Would anyone know if the ingredients of Mercury Pharma’s Levothyroxine have changed at all of the past few years? I’ve been taking 25 mcg for a few years now, always the same brand. I’ve been experiencing severe bloating and heartburn. Doctors can’t find the cause so I’m looking into a potential change in ingredients / fillers.
Current ingredients (exp date on box: 07/2024) are:
- Anhydrous levothyroxine sodium 25 mcg
- sodium citrate
- lactose
- maize starch
- acacia powder
- magnesium stearate
Any input / experiences you’d like to share will be much appreciated.
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PinkCat2023
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I had been feeling terrible when taking my tablets, so much so I had to stop taking them (Levo 50mcg not sure which brand). I started feeling much better and put it down to the acacia powder. I also noted years ago feeling awful after taking vitamin tablets with similar fillers!
My T3 & T4 levels are ok but TSH is high now that I am off the levo.
Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
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.
Pmcg123 thank you. I do wonder about the acacia filler. I have mast cell activation syndrome and apparently acacia can be a trigger. I’ve requested a prescription for Tirosint from my doctor, it’s a type of Levo that supposedly has no fillers. I hope you can get your TSH down somehow, if you felt that would be beneficial for you.
I am also hypersensitive to meds and supplements and it's getting worse, which is why I wondered if the fillers may be at least part of the issue. I have histamine intolerance and MCAS, most likely as a result of prolonged indoor mold exposure. Would you know if you have this as well and if that's what might be causing you symptoms? It may well be something different for you, of course.
Possibly, I have considered it, I have Ehlers Danlos which is associated with MCAS. I've had issues with asthma, hayfever and very sensitive skin since childhood, and I had an anaphylactic reaction to a previously well tolerated pain killer out of the blue. I'm not sure I have the energy to battle with the NHS about getting diagnosed though.
I'm so sad to read this. I think mold exposure is at the root of my MCAS personally, but I'm not sure if the NHS would test for that at all (urine tests - I was advised to do both the Great Plains Mycotoxins and RealTime Mycotoxins tests). Just in case you're interested in learning more about MCAS, I've found Beth O'Hara's blogs, Facebook lives etc super helpful. She has MCAS and had mold toxicity, SIBO etc, etc, so she really speaks from experience and she's a trained in so many fields, though not an MD. Her site is mastcell360.com. She covers topics such as best foods for MCAS (taking into account many people w MCAS also have oxalate intolerance, salicylate issues, fodmap issues, etc), recipes, supplements, beauty product ingredients to avoid, mold, different types of testing and much more. Most of it is available for free.
PinkCat2023, I cannot tolerate Acacia powder. Are you only taking 25mcgm per day? What are your last test results like for TSH, T4 andT3. If gp says they are in range that isn’t good enough, you need the numbers and the ranges in brackets. You are legally entitled to have your blood test results.
crimple thank you. Sounds like acacia isn’t well tolerated by some people. I have mast cell activation syndrome and apparently acacia can be a trigger. I’ve requested a prescription for Tirosint, which is a type of Levo that supposedly doesn’t have fillers. I hope I can start it soon.
I was trying NDT (Erfa) for a short while (probably just over a week) and wasn’t feeling well. I had my bloods tested but this was while taking NDT:
TSH 0.75 (0.27 - 4.2)
FT4 12.4 (12 - 22)
FT3 4.6 (3.1 - 6.8)
This is when I added 50 mcg of Levo (Mercury Pharma) to my daily routine and when the bloating increased and the heartburn really took off.
I alternate my Levo atm between 25 mcg one day and 50 mcg the next day. It used to be when I took 50 mcg per day, I’d start feeling anxious, rapid heartbeat etc, which I why I alternate.
Felt so much better on NDT for 1 day (1/2 grain) and then again a few days later (1/2 grain am + 1/4 grain pm) but definitely in a downward spiral at present.
I’ve read that some people do have a problem with the Mercury Pharma brand, but I’d say your biggest problem is you’re under medicated. 25mcg is a starter dose and you shouldn’t have been left on that for years. Incidentally, the symptoms you experience are amongst those I had when recently I needed a slightly higher dose of T4. Like Crimple said, post your latest test results so members can comment on that aspect.
ZeldaR thank you. I’m sorry to read you’ve experienced similar symptoms - and more. I hope you’re feeling better now you’re on a higher dose? I did wonder if my symptoms could be due to low T4, which I when I added 50 mcg of Levo to my NDT. This is when my symptoms got way worse.
Good point re the levels:
I was trying NDT (Erfa) for a short while (probably just over a week) and wasn’t feeling well. I had my bloods tested but this was while taking NDT and no Levo:
TSH 0.75 (0.27 - 4.2)
FT4 12.4 (12 - 22)
FT3 4.6 (3.1 - 6.8)
This is when I added 50 mcg of Levo (Mercury Pharma) to my daily routine and when the bloating increased and the heartburn really took off.
I alternate my Levo atm between 25 mcg one day and 50 mcg the next day. It used to be when I took 50 mcg per day, I’d start feeling anxious, rapid heartbeat etc, which I why I alternate. I mentioned only the 25 mcg pills because those are the ones I take: 1 pill one day, 2 pills the next day
Felt so much better on NDT for 1 day (1/2 grain) and then again a few days later (1/2 grain am + 1/4 grain pm) but definitely in a downward spiral at present.
Most recent test results before NDT, so when taking Levo 25 mcg / 50 mcg on alternating days, are from early November 2023:
TSH 1.68 (0.27 - 4.2)
FT4 13.6 (12 - 22)
FT3 3.7 (3.1 - 6.8)
I’ve requested a prescription for Tirosint, which is a type of Levo that supposedly doesn’t have fillers. I hope I can start it soon and that that’ll make a difference.
My main question, in response to your comment, is about Levo vs. NDT:
But will need to increase dose SLOWLY to avoid issues tolerating increase
At the moment you need to SLOWLY increase levothyroxine
Before even considering NDT - what's the reason for staying on Levo, rather than changing over to NDT please? I am planning to stay on Levo for now, but only because I want to have some sort of baseline before trying anything new again. My T4 to T3 conversion isn't great so I think I'll eventually need to supplement with either NDT or T3, to get that up. Just taking T4 may not be the answer for me personally.
How long had you been on this dose before testing - about 4 years
Highly likely you have very low vitamin levels -
Nov 2023: Serum vit D 84 (50 - 200)
Most recent other tests are from this summer:
Active B12 >256 (25.1 - 165.0)
Red cell folate 588 (340 - 1474.7)
Ferritin 13 (13 - 150) *low*
My iron used to be low but that’s now back in range, since starting to eat meat again my ferritin hasn’t been re-tested since this summer but I’m hoping that’s up as well. Recommended lower level for females is 27. I’ll have this re-tested in the next few months. I saw you also kindly gave lots of information about ferritin in another reply to this post, I'll check that out and will revert asap.
I was on 100mcg T4, now on 125mcg T4 plus 10 mcg T3. I’m sure my level of symptoms for which I got the increase was far milder than yours probably are on that small dose you have currently! As shown by your lab results, and as SlowDragon explains, you’re quite undertreated. I can tell you that I’m much improved after a mere 3 months on the increased dose, and I’m sure you’ll feel lots better once your dose is right and you’ve added the supplements as SD suggested.
ZeldaR thank you. I'm glad you're feeling so much better! I agree I need to improve my thyroid levels somehow, to try to feel better. The thing is though, I was on Levo 25 / 50 mcg (alternating days) for 4 years before I tried NDT iso Levo. On NDT, I soon started getting heart palpitations, and feeling worse, except for the very first day I took it - and except for the day I increased my NDT dose from 1/2 grain AM to 1/2 grain AM + 1/4 grain PM. I had so much more energy, so there's definitely something to pursue there. It was only when I got my test results, saw my especially low FT4, that I added the Levo back in - and that's when the bloating went out of control and the heartburn started. So I'm wondering if by being off Levo for just a short while, I somehow became sensitive to some of its fillers, or something else happened, that triggered these symptoms. I was already bloating but not like this. My heartburn is also new, in this capacity.
The thing is though, I was on Levo 25 / 50 mcg (alternating days) for 4 years
This is a ludicrously low dose
Approximately how much do you weigh in kilo
You should have been started on 50mcg and increased up in 25mcg steps as fast as possible until on approximately 1.6mcg Levo per kilo of your weight per day
Unless extremely petite that’s going to be at least 100mcg per day
Are you saying you are ONLY taking 25mcg levothyroxine per day?
standard STARTER dose levothyroxine is 50mcg unless over 65 years old
And all patients need to slowly INCREASE dose upwards over first 6-24 months
Levothyroxine doesn’t “top up” failing thyroid, it replaces it
Therefore almost everyone eventually needs to be on full replacement dose. Typically that is approximately 1.6mcg of levothyroxine per kilo of your weight per day
I’ve been experiencing severe bloating and heartburn
These are symptoms of being on too low a dose Levo and hypothyroid
what are your most recent thyroid and vitamin test results
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Also both TPO and TG thyroid antibodies tested at least once
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
Having been left on just 25mcg levothyroxine, likely your vitamin levels are very poor
Low vitamin levels tend to lower TSH
Essential to test vitamin levels and maintain at GOOD levels by supplementing if necessary
Many, many thyroid patients need to supplement vitamin D, magnesium and vitamin B complex continuously
I alternate between 25 mcg Levo one day and then 50 mcg Levo the next day. I went 50 mcg per day some time ago and didn’t feel well, very anxious and rapid heart beat. Hence why I alternate.
did wonder if my symptoms could be due to low T4, which I when I added 50 mcg of Levo to my NDT. This is when my symptoms got way worse.
Good point re the levels:
I was trying NDT (Erfa) for a short while (probably just over a week) and wasn’t feeling well. I had my bloods tested but this was while taking NDT and no Levo, at the end of December:
TSH 0.75 (0.27 - 4.2)
FT4 12.4 (12 - 22)
FT3 4.6 (3.1 - 6.8)
taken NDT 1/2 grain about 4 to 5 hours before blood test, because I wanted to see what that did to my levels
After this blood test, is when I added 50 mcg of Levo (Mercury Pharma) to my daily routine and when the bloating increased and the heartburn really took off.
I alternate my Levo atm between 25 mcg one day and 50 mcg the next day. It used to be when I took 50 mcg per day, I’d start feeling anxious, rapid heartbeat etc, which I why I alternate. I mentioned only the 25 mcg pills because those are the ones I take: 1 pill one day, 2 pills the next day
Felt so much better on NDT for 1 day (1/2 grain) and then again a few days later (1/2 grain am + 1/4 grain pm) but worse again the day after that and am definitely in a downward spiral at present.
Most recent test results before NDT, so when taking Levo 25 mcg / 50 mcg on alternating days, are from early November 2023 (fasting incl Levo for more than 24 hours prior) :
TSH 1.68 (0.27 - 4.2)
FT4 13.6 (12 - 22)
FT3 3.7 (3.1 - 6.8)
Serum vit D 84 (50 - 200)
Most recent other tests are from this summer:
Active B12 >256 (25.1 - 165.0)
Red cell folate 588 (340 - 1474.7)
Ferritin 13 (13 - 150) *low*
My iron used to be low but that’s now back in range, since starting to eat meat again my ferritin hasn’t been re-tested since this summer but I’m hoping that’s up as well. Recommended lower level for females is 27. I’ll have this re-tested in the next few months.
Supplements:
- Vit D, as calcifediol - 10 mcg (1200 IU) , per day, since my parathyroidectomy in March 2022
- Magnesium glycinate - 720 mg per day, divided over 6 tablets during afternoon and evening. If I take any less, I get muscle cramps and constipation. I have mold toxicity, which apparently uses up a lot of magnesium
- Magnesium L-threonate - 48 mg per day, at 10 pm
- Vit K2 MK7 - 120 mcg per day, after dinner
- Vitamin A (as retinol palmitate) - 2,000 IU per day, after dinner
- Vit B1 (benfotiamine) - 150 mg per day
- Vit B2 (riboflavin) - 10 mg per day
- Vit B9 (methylfolate) 50 mcg per day
- Beef liver capsule - 1 per day
- Omega 3 fish oil - 690 mg per day
- Vit E complex - 2 per week
I’ve temporarily stopped taking everything except Levo, magnesium, beef liver and omega 3 fish oil, to see if I’m having a reaction to one of the fillers in any of these supplements.
I used to take B6 and B12 as well but I didn’t feel well on these and stopped taking B6 in Sep 2022 and B12 in Oct 2022. I had B6 toxicity at the time
I cannot do any type of artificial Iron supplement, except for there’s a tiny bit of natural iron in my beef liver supplement
I’ve requested a prescription for Tirosint, which is a type of Levo that supposedly doesn’t have fillers. I hope I can start it soon and that that’ll make a difference.
That’s so interesting re the autoimmune thyroid disease being missed in 20% of the cases in the UK, I had no idea. My levels hadn’t been great for a long time but got really bad after a failed parathyroidectomy, They took out half of my thyroid to see if my parathyroid adenoma was hiding in there. It wasn’t. Whoopsie. After this, I started taking 25 / 50 mcg Levo but my doctor told me, based on my previous lab results, I’d had hypothyroidism for ages. I think my issues started soon after the Chernobyl disaster. I was in Germany at the time and the radiation was definitely increased there - and further afield of course.
Would you know what this specialist thyroid ultrasound is called? My antibodies have always been well in range but I had no idea that didn’t exclude autoimmune hypothyroidism. My grandmother on my dad’s side had some thyroid issue but no one knows what exactly. I do have hypermobility, just like my mom, and this is coded for in a gene on the 6th chromosome, which is where a lot of autoimmune diseases are found. So definitely worth looking into for me.
My iron used to be low but that’s now back in range, since starting to eat meat again my ferritin hasn’t been re-tested since this summer but I’m hoping that’s up as well. Recommended lower level for females is 27. I’ll have this re-tested in the next few months.
Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron
Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
We have received further information the lab about ferritin reference ranges. They confirm that they are sex dependent up to the age of 60, then beyond the age of 60 the reference range is the same for both sexes:
Males 16-60: 30-400 ug/L
Female's: 16-60: 30-150
Both >60: 30-650
The lower limit of 30 ug/L is in accordance with the updated NICE guidance and the upper limits are in accordance with guidance from the Association of Clinical Biochemists. ‘
Fast heart rate can be low ferritin – this was mostly at night, do ferritin levels also fluctuate, not sure? Or might this be due to too low T4 (since FT4 was 12.4 (range 12 - 22) about 4 to 5 hours after taking NDT? It surely was too low overnight and within about an hour or so after taking NDT, I started feeling better.
Aiming for ferritin as MINIMUM over 70 – I’m pretty sure I won’t have that but am hoping to be pleasantly surprised after my next blood test. If it is still quite low, at least then I’ll know and I can hopefully do something about it. I also have stage 4 endometriosis and very heavy periods. I feel my current symptoms have come up too suddenly to be directly related to that though.
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. – I can’t do iron supplements full stop. I’ve tried Three Arrows heme iron, QuattroFerrin, Lactoferrin, PatchMD iron plus and many others. The side effects are too much. I apparently also have some DNA defects that mean I shouldn’t supplement with iron. Natural iron seems to be ok. I can’t do iron IV, because I have MCAS.
Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test – great advice, thank you.
Look at increasing iron rich foods in diet – will do. I've started eating meat, incl red meat, again. I saw there are many more options, which is so good to know.
Thank you also for all the links you’ve shared, much appreciated!
I do have hypermobility, just like my mom, and this is coded for in a gene on the 6th chromosome, which is where a lot of autoimmune diseases are found. So definitely worth looking into for me.
We have many EDS members…..
(Search facility is poor on here …but here’s a few)
We have many EDS members – I’ve been tested for EDS and do not meet the criteria, but the same doctor confirmed I definitely have hypermobility.
Request coeliac blood test BEFORE considering trial on strictly gluten free diet – I’ve had a biopsy performed during an endoscopy and have had coeliac ruled out. I do get more zits when I eat gluten, so I do not tolerate them well.
Have you tested BOTH TPO and TG antibodies – yes, I had them tested several times. Most recent test results:
TPO Abs 11.00 (0 – 35) – 12/04/22
Anti TPA Abs 18.00 (0 – 50) – 07/09/22
TG Abs 5.00 (0 – 50) – 09/08/21
Anti TG Abs 19.00 (0 – 100) – 07/09/22
Thyroglobulin 12.20 (3.5 – 77) – 09/08/21
RT3 0.27 (0.09 – 0.35) – 09/08/21
T3 uptake 26.45% (22 – 37%) – 04/04/19
If both are negative Definitely worth getting ultrasound scan of thyroid - I’ll discuss a thyroid US when I chat with my doctor in a couple of weeks. Thank you!
alternate my Levo atm between 25 mcg one day and 50 mcg the next day. It used to be when I took 50 mcg per day, I’d start feeling anxious, rapid heartbeat etc, which I why I alternate. I mentioned only the 25 mcg pills because those are the ones I take: 1 pill one day, 2 pills the next day
many members need to take same dose everyday
So cutting 25mcg in half taking 37.5mcg daily
Retest after 6-8 weeks
Then try 50mcg daily
You may (initially) find it better to take as 25mcg waking and 25mcg at bedtime
After few weeks try taking whole dose at bedtime
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
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
Similarly if normally splitting your levothyroxine, take whole daily dose 24 hours before test
Which brand of levothyroxine are you using
Many patients find different brands are not interchangeable
Felt so much better on NDT for 1 day (1/2 grain) and then again a few days later (1/2 grain am + 1/4 grain pm) but worse again the day after that and am definitely in a downward spiral at present.
many members need to take same dose everyday – I’ve requested a prescription for Tirosint 13 mcg and 25 mcg tablets, so I can dose the same amount every day. I’ve never liked alternating the doses but was not aware of an alternative between 25 mcg and 50 mcg until recently.
You may (initially) find it better to take as 25mcg waking and 25mcg at bedtime. After few weeks try taking whole dose at bedtime – I take my Levo around 4 am at present, when I use the loo 😊 I have yogurt in the morning (after 8 am, lots of calcium) and magnesium in the afternoon and evening, so taking it once a day would be ideal for me, hence the current 4 am routine.
Which brand of levothyroxine are you using – I’ve been on Mercury Pharma from the start.
Far too soon to consider adding any T3 or NDT (in reply to my “Felt so much better on NDT for 1 day (1/2 grain) and then again a few days later (1/2 grain am + 1/4 grain pm) but worse again the day after that and am definitely in a downward spiral at present”) – I soon felt miserable on NDT alone. My FT4 was definitely too low at 12.4 (range 12 - 22) about 4 to 5 hours after taking NDT – means it was even lower before taking it. What would be a better way to approach to this in the future please, without feeling miserable for weeks / months on end due to sticking to the same dose?
You are legally entitled to printed copies of your blood test results and ranges.
The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results
UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.
SlowDragon thank you so much for this. I feel super fortunate to have private health insurance through my husband’s work. I basically get tested whatever I want and whatever the doctor suggests. We work together and discuss the options, which I really appreciate. The doctor’s assistants have been super helpful as well and assist me in getting the lab results. They report them as soon as they have them.
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
SlowDragon thank you again, so much for this! I’ve requested Tirosint 13 mcg and 25 mcg from my doctor. I’ll call his assistant on Monday, to ask them to prescribe this urgently. I may ask to add NDT or T3 later but feel I need to get to a place where I feel comfortable about this first. I feel my levels are going all over the place atm - and especially since stopping Levo and starting NDT, then adding Levo back in…. Hoping to start Tirosint soon.
You almost certainly don’t need Tirosint ….just get dose levothyroxine increased
Your extremely low ferritin levels will have been lowering TSH hiding how hypothyroid you are
If in U.K. Tirosint virtually impossible to get
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,
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
You might need lactose free levothyroxine
Lactose free brands - currently Teva or Vencamil only
Teva makes 25mcg, 50mcg, 75mcg and 100mcg
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
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
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.
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.
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).
You almost certainly don’t need Tirosint ….just get dose levothyroxine increased – I have MCAS and am hypersensitive to, well, everything. My mast cells have gone completely haywire and I’ll need to do a lot of work post house move (getting away from mold) to detox and reset my mast cells and nervous system. I thought Tirosint could therefore be helpful for me, as it is Levo without fillers?
Your extremely low ferritin levels will have been lowering TSH hiding how hypothyroid you are – oh my goodness, I had no idea. Whoops. Really good to know!
If in U.K. Tirosint virtually impossible to get – yes, I'm in the UK. My doctor works with a pharmacy that, supposedly, prescribes it.
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord – I take Mercury Pharma atm and need a change, I feel I’m reacting to something. So odd I wasn't reacting to it in the same way before I switched to NDT only - and then when I added Levo back into the equation, I started having symptoms. These symptoms have persisted since I've stopped taking NDT (back on Mercury Pharma Levo only).
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 – if Tirosint is not available, this is the alternative brand I was considering.
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 – I can’t do mannitol unfortunately, as I need to watch my fodmaps. I’m not lactose intolerant (whoohoo) 😊 I do have a lot of bad gut bacteria and not enough good ones (Zoe stool test), so I'll need to keep working on that as well. Until we move away from our moldy house though, I won't be able to fully heal and feel better, gut wise.
and especially since stopping Levo and starting NDT, then adding Levo back in….
It can take months to recover from sudden changes in thyroid medication…..especially adding T3 in too early as this will exacerbate any adrenal fatigue
SlowDragon thank you. What would be the best way to change thyroid meds please? I'd like to do this the right way, but staying on a low dose NDT, for instance, while feeling miserable because my levels are low (FT4 was 12.4 -range 12 - 22- and this was a bout 4 to 5 hours after taking my NDT) just to stick to the same dose of meds... surely there's a more customer friendly option? 😊
The ONLY change to formulation of levothyroxine products in the UK this century relates to the Teva product. And that was brought back to market after complete reformulation in 2016 - and emblazoned across every pack.
Of course, minor changes to the regulations occur - the precise tests required to approve an excipient (inactive ingredient), etc. And companies might purchase their ingredients from different sources.
And products new to the UK have arrived on the market - each with their own formulation.
Pharmaceutical companies do their best to avoid the costs and other issues of changing formulations.
And no-one can rule out accidental/inadvertent changes, mistakes in the factory, etc.
I agree with others that your dose is far more likely to be the issue.
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 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 thank you! That looks like a great resource, I really appreciate you sharing this. I would love to get my levels up a bit more. Tried NDT for about a week or so, then found out my FT4 was a bit low and added Levo back in, which is when my symptoms really kicked off. I’ve asked my doctor to prescribe Tirosint, a type of Levo which supposedly has no fillers. I’ve asked him for 13 mcg and 25 mcg capsules, so I can add a bit as needed. I may well add in NDT or T3 at some point but will start with just the “natural” Levo for the time being.
helvella thank you. So even though Tirosint has a lower number of fillers, the actual amount of fillers in Tirosint is higher than in most other tabs? I had no idea! I think I'm ok with gelatin an glycerol. I've been working with a doctor who works with a pharmacy, that, supposedly, prescribes Tirosint. And I am not looking forward to hearing the price tag, I'm sure! If it can help me feel better, I'd like to try it though.
A UK levothyroxine tablet probably weighs between 50 and 120 milligrams.
I do not know how much a Tirosint gel cap weighs. But I would be amazed if it weren't significantly more. Some will be water, but the rest will be glycerol and gelatin.
Tirosint SOL could be better because it has no gelatin - but even less easy to access. We have some members who do not tolerate gelatin.
helvella thank you. I didn't even know there was an oral Tirosint solution, thought it was just the gel caps. Good to know. I'll keep it in mind, in case I do try Tirosint and it doesn't sit well with me, then I can request Tirosint-SOL.
My issue with Acacia its a tree and for people like myself if you have a tree allergy you most likely will have a reaction to Acacia and unfortunately for some of us it’s a slow process before you realize what’s causing you problems….. Rashes, breathing problems, congestion, runny nose, burning eyes, palpitations and generally feeling awful… like I said the reaction was slow didn’t happen immediately it took a long time Im guessing a build up was required…. I only ingest thyroid meds without Acacia and have not had any problems since .
Acacia Powder has to be heat-treated before it can be used with soap. This snippet was in an old version of Medical Excipients Handbook that was on the old Thyroid UK website (before HealthUnlocked took the forum over). The change of heat-treatment is in the latest version of this book (Bible) which now costs about £150. Sorry, I do not know how to do links and can't find the one that was given to me. I do know that acacia is very allergenic, but the skin problem I have had since 2010, when my Levothyroxine was changed from Goldshield Eltroxin to Mercury Pharma Levothyroxine is still ongoing and other things seems to be affected also since then.
Batty1 nightingale-56 I’ll certainly look into acacia free alternatives. It’s so silly though, in my case, I didn’t have these symptoms until after I’d stopped taking Levo for a few days, noticed my FT4 was quite low, and then added Levo to my NDT. That’s when my bloating got really bad (it already wasn’t good) and the near-constant heartburn started. Now back on Levo only, so no NDT but the bloating and heartburn appear to not be ready to leave me just yet.
I didn’t have these symptoms until after I’d stopped taking Levo for a few days, noticed my FT4 was quite low, and then added Levo to my NDT. That’s when my bloating got really bad (it already wasn’t good) and the near-constant heartburn started. Now back on Levo only, so no NDT but the bloating and heartburn appear to not be ready to leave me just yet.
As soon as we take anything containing T3 (eg NDT) this will significantly and immediately lower TSH reducing how much thyroid hormone your own thyroid releases.
TSH will be slow to recover after stopping T3
That’s why it’s very important to get Ft4 high enough and up to full dose BEFORE changing to anything containing T3
As you improve your dire ferritin up towards 70-100 you should be able to tolerate higher doses of levothyroxine
SlowDragon thank you so much for clarifying this for me. My FT4 was definitely not optimal when I started NDT, I thought I was going to be fine as I was taking both (as in NDT contains both T3 and T4). When TSH plummets due to T3 supplementation, does that then mean less T4 is produced / secreted so that's why T4 goes down? And, if that is the case, should I not aim for a combination of T3 and T4?
Might anything come to mind that I can do right now to feel less bad?
Good morning I saw your post re Mercury Pharma I too am having problems , I have been taking this brand for years. Did you manage to find out if ingredients have changed?
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