Can some Levothyroxine brands cause gastritis/reflux?

[UFU011878]

Hi everyone, I'm hoping to get some advice. I've been taking 75micrograms Levothyroxine since 2017. I've never been referred to an endocrinologist. I have had long term digestive issues since my gallbladder was removed 30 years ago, but symptoms were controlled until the last 18 months. I was not paying much attention to the brand of Levothyroxine, but I did notice that it changed a while ago. It is now Hillcross for the 25 tablet and Accord for the 50. Has anyone else had problems with these brands? I'm feeling really miserable with no help from GP

[helvella Administrator]

Hillcross 25 micrograms only is actually Teva product. (The 50 and 100 microgram Hillcross are Accord.)

A considerable number of members find that the Teva formulation causes stomach issues. (While some find it very good for them.)

Do you have enough Accord to try splitting them and seeing if taking one and a half Accord 50 microgram tablets helps?

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. There is now a specific world desiccated thyroid document.

I highly recommend viewing on a computer screen, or a decent sized tablet, rather than a phone. Even I find it less than satisfactory trying to view them on my phone.

helvella - Thyroid Hormone Medicines - UK

The UK document contains up-to-date versions of the Summary Matrixes for levothyroxine tablets, oral solutions and also liothyronine available in the UK. Includes descriptions of tablet markings which allow identification. Latest updates include all declared ingredients for all UK products and links to Patient Information Leaflets, etc.

dropbox.com/s/bo2jzxucgp9hl...

helvella - World Desiccated Thyroid

Contains details of all known desiccated thyroid products including information about several products not considered to be Natural Desiccated Thyroid (NDT/Desiccated Thyroid Extract/DTE).

dropbox.com/scl/fi/gx6dmz5i...

helvella - Thyroid Hormone Medicines - RotW

Contains details of all levothyroxine, liothyronine and combination products - excluding desiccated thyroid products. Details available vary by country and manufacturer.

The link below takes you to a blog page which has direct links to the documents from Dropbox and QR codes to make it easy to access from phones. You will have to scroll down or up to find the link to the document you want.

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

[UFU011878 in reply to helvella]

Thanks for all this info. As per reply to slowdragon, I have been given some momentum by the 2 of you to try and get myself sorted.

[SlowDragon Administrator]

acid reflux is a symptom of being hypothyroid

75mcg is only one step up from standard STARTER dose

Hillcross is Teva - Teva brand upsets many, many people

Get more Accord 50mcg tablets and cut in half to get 25mcg

Retest in 6-8 weeks time

Unless extremely petite, likely to need dose increase after next test

are you male or female

Approx age

(Please add these on your profile)

What were most recent thyroid and vitamin results

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

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

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease and if been left on inadequate dose levothyroxine

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)

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)

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)

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

[SlowDragon Administrator]

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 (typically 1.6mcg per kilo of your weight per day)

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

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.

Some people need a bit less than guidelines, some a bit more

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

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).

[UFU011878 in reply to SlowDragon]

Thanks so much for this info guys. It took 7 yrs and finally a private blood test to get any treatment at all. I only managed to get the dose increased about 2 yrs later by seeing a different gp. My dose has been the same for approx 5 yrs. T3 and antibodies have never been tested and it's probably 2yrs since they checked my t4 and tsh. I know I should have been pushing more, but I've been feeling dreadful and haven't had the energy to persist. I think at this point, I will just have to find the money to go privately and see a consultant and you've given me the momentum to get started

[SlowDragon Administrator in reply to UFU011878]

First step get FULL thyroid and vitamin testing done

Come back with new post once you get results

First step will be (probably) to get increase in dose levothyroxine and highly likely low vitamin levels will need improvement too

Members can advise on next steps

Roughly where in U.K. are you

Vast majority of endocrinologists are diabetic specialists and frequently useless for thyroid

Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations

thyroiduk.org/contact-us/ge...

levo doesn’t top up failing thyroid, it replaces it. ESSENTIAL to be on high enough dose and for good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we MUST have optimal vitamin levels

30 years ago I was left 5 years on just 75mcg Levo, became extremely unwell……more on my profile. GP and local endocrinologist were hopeless.

[UFU011878 in reply to SlowDragon]

I'm in Co Down, Northern Ireland

[SlowDragon Administrator in reply to UFU011878]

So may need to do zoom consultation if no one nearby

[UFU011878 in reply to SlowDragon]

Needed a little vent - I took the bull by the horns this morning and phoned my surgery. The gp I spoke to didn't want to talk about my splitting the accord 50 tablet. He just kept repeating that they don't prescribe a brand and it's between me and the pharmacy. He agreed to repeat my t4 and tsh tests and when I asked for t3, he said it wasn't necessary. I replied that if I wasn't converting the t4, I wasn't getting the benefit from it and he asked what my background was. When I said I was a scientific officer in clinical chemistry, he told me that t4 is the active form and he would do my t3 if I insisted, but it wasn't necessary! No vitamin checks. So frustrating, and part of the reason I've been putting up with the symptoms. Apologies for bending your ear - you must be tired of hearing these rants!

[SlowDragon Administrator in reply to UFU011878]

Many members just test privately

Personally I haven’t had NHS test for over 10 years

I am prescribed T3 on NHS alongside my levothyroxine

Taking almost T3 will significantly lower or suppress TSH ……and guidelines say if TSH is suppressed they should test Ft4 and FT3 … but they don’t

[SlowDragon Administrator in reply to UFU011878]

vitamin D test twice year

Test Folate, ferritin and B12 at least annually

Optimal vitamin levels

Vitamin D at least over 80nmol

Serum B12 over 500

Active B12 over 70

Ferritin over 70

Folate at top of range

[helvella Administrator]

Quite a while ago I switched from Accord to Aristo Vencamil - and am happy that I did.

For whatever reason, my feeling through the 24 hours between doses seems a bit more even.

[cbraffe]

Teva damaged my gut. You could Google reports on the side effects of Teva and email it to your GP. That is what I did when I was diagnosed with gatritis. My GP was telling me it was the only brand without lactose until I educated him. Good luck

[UFU011878 in reply to cbraffe]

Thanks for your reply. It's comforting to know that it's happened to other people and can be sorted. My gp said it was between me and the pharmacy who told me that they have to take whichever brand the wholesaler sends them. My gp has now increased my accord prescription, so that I can divide tablets to make up the 75 micrograms. I only started this2 days ago and haven't had any improvement yet, but live in hope! Still very miserable with stomach symptoms

[cbraffe in reply to UFU011878]

So sorry. Ask him to put a brand on your prescription . I have Aristo recorded on mine. Teva was discontinued sometime ago. It is on record that it affects your gut

[helvella Administrator in reply to cbraffe]

The old formulation of Teva was discontinued in, I think 2012. But, at that time, it was a formulation Teva had acquired.

The new formulation of Teva has been available since 2016. The new formulation is entirely different and, to begin with, prominently displayed "New Formulation" on the packets. And it is the new formulation which seems to cause stomach issues in some of us. Suspected, but not proved, to be due to the mannitol ingredient.