Cutting Accord tablet

[Sailing14]

I need a slight dose reduction and was going to trial 75/100 instead of 100 a day. I only get on with Accord. Can I split this to 87.5 per day? Or do I risk loosing parts of it to do this?

I have taken 75 today to start the trial but feel really tired and this happened before recently. It was suggested I take 75 for one day to start the reduction by helpful advice on here, but the 75 seems too low on any one day for me.

I am also thinking of night time dosing but am I right in that I need the dose reduction period first or I will get confused doing both?

I have had many problems with 50 mcg Accord (being substandard) so these aren’t an option due to this and the issues they have already caused.

Thank you again for any possible advice.

[Buddy195 Administrator]

I would use a pill cutter to reduce your 100mcg tablet to 87.5mcg, as this slight reduction may be enough to get FT4 within range. Try this reduction first, before trialling a change in time of day (as I’ve found it’s best just to make one change at once).

Your last bloods showed

Free T4 (fT4) 22.2 pmol/L (12 - 22)

Free T3 (fT3) 5 pmol/L (3.1 - 6.8)

TSH 0.35 mu/L TSH (0.27 - 4.2 )

You are clearly a poor converter, as FT3 only half way through the range.

Has your GP agreed to retest 6-8 weeks on your slightly reduced dose?

[Sailing14 in reply to Buddy195]

Thank you for your help. I am trialing things myself as the GP is not involved as it is mainly my Endocrinologist but I can’t see him at present.

I will cut the 100 tablet as advised but they are tiny and are okay halved and quartered but I struggle with the next break.

Have you got any advice on this?

Thanks again

[Buddy195 Administrator in reply to Sailing14]

I bought a pill cutter from Amazon to help divide the 100mcg pill. It is tricky and sometimes looks like you are removing ‘dust’!

[Sailing14 in reply to Buddy195]

I have got a pill cutter so will try this method again. If I cut the one tablet up, do I have too keep the tiny part for the next day and so on?

[Sailing14 in reply to Buddy195]

Sorry I was not sure where to put this question but it relates to this conversation. I have a viral infection at present and feel quite low and run down with it. Do I wait for this to clear before I consider this reduction and could this be why I am so tired when I try?

Also, I am not sure if I have symptoms of overactive thyroid (not the usual like palpitations, increased hunger and anxiety). Could I continue on 100 or is the T4 quite high and is the virus not helping?

Thanks again.

[Buddy195 Administrator in reply to Sailing14]

I would not want my FT4 to be over range, so personally would reduce Levothyroxine.

I would look to start a new post with your key vitamin results. It may be that these are not optimal and this is making you feel more tired.

Forum advice is to check folate, ferritin, B12 and vit D.

[Sailing14 in reply to Buddy195]

Thank you. I have been looking into my vitamins and have got to get these together as they were tested privately and at GP practice.

Could I ask how the T4 being slightly over range impacts our health?

[Buddy195 Administrator in reply to Sailing14]

Over range FT4 may adversely affect heart health, plus there are thoughts it could be a cancer risk.

FT4 may not be as affective when you exceed your ‘sweet-spot’- as T3 conversion reduces the higher you go. radd may be able to provide more information (as she has posted about this previously). I’ve certainly found I achieve better FT3 levels with my FT4 slightly lower.

[Buddy195 Administrator]

You can just discard it if you have enough tablets

[Sailing14 in reply to Buddy195]

Thank you. I know the crumbs have to be taken with the complete pieces but do I need to worry about the dust particles?

[crimple in reply to Sailing14]

Sailing14, I needed to increase my levo from 100 to 112.5 mcgm and can only tolerate Vencamil, so I cut a 100mcgm tablet into quarters and keep the quarters in a small pill box including any crumbs. I then take a quarter on alternate days (25 mcgm every 2 days ) This has worked quite well for me. I believe Accord have 50mcgm tablet, can you get them to cut into quarters? Then you could take a quarter every day.

[Sailing14 in reply to crimple]

I will consider this option but would this be more difficult when reducing? Also, I can’t use 50s as I had problems with substandard issues in the past.

Thank you for your help.

[crimple]

Sailing14, re issues with Accord, I had issues with how much T4 was being delivered. So moved to Vencamil last year. They only do 100 mcgm but helvella has mentioned they have 50 and 25 mcgm waiting for MHRA approval🤞it will be soon

[helvella Administrator Thyroid UK in reply to crimple]

And 75 - which might be first!

(And 12.5 - but that could be ages yet.)

[Sailing14 in reply to helvella]

Thank you for this information. I do have vencamil but when I tried them I got indigestion and stomach issues within a few hours. I am lactose intolerant so would have liked to have changed to these.

Can you advise if I can introduce these gradually and whether this may help due to them being too strong possibly for me?

[helvella Administrator Thyroid UK in reply to Sailing14]

I wish I could answer helpfully!

I do think that the absorption profile (how much your blood levels rise over time), and total absorbed, have been largely ignored by the pharmaceutical people. They do test in the lab and, to a very limited extent, in volunteers. But we'd probably find that in real world patients - such as members here - the reality can be up or down from that is thought.

Maybe try only taking a half and a quarter (yes - first break is easy, next is more difficult)? Or half in the morning and half in the evening? Not necessarily to switch to a different approach but to see if it makes any difference.

[Sailing14 in reply to helvella]

Thank you that is interesting about the absorption issues and what the reality really is.

I will trial the vencamil again as this tablet is now being produced in other strengths. I am not sure I will get on with it but I can only hope I do.

Can I ask, I believe you take your tablet at night. Do you take it last thing and leave two hours after your meal and also after you take it?

Thanks again for your help.

[helvella Administrator Thyroid UK in reply to Sailing14]

Not yet available in other doses! Probably July 2024... (Unfortunately.)

[Sailing14 in reply to helvella]

If I try the half and then a quarter together as suggested, when would I take the other quarter? I am not sure on a night time dose at the moment so could it be taken early evening as long as on an empty stomach? Maybe I could take the whole tablet in one go after a week or so as hopefully my body may get more adapted to it.

Thank you for any advice you may be able to recommend.

[helvella Administrator Thyroid UK in reply to Sailing14]

If you are being prescribed but only taking a half and a quarter, I think I would simply throw away the quarter.

Many of us have felt the need to make small changes. Sometimes we confirm that. Sometimes we revert to the previous dose. Very difficult to predict but entirely possible that you could 'get used' to it - but maintain awareness and act if needed!

[Sailing14 in reply to helvella]

Thank you for your help. I was going to remain on 100 mcg but take 75 in the morning and then the rest later on to see if I can adjust to the tablet.

Is this what you were referring to previously?

[helvella Administrator Thyroid UK in reply to Sailing14]

Yes - try that! Do whatever adjustment you need but don't rely on accuracy of quartered tablets! And don't keep bits of tablets more than a day or so.

[Sailing14 in reply to crimple]

Thank you for letting me know as you do wonder if it is just you making these assumptions. I dropped from 100 to 75 at Endocrinologist’s advice using the 50 mcg tablets. I found out the hard way as I went seriously underactive and have not been the same since with trying to work things out with Covid in between.