accord / Wockhardt Levothyroxine

[RoseStar]

anyone else find they get constipation on Accord? Might be total coincidence but I’m now on accord and constipated - after being fine on Wockhardt.

[helvella Administrator Thyroid UK]

Ask for a replacement - obviously one option being reverting to Wockhardt. Depending on circumstances you might find it best to go via your GP or your pharmacy. Either should try to help you.

Then put in a Yellow Card report.

There have been a few reports here of people taking Accord who felt it was not working as expected. And we simply have to put in reports so evidence accumulates that there is an issue.

🟨 Making Yellow Card Reports 🟨

healthunlocked.com/thyroidu...

[helvella Administrator Thyroid UK in reply to helvella]

In case you need to know what other formulations are available:

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.

The UK document contains up-to-date versions of the Summary Matrix for tablets, oral solutions and liothyronine available in the UK.

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

[Jaydee1507 Administrator]

Have you had your FT3 tested at all, also didn't you reduce dose a short while ago? Constipation may be related to a dose reduction.

How are your key vitamins looking - ferritin, folate, B12 & d3?

If you would like to stay on the same brand, which is recommended by the way, you can do this by getting GP to write the brand you prefer in the first line of the prescription. Many people find that different brands are not interchangeable.

named brand prescription

[RoseStar in reply to Jaydee1507]

To be honest, I’ve had an absolute nightmare. I was subclinical with T4 in range, TSH 4.82 and positive TPO/thyroglobulin antibodies, so was diagnosed with Hashimoto’s by a private endo but he decided to bang me straight on 100mcg, which made me very ill. Every 6/8 weeks, I’ve reduced from 100 to 75 to 75/50 to 50 and I still feel dreadful. Finally T4 in range 16.4 (9.0-19.0) after reduction to 75/50 alternating but apparently my TSH was slightly too low at 0.10 (range 0.30-4.20), so I was reduced to 50mcg about 1 week ago. Although within range, my ferritin and folate were low so I have been supplementing with Spatone (even 2 sachets of this days makes me constipated I swear!!!) and Thorne B Complex. My cortisol has also been dropping over the past 9m - 400,271,236 which is apparently “normal”?!!!!! But I kicked off and demanded a referral to endocrinologist (name removed by admin)

Seeing him next week. No T3 tests

[SlowDragon Administrator in reply to RoseStar]

Finally T4 in range 16.4 (9.0-19.0) after reduction to 75/50 alternating but apparently my TSH was slightly too low at 0.10 (range 0.30-4.20)

Ignore TSH …..look at Ft4

How much do you weigh in kilo

Essential to maintain GOOD vitamin D, folate, B12 and ferritin

What were most recent vitamin D and B12

Are you taking any magnesium supplement

As you have Hashimoto’s have you had coeliac blood test or are you already on strictly gluten free diet or dairy free diet

[RoseStar in reply to SlowDragon]

I’m overweight at 82kg but on 100mcg and 75mcg, I was sweating, flushing, breaking out in hives and rashes, tingling round my chin and thyroid and an anxious mess! And my blood results proved it as T4 and TSH both out of range. Maybe they shouldn’t have dropped me from 62.5mcg to 50 a day if it was just my TSH out of range. But I felt shit on 62.5 for 7 weeks anyway. I know my vit B was in the 500s but Vit D only 80, so I have been supplementing that too. Doc wouldn’t recheck all vitamins and minerals as they weren’t out of range in first place 😡 My mum is coeliac, so I had a test in October and March (both fine). I also have PoTS so have just been started on salt tablets. Sometimes I drive myself crazy thinking I have been misdiagnosed as I didn’t have 2 tests 6m apart but although I was diagnosed earlier by going private (GP said they wouldn’t have done anything until my TSH hit 10 and 2 out of range tests 3/6m apart), I guess I have positive antibodies.

[SlowDragon Administrator in reply to RoseStar]

So next step it’s ALWAYS worth trialing strictly gluten free diet

Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential

A strictly gluten free diet helps or is essential due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and may slowly lower TPO antibodies

Trying gluten free diet for at least 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial

Hashimoto’s and leaky gut often occur together

[SlowDragon Administrator in reply to RoseStar]

82kg but on 100mcg and 75mcg, I was sweating, flushing, breaking out in hives and rashes, tingling round my chin and thyroid and an anxious mess!

Even though we need higher dose eventually, most people are best started on 50mcg initially …..then SLOWLY increase dose levothyroxine in 25mcg steps up over next 6-12 months

Starting too much too soon, causes too many problems for many people

Were you always on Wockhardt…..or did you start on different brands?

[RoseStar in reply to SlowDragon]

Yes I agree and I’m very sensitive to medication, which I told him. He started me on Accord. I only swapped to Wockhardt after reading on here about halfway through my time on 75

[janeroar in reply to RoseStar]

it’s possible you still have coeliac, depending on what tests you had. I would investigate further given your family history. From the website coeliac Uk:

Total immunoglobulin A (IgA)

IgA Tissue transglutaminase antibody (shortened to tTG)

It's important to continue eating gluten until you have had all the required tests - blood tests and biopsy where necessary. If you remove or reduce the amount of gluten in your diet before testing this will affect your results.

It’s possible to have a negative blood test and still have coeliac disease. If you weren't eating gluten at the time of your blood test, you may have received an inaccurate result.

If you have ongoing symptoms that suggest coeliac disease but have had a negative blood test, ask your GP to check to see if you have been tested for IgA deficiency.

IgA deficiency

Some people with coeliac disease do not make the usual coeliac disease antibodies. This is called IgA deficiency. When the laboratory is measuring your antibody level they should also check your total serum IgA to detect IgA deficiency. If you are IgA deficient the following tests should be considered:

Immunoglobulin G (IgG) EMA

IgG deamidated gliadin peptide (DGP)

IgG tTG

If you have tested negative for coeliac disease, particularly if you have Type 1 diabetes or you are a close relative of someone with coeliac disease, it is important to note that coeliac disease may present with a wide range of symptoms and you should consult with your GP if any symptoms arise or persist.

[GreenCardigan]

I too am on accord brand Levothyroxine ( 50 mg )and permanently constipated with many more negative consequences . Gp is

[Jaydee1507 Administrator in reply to GreenCardigan]

I'd recommend you start a new post with your latest blood results to discuss why you are still on a starter dose of Levo. Include any vitamin results you have too.

[RoseStar in reply to GreenCardigan]

I have a bowel prolapse so constipation is even more of a huge no no!

[SlowDragon Administrator in reply to RoseStar]

Are you taking magnesium to help improve constipation

Have you considered trying lactose free levothyroxine

Either

Teva (25mcg, 50mcg, 75mcg 100mcg tablets)

Vencamil - previously called Aristo - currently 100mcg only

[GreenCardigan]

oh poor you , are you getting any help in that direction or just

[RoseStar in reply to GreenCardigan]

I’m only 32 so they are reluctant to operate but I’ve exhausted all conservative measures 😭

[GreenCardigan]

I do feel for you, l really do ! and so wish I could find words of encouragement for you , but with the N HS . at near breaking point I can’t help feeling people are being fobbed off with any excuse for treatments being withheld, Have you not even been offered a change in your Levothyroxine brand from Accord ?

[Flowerloverforever]

Hi Rosr Star normally I'm ok but the last few weeks I have been but I think it's because I have been in the garden in red hot sun and not drank enough water as soon as I remedy that I am OK

[BlueKeith]

I asked my doctor the same thing. Turned out I just needed an increase in dosage and now constipation free.

[Luckyclaire]

Hi RoseStar, I have skimmed through the replies here, and the one thing that struck me is the gluten. I worked out decades ago that gluten was my enemy for what I now understand to be Hashimoto classic reasons. The most obvious and tangible symptom is gluten constipated me. It is like glue in my system. I finally gave up gluten entirely in 2001 after a month of no movement. Absolutely horrid. With no gluten (despite no celiac diagnosis) I have normal digestion, my skin improved, mood and energy improved, anaemia improved, bloating improved, and it appears that my thyroid survived on for twenty years, as it was nolonger under attack. I would give first hand testomy that gluten free is definitely worth trying for eight weeks - for me the resolution of constipation was the most tangible gain, and the other things kind of improved like a mist lifting slowly. My sympathy as I know about sever constipation, it is so horrible and toxic. X good luck.

[Gingernut44]

See my reply to you 2 months ago !!

[Odinil]

I was good on Actavis until it became Accord.I couldn't tolerate it, it was some time ago so i can't remember my exact symptoms only that I felt very unwell.

Was good on Wockhardt until pharmacies had a problem getting it.