Liothyronine Trial

[FleetRose]

I saw an NHS Endocrinologist last week who has agreed to my request for a 3 month trial of Liothyronine, something I have wanted for many years. The suggestion is to drop from 75mcg levothyroxine daily to 25mcg and to take 5mcg of T3 in the morning and again at lunchtime.

After nearly 20 years on Levo (because of Hashimotos) I am now nervous about making the change! The Endo warned me about heart palpitations, bone thinning etc. I am not a well person as I have Polymyalgia (PMR) for which I take prednisolone, have ongoing symptoms of hypothyroidism and suffered from low cortisol before the steroids suppressed all production. It's difficult to tell whiich symptoms are caused by what.

You can see from my results that my T3 is at the bottom of the range and T4 near the top and this has always been the case. A Deiodinase test showed that I do not convert well (homozygous variant).

I would be interested to hear of others' experiences of changing from T4 to a mixed regime, especially after so long ( the leaflet warns of danger after being hypothyroid for a long time and of being elderly (I am 73 and also very small frame 44 kg). Also any hints as to how to minimise side effects.

My recent results were

TSH 0.36 (0.27-4.2), T3 3.51 (3.1-6.8) T4 21 (12-22)

Folate 11.57, Vitamin B12 115, vitamin D 101, Ferritin 116

Thyroglobulin Antibodies 15, Thyroid peroxidase antibodies 107

Many thanks. Sorry about the long post.

[SlowDragon Administrator]

Which brand of levothyroxine are you currently taking for 75mcg

Are you taking 50mcg and 25mcg tablets?

Or single 75mcg tablet (which would be Teva brand)

Is T3 on NHS?

Do you know if you are getting 5mcg T3 tablets or capsules

We always recommend starting SLOWLY

Initially reduce levothyroxine by 25mcg …..after 4 days add 5mcg T3 in the morning……or if you have tablets…..you could cut in half to take 2.5mcg in morning and then 2.5mcg about 10-12 hours later

Hold at that dose for 4-5 days

Then reduce levothyroxine by another 25mcg …..4-5 days later add 2nd 5mcg dose late afternoon

Retest in 6-8 weeks

Day before test……move 2nd dose T3 later to around 9pm

Test next morning at 9am

[FleetRose in reply to SlowDragon]

I’m taking 50mcg (Accord) and 25mcg (North Star) although make varies with each prescription. I have learnt that I should specify! The T3 is on the NHS.

The Endo said they would be capsules so not possible to halve but on collection they appear to be small white, round tablets. I have a tablet cutter so will try to halve them.

I’m very grateful for your suggestion as Endo said to move straight to the new regime which didn’t seem right as I know Levothyroxine has a long half life.

Would T3 in the evening keep me awake?

Thank you again. I feel much happier with your plan for a slower transition.

[SlowDragon Administrator in reply to FleetRose]

Like many members, personally I find small dose T3 at bedtime improves sleep

But it doesn’t help everyone

Even if initially it might not, it may do in few months time

[SlowDragon Administrator in reply to FleetRose]

on collection they appear to be small white, round tablets. I have a tablet cutter so will try to halve them.

Which brand?

Morningside?

[FleetRose in reply to SlowDragon]

yes, Morningside. I’ve just noticed my North Star 25mcg Levo says Teva on the side of the packet!

[helvella Administrator in reply to FleetRose]

Teva 25 microgram (only) levothyroxine has always been Teva. And their 50 and 100 micorrgam tablets have been Accord.

However, Northstar no longer exists! So should not be a question into the future.

[SlowDragon Administrator in reply to FleetRose]

Northstar now discontinued

Northstar was always boxed

50mcg and 100mcg Accord brand

But Accord doesn’t make 25mcg brand

So 25mcg was always Teva brand

[SlowDragon Administrator in reply to FleetRose]

are you on dairy free diet or do you suspect/know you are lactose intolerant?

Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva is lactose free. But 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)

Many people find Levothyroxine brands are not interchangeable.

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets 

Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz 

Accord only make 50mcg and 100mcg tablets 

Accord is also boxed as Almus via Boots and use to be boxed as Northstar (discontinued in March this year)

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 

So if taking 25mcg per day and avoiding Teva

It would be Mercury Pharma brand or Wockhardt

Or cutting Accord 50mcg in half to get 25mcg

 

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 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).

Discussed here too

healthunlocked.com/thyroidu...

[FleetRose in reply to SlowDragon]

Thank you SlowDragon and helvella for info on brand changing. My brands are swapped around all the time so will now specify. I do avoid dairy but small amounts seem to be fine so will try avoiding the mannitol in Teva .