change of meds.

[Alixleo24]

so I’ve been on levo for 15 years and have hashimotos . Around 3 years ago I was added t3 too. I still feel awful and would like my GP to change my levo to a different brand maybe? As all my symptoms seem to be inline with my levo and the side effects. Has anyone had success with this ? I would really appreciate any help or info x

[helvella Administrator Thyroid UK]

My first answer would be that unless that actual make is written on the prescription, try getting a pharmacist to dispense a different product?

It would help if you gave us a bit more information like adding your location to your profile, telling us what doses you take, adding any relevant blood test results (including reference intervals - ranges).

[Alixleo24 in reply to helvella]

Hi , thank you. Thats interesting! Thanks I will add those now to my profile.

[SlowDragon Administrator]

welcome to the forum

What are your most recent thyroid and vitamin results

Which brands of Levo and T3 are you taking

You can request GP specify brand on prescription once you work out which brand suits you best

Many people find Levothyroxine brands are not interchangeable.

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 

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)

Vencamil (currently 100mcg only) is lactose free and mannitol free. 25mcg and 50mcg tablets hopefully available from summer 2024

March 2023 - Aristo now called Vencamil

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Helpful post about different brands

healthunlocked.com/thyroidu...

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Government guidelines for GP in support of patients if you find it difficult/impossible to change brands

gov.uk/drug-safety-update/l...

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.

academic.oup.com/jcem/artic...

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).

And here

pharmacymagazine.co.uk/clin...

Discussed here too

healthunlocked.com/thyroidu...

[Alixleo24 in reply to SlowDragon]

Hi

Thanks so much ! I’m awaiting my latest blood results so will post next week when they’re back .

So I take 125 mg of levo and 20 mg of t3 a day.

I cannot tolerate any levo that’s Teva or accord. So make sure I have different for that.

Also the only t3 I can tolerate is morningside.

My joint pain etc has always been unbearable. And is gradually getting worse, I have had lots of tests for RA and even osteoporosis , even early menopause etc . All coming back fine.

I’m just finding it so hard to carry on with this joint pain daily going to work etc , my joints just crack constantly and my hands / feet / knees are so so painful. I have b12 jabs every 8 weeks to keep that optimal . I am also gluten free but not sure if that’s going more harm than good at the moment to be honest.

[SlowDragon Administrator in reply to Alixleo24]

What vitamin supplements are you taking apart from B12

When was folate last tested

As you have B12 injections it’s recommended to supplement a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and may help maintain B12 levels between injections too

Difference between folate and folic acid

healthline.com/nutrition/fo...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid supplements

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

Post discussing different B complex

healthunlocked.com/thyroidu...

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg)

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

How much vitamin D are you taking

[Alixleo24 in reply to SlowDragon]

That’s great thank you , I will have a read through all the info 😊

[SlowDragon Administrator in reply to Alixleo24]

So I take 125 mg of levo and 20 mg of t3 a day.

I cannot tolerate any levo that’s Teva or accord. So make sure I have different for that.

Also the only t3 I can tolerate is morningside.

Do you normally split your T3

As two or three or four smaller doses spread through the day

[SlowDragon Administrator]

What vitamin supplements are you taking

When were vitamin levels last tested

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine or T3

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common when hypothyroid, especially with Hashimoto’s

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)

T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

Post all about what time of day to test

healthunlocked.com/thyroidu...

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

As you have Hashimoto’s are you gluten free and/or dairy free

[Alixleo24 in reply to SlowDragon]

I did question my folate a few weeks ago but apparently “normal” even though they don’t state of that is optimal or normal 🙄I will chase up numbers so I can post those too. I take magnesium glycinate daily for my PMDD and also used to take vitamin D (I’m not sure if to take in summer etc ?) I don’t want to take too much.

[SlowDragon Administrator in reply to Alixleo24]

Test vitamin D twice yearly when supplementing

Can test via NHS private testing service

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7.

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with Hashimoto’s we frequently need higher dose than average

Vitamin D and thyroid disease

grassrootshealth.net/blog/t...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Recipe ideas

bbc.co.uk/food/articles/mag...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going daily maintenance dose to keep it there.