other approach.

I think the micrograms per millilitre will be selected to achieve one spoonful a day. And no other possible factor would be acknowledged or allowed for.

[McPammy in reply to helvella]

I agree not enough thought goes into people’s doses and how to manage it for them. Liquid isn’t by the spoonful it’s by syringe so you can measure exactly your dose. This I do each day. I think I’m very lucky I can draw my dose in a measured syringe. But I don’t understand why an uplift in strength of the medication and reduce the dose calculated by pharmacist to meet your normal dose on lower strength medication can cause such an uplift with levels in your blood results. I was very surprised.

[helvella Administrator in reply to McPammy]

It wouldn't be the first time a pharmacist or doctor has miscalculated!

(Yes - I just used "spoon" as a colloquialism. An oral syringe is obviously more appropriate.)

[McPammy in reply to helvella]

but it wasn’t miscalculated as I also worked out how much I needed to take.

Although pharmacies may make mistakes time to time.

I’m still unsure if the uplift in strength played a major part. I shall ask my private only endocrinologist and NHS endocrinologist next time I have my consultations.

Thanks for your help and support as always. 👍😀. Don’t know what I’d do without this site and admins people.

[Geegee777 in reply to McPammy]

Very interesting, im thinking of changing or increasing my levo once my t3 is sorted, which i will test beginning of April. It certainly is a minefield out there. I have been offered Roma capsules, but not quite sure just yet, I'll keep researching

[McPammy in reply to Geegee777]

Yes, it can be a mine field. I truly believe Drs nor pharmacists truly understand how difficult it can be obtaining the correct medications and how to dose individuals correctly. It’s made all the more difficult for those on tablet form. Either they have to cut up the tablets or Drs increase or decrease mainly be 25mcg for Levo which can be a big change for most people. A minefield for sure. No wonder so many take things into their own hands.

[Wua13262348 in reply to McPammy]

Will do a separate post to explain my situation and ask advice for bloods done 21/3/23, so as not to hi-jack the post, but will mention the following which is pertinent to your post.

I, too, am dosing a lesser dose from 125mcg strength Zentiva liquid levothyroxine, since 1/1/23. I am taking 3ml to equate to a 75mcg dose. Previously, from 12/11/22 to 31/12/22, I dosed 7.5 ml for a dose of 75mcg from 50mcg strength, Teva liquid levo.

Prior to this I was forced to use Teva, Brillpharma, and Wockhardt 50mcg strength liquids, when dosing 50mcg and then, from 20/9/22, 75mcg from a 50mcg strength bottle. I have had 1 bottle of 100mcg strength, Teva liquid, dosed at 3.75ml for a 75mcg dose.

My TSH has plummetted , 20/3/23, to 0.14, when it was 0.97, 21/11/22.

My FT4, 20/3/23 has risen to 20.3, when it was 18.8, 21/11/22.

My FT3, 20/3/23 has dropped to 5.2, when it was 5.9, 21/11/22.

There is also a change in my selenium status , which I stopped supplementing, 1/12/22 and retested 20/3/23. It has dropped from 441.18% through the range, supplemented for 120 days until 1/12/22, to 142.86% through the range ,unsupplemented.

I may also have a U.T.I.

Both of the above may be affecting my results, but very strange that you have highlighted the effects you have, just at the right time for me to also have to consider that dosing 75mcg from a 125mcg strength product may also be skewing my results too!

Well done for raising the issue. I think you may be onto something!

[McPammy in reply to Wua13262348]

I was really surprised when my results came through. I actually thought I might have been under medicated. I was getting swapped from one thing to another. My usual 50mcg Wockhardt oral Liquid Levothyroxine was no longer available. Then I couldn’t get ‘any’ brand or strength. So I was switched to tablets. That went badly. I quickly went down hill and my bloods were showing under medicated. I managed to get just one bottle of liquid but that was only 25mcg strength. I had to double my dose now. I felt a bit better but not as good as I’d usually feel. Then they could only source 125mcg strength Zentiva. Now I was only taking just over 2.5mcg to calculate to my usual 68mcg dose. Quickly my muscles were not working too well. Very stiff everywhere even my stomach muscles and also having night sweats. Felt like I’d ran a marathon each morning waking. Now I have Brillpharma 50mcg and dosing like I used to at 68mcg. I’m now feeling so much better. At last I feel like I used to before Christmas and all these stock outs and differing levothyroxine brands and strengths. I can walk with ease again and sleeping well on 50mcg correctly dosed. I split my levo dose but couldn’t on 125mcg strength as the dose was so small. I’m sure the higher strength can have a negative effect even if you dose correctly. My TSH went suppressed and T4 and T3 never been that high before on higher strength. This has never happened to me before. I even use to think what’s the point of T4 levo as I’m a very poor converter and take T3 daily also 5mcg twice a day. Now I know Levo has an important part to play. We are learning from each other on here. I’m looking forward to discussing all this with my Endo’s. I do think I may be onto something. Weird your figures and mine are higher with suppressed TSH on higher strength.

[Wua13262348 in reply to McPammy]

Interesting that on a dose of 68mcg you have always been prescribed the 50mcg strength liquid, rather than the 100mcg strength, which may work out cheaper and would certainly last longer. At a dose of 75mcg, I was prescibed the 50mcg strength, rather than than the 100mcg strength too.

How different were your results, for TSH, FT4 and FT3, if you don't mind me asking?

[McPammy in reply to Wua13262348]

Here are my latest results. Firstly abnormal TSH in Jan after being switched to tablets. Then still too high after switching back to liquid but only 25mcg strength. Then lastly abnormally low when on 125mcg strength. I followed the dose correctly and the doses were right for my normal 68mcg a day.

I keep trying to add a copy of my results but the system won’t let me I can only add one photocopy it seems

TSH results

[Wua13262348 in reply to McPammy]

Zentiva liquid contains citric acid anhydrous.

Brillpharma and Teva liquid contain citric acid monohydrate.

Apart from this the 3 brands appear to be the same.

One side effect listed for citric acid anhydrous is stomach pain per google search.

Google search quotes the difference between anhydrous and monohydrate to be that anhydrous is undiluted and has a more potent impact.

I don't know if this is significant or not, in how you have reacted to the products.

Just a thought to throw into the mix.

[helvella Administrator in reply to Wua13262348]

The difficulty with such things is that the words describe the ingredient.

But the processing might affect the hydration of the citric acid. Or, indeed, dictate which form will be chosen.

For example, some pills are manufactured using a wet slurry process. In which case anhydrous forms of ingredients could well become partially or fully hydrated.

But in the case of oral solutions, which have water as one of the ingredients, it is likely that they will all be fully hydrated in the final product - whatever form they were in originally!

The hydration level needs to be identified because it changes the weight of the ingredient. If the anhydrous version of some substance meant one kilogram is required for a batch, the monohydrate form could need 1.2 kilograms. (Totally made up!)

Also, the acid/alkaline ingredients in these oral solutions appear to be present mainly to finely adjust the final pH of the product. The amounts required might be very, very small.

[McPammy in reply to Wua13262348]

Thanks for all that information. I don’t think it’s anything to do with excipients really. I think i was just over medicated with the 125mcg strength even though I was definitely only taking the correct dose ( 2.5ml) for my normal 50mcg strength at 68mcg a day.