I’ve been on levothyroxine since 2017, and last year was told I needed to up my dose to 75mg. was always on the Accord brand but briefly tried the Teva brand when it was out of stock before and it caused me issues with dizziness et cetera. I was told that Teva are the only company to make a 75 µg tablet, so I’ve been taking one whole Accord 50mg and halving one of the 50s per day.
I have been feeling extremely depressed, low and tearful for a few months now and I’m wondering if my potentially inconsistent dosing (the pill cutter I have isn’t the best) could be the cause of this.
Does anyone know if there is a non Teva 75mg thyroxine I could get in the UK on prescription and if my GP might consider letting me try this to at least rule this out as a cause of my issues?
Thanks!
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ohgem
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I understand that levothyroxine is a long lasting (long half life) hormone and as such it shouldn’t make too much difference if your splitting of the tablets is not perfect. I am not aware of any other brand of levothyroxine at 75mcg dose. I take 50mcg of Accord and 25 mcg of wockhardt a day; you might want to try this compromise but it does mean mixing brands.
I think your best course of action is to check your most recent blood test results and pop them on here for advice. Or, if you’re feeling up to it, do a private blood test for TSH, FT4, FT3, vitamin D, B12 and folate, as well as ferritin as this will give you a good picture of your thyroid health.
75mcg levothyroxine is only one step up from standard starter dose
Unless extremely petite you’re likely ready /in need of next increase to 100mcg
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)
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune
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 TPO and/or high TG 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.
Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
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)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
Testing options and includes money off codes for private testing
Your GP should have retested Thyroid levels 2-3 months after increasing dose to 75mcg
Please add those results
Guidelines of dose Levo by weight
approx how much do you weigh in kilo
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.
TSH should be under 2 as an absolute maximum when on levothyroxine
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).
My TSH is 0.17, but my Free T4 is 1.1 in a range if 0.8--1.8, and Free T3 is 3.0 in a range of 2.3--4.2. Blood draw at 8 AM before taking the thyroid pill. This was on 96 mcg T4 per day, I weigh 155 pounds. I'm starting a new doctor who is not an endo but supposed to specialize in hormones oncluding thyroid. He says to do the blood draw on the same day I take the pill, a couple hours to a few hours after taking it. What effect on the kevels might this have? I've been doing it 24 hours post pill for years. Why should TSH not be below 0.1, even with Hashimotos? Mone was at zero for years when I was taking 125 mcg T4. I've been reducing my amount since 1 year ago when I developed afib.
Many people on Levo will find they need Ft4 at least 60-70% through range
155 pounds = approx 70 kilo,
Guidelines on dose by weight of 1.6mcg per kilo
He says to do the blood draw on the same day I take the pill, a couple hours to a few hours after taking it. What effect on the kevels might this have?
You will see significant increase in Ft4 result
Why should TSH not be below 0.1, even with Hashimotos?
Oh ignore that….that’s general advice
Many, many patients on replacement thyroid hormone end up with very low or suppressed TSH
Most important results always Ft3, Ft4 and GOOD vitamin levels
There is currently no other 75 microgram levothyroxine than Teva.
In the next few months, we are hoping to see an Aristo Vencamil 75 microgram tablet arrive. Until then, you have to alternate day dose or split tablets in order to avoid Teva.
Thank you all for the replies and advice - apologies for the delay in responding.
I’m definitely not petite, I haven’t weighed myself lately but my last GP records in 2019 say I am 97kg (I think I’m a bit less now as I’ve been exercising / eating better etc. but I don’t weigh myself at home due to history of eating disorder.)
From my poor online GP records it looks like this:
31/12/21 Serum TSH 2.0 miu/L
Serum free T4 14.5 pmol/L
27/2/23 Serum TSH 2.8 miu/L
Which is when they increased me to 75mg levo but it doesn’t look like they checked my bloods again after changing that.
05/12/23 Serum TSH 1.5 miu/L - I didn’t know they were doing this blood test as it was for something else at the hospital, so I’d taken my meds as normal this day and this test was at about 4pm.
So - I need to book in for some more bloods by the sounds of it?! My GP surgery are not great and often don’t let me book things so it might be a battle. I have a diagnosis of pernicious anemia from 2011 and they’re currently trying to remove that diagnosis from my records and stop treatment for that - if that gives you any idea of what they’re like!
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