Which strength & make of T4 has the lowest number of excipients/ingredients please?

[Bertwills]

Enquiring on behalf of another member who’s really struggling with stomach reactions to all forms of thyroid hormone medication including liquid.

Many thanks

[TiggerMe Ambassador]

I think it's Vencamil has the least... no lactose, acacia or mannitol but it only comes in 100mcg

[Bertwills in reply to TiggerMe]

Thank you. I had a look & it includes maize starch which maybe problematic. I was amazed to find 2 forms of magnesium, oxide & stearate. I thought magnesium blocked absorption of T4!

[TiggerMe Ambassador in reply to Bertwills]

I was going to add that about corn starch... I assume the minute quantities of magnesium are just there to stabilize as it seems to be in many pills?

If liquid T4 isn't tolerated I would imagine the other option is T3 only, though it has many of the same excipients?

[helvella Administrator in reply to TiggerMe]

You can look up the purposes of many excipients here:

pharmaexcipients.com/

A vast number actually have multiple purposes. Sometimes the secondary effects seem to explain why the choice was made between otherwise very similar substances.

[TiggerMe Ambassador in reply to Bertwills]

Perhaps looking at excipients in other pills taken might help track down the offenders?

[Ellie-Louise in reply to TiggerMe]

My friend is exactly the same, no thyroid and extremely sensitive to all that is T4 even Vencamil which was the last one she tried.

Edit for spelling.

[TiggerMe Ambassador in reply to Ellie-Louise]

😕 Has she had any more joy with T3?

[Bertwills in reply to TiggerMe]

She tried some Thybon Henning without any improvement unfortunately

[Ellie-Louise in reply to TiggerMe]

I just asked her, she said this:

Tried it, I felt numb all down left side, then someone said I should have syatyrf on a lower dose, so mentioned it to dr. and he said he had prescribed correctly. Another dr. said he knew it wasn't suitable. It cost £200 for a month. First dr. said the NHS were just being ripped off as it cost a penny to make. Even the chemist said these are very special! Anyway that was that.

[TiggerMe Ambassador in reply to Ellie-Louise]

TH only comes in 20mcg did they get her to split it and work her way up?

[Ellie-Louise in reply to TiggerMe]

She can’t remember, thinks she took a single tablet.

I’m messaging her about it but I have to go now and she has guests today.

[Bertwills in reply to Ellie-Louise]

Oh dear. There seems to be the need for a slow release skin patch. It would be so useful in many ways. I’ve used skin patches for CBD, Vit B12 & D. Oestrogen & progesterone patches are available & of course, nicotine.

[Bertwills]

Yes, she’s tried Thybon Henning T3 with no improvement. It’s a real puzzle.

[helvella Administrator]

Where I know them, I have included weights of tablets in my medicines documents.

I really don't see why the number of excipients is a target for deciding product. If there were a formulation that contained just one excipient, that wouldn't help someone who cannot tolerate that substance.

And someone just might do better with tiny amounts of, say, ten excipients than they would with larger amounts of two or three...

It is important to focus on what the excipients are. And, yes, if there are few, it is easier to work through them.

[Bertwills in reply to helvella]

I think the fewer ingredients there are it might be easier to identify the culprit. Is it possible to obtain T3 or 4 in just purified water? Maybe as a special order?

[helvella Administrator in reply to Bertwills]

No.

Levothyroxine is pretty much insoluble in water. And this is a major problem in trying to produce other forms.

The oral solutions started when someone realised that levothyroxine dissolves in an alkaline solution. You can then add an acid to neutralise the solution, add glycerol to stabilised that and the levothyroxine remains in solution or in an ultrafine dispersion. That approach was then patented. Until then, there were none.

I think manufacturers have moved on since then and found at least slightly different ways of achieving the same end.

There is an Italian T3 product - Liotir which is a solution of T3 in ethanol (alcohol). So far as I am aware, not available outside Italy.

Magnesium stearate has several functions in medicines - lubricant, anti-adherent, binder.

pharmaexcipients.com/magnes...

Magnesium oxide also has several functions.

pharmaexcipients.com/news/m...

And whilst magnesium might have some effect, so too do many other excipients, calcium phosphate used to be quite common and has sometimes been offered by compounders when formulating specials. And as something present in every tablet, its effect would be expected to be pretty stable whereas with food, supplements, etc., it can vary each time it is taken!

Missed adding this in my previous reply:

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.blogspot.com/p/hel...

[Bertwills in reply to helvella]

Thank you. I did have a quick look at your wonderful document but I thought I’d cheat & see if somebody had the answer at their fingertips!

[SlowDragon Administrator]

Are they on high enough dose

Gut issues common when on inadequate dose due to low stomach acid

Have they been tested for H Pylori and SIBO

Also consider going dairy free and/or gluten free too

[Bertwills in reply to SlowDragon]

No treatment at all at the moment. No thyroid as surgically removed. TSH over 11 & increasing as to be expected. Gastroenterologist has been involved some time ago but now waiting for appointment in April! I think treatment or testing other than NHS or over the counter is unaffordable.

[helvella Administrator in reply to Bertwills]

You will note that in my document I identify an injectable levothyroxine. Usually would be reserved to hospitals and is expensive. But without any thyroid and no medication severe consequences are pretty much a certainty in the near future.

[Bertwills in reply to helvella]

That’s what I’ve been thinking. GP & hospital endocrinologist are not taking the situation seriously enough. They keep prescribing unusable T4 tablets. Even if the member tries them I would imagine absorption would be at very low levels. I foresee a huge crisis. I will message re injections. Can’t see the unhelpful & irresponsible GPs being happy with the idea though.

[Bertwills in reply to SlowDragon]

I have suggested taking probiotic S Boulardii which is very effective against diarrhoea & I think that’s going to be bought from H & B. They already have a restricted diet I think.

[joydot]

my system doesn’t use t4 so I immediately feel unwell if I take it so I don’t now. Medics still try but I ignore them. Imagine giving anemia patients cancer drugs? Somehow if it’s THYROID taking superfluous drugs isn’t an issue. ???

[Bertwills]

problem is that the member has no thyroid so she has to have thyroid hormone from elsewhere.