Medscape article: what's in a name? (brand vs genetic levothyroxine)

[BB001]

This made interesting reading and I've got mixed feelings after reading it. Certainly they are focused on TSH as a measurement of adequate levothyroxine replacement, which I think is dubious. However it contains some good explanations. They seem to be totally unaware that allergies and intolerances exist and that even a small amount of an inactive ingredient can cause problems for some people. I'm sure other people will also have bits they like and dislike.

medscape.com/viewarticle/99...

[FallingInReverse]

Interesting… I noted 2 things…

“Back in 2023, we embarked on this podcasting journey with the focus on the emerging topic of T3 use for hypothyroidism. This has since gained mainstream recognition with the release of the new joint British Thyroid Association guidelines.

T3 in BTA guidelines?? Has T3 gained mainstream recognition?!

and…

“Levothyroxine, I believe, has a very interesting way to be absorbed and metabolized. Once somebody takes the pill, it goes into the stomach. That is the part that is very crucial for the absorption of the pill because the majority of people take what is called tablet levothyroxine.

The acid production of the stomach will dissolve what is around the active component of the tablet. Our gastrointestinal system will finally have the active form.

“The main rationale behind that is that you really need to have acid in your stomach to dissolve the tablet to release the active ingredient.”

There is periodic discussion here about taking Levo or Lio sub-lingual. It is well documented as above and in other patient literature that you can’t - that stomach acid is an essential step in the process.

Although everything says this to be the case - I have always taken mine sub-lingual. And my TSH and Free Ts are moving in the right direction. Whether they’d move faster if I swallowed each, I don’t know.

But it’s clear that stomach acid is not “required” although might be more efficient. Or one could say that I end up swallowing it all, sending it to my stomach very inefficiently. Who knows!

I plan to take one of my next 6-8 change periods to switch to swallowing and see what impact it has.

[greygoose in reply to FallingInReverse]

I'd be interested to know why you take it sublingually. I tried that in the early days, when I knew next to nothing about thyroid, but really didn't like the taste, and they took so long to disolve. Plus, I didn't find any advantage to doing that, so I stopped.

[FallingInReverse in reply to greygoose]

tried that in the early days, when I knew next to nothing about thyroid

👆that!

I just started doing it, no reason, but before I knew anything at all. (Edit: also, come to think of it, I assumed it was more efficient.. imagined it was right to the bloodstream, vs the journey through the stomach.)

I guess it helped that Synthroid and Cytomel have a bit of a sweet taste : )

Then by the time I found this board, and in previous posts realized it wasnt intended to be taken that way, I was stuck. I guess I could start swallowing it any time, but I think I am too curious and will change that as one of my next titrations. I don’t know … but I’m a die hard one-change-every-6-8-weeks person to can’t bring myself to just change in the middle.

It will be only one data point, and won’t be perfect, but I really am curious, and reading what is said about how stomach acid is required, I expect it will have a noticeable impact. I’ll be surprised if it doesn’t, but so curious!

[greygoose in reply to FallingInReverse]

Wouldn't be a good idea to change mid-way between tests, anyway. You'd get unhelpful results. I also firmly believe in waiting the full six weeks, at least.

[FallingInReverse in reply to greygoose]

Yeah, me too. So here I am, stuck sublingual : )

I think I’ll get my latest bloods done this week, and at 75 Levo and 10 Lio…. This might be the right time to change. We’ll see. But I am definitely sooo curious.

[greygoose in reply to FallingInReverse]

Yes, it would be very interesting to know what happens when/if you change. Most people who talk about it on here never report back after changing, so we don't really know how much impact it actually has. But, my guess is that absorption is erratic, which is hard to prove unless you test every day. So, that's out!

[arTistapple]

I normally swallow. However there are times when I can’t get the glass of water quickly enough to my mouth. The tablet is already dissolving before I get to the water. It does not take long at all (in my case) to begin to break it down.

This post has reminded me, I certainly don’t use a full glass of water either to swallow the pill. Feels like overkill.

However I do feel it’s important to do your ‘method’ habitually.