I think I remember reading on here that it is best to stay on the same brand of levothyroxine and not to change it.
I have just received my new 25mcg levothyroxine tablets from the pharmacy and they have changed the brand. Previously I was on Wockhardt 25mcg. This time they have given me Hillcross 25mcg. I have been on accord 100mcg and Wockhardt 25mcg for several years. Is this change of brand likely to have any affect on my hypothyroidism or my thyroid levels? Or cause me any problems?
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AlphaWolf5195
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Hillcross 25 is Teva formulation. (Hillcross 50 and 100 are Accord formulation.)
You might be just fine. You might not. And this is a core part of the problem - we really cannot foretell who will have issues.
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. PLUS how to write prescriptions in Appendix F.
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).
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.
Many thanks for your reply and the links. I’ll have a look at them. I have never had either Hillcross or Teva before so I guess it’s just wait and see what happens.
Hillcross 25mcg is actually Teva brand inside the box
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
many, many members have note added to all prescriptions “no Teva” brand Levo
Alternative for 25mcg if Wockhardt not available is Mercury Pharma brand
Government guidelines for GP in support of patients if you find it difficult/impossible to change brands
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.
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).
I already suffer from IBS so hope it doesn’t make it worse.
Very common with autoimmune thyroid disease to result in IBS, poor gut function
What are your most recent thyroid and vitamin results
ESSENTIAL to test BOTH thyroid antibodies at least once
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
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
Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee
If Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances.
Most common by far is gluten.
Dairy is second most common.
A trial of strictly gluten free diet is always worth doing
Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential
A strictly gluten free diet helps or is essential due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and may slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first as per NICE Guidelines
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Similarly few months later consider trying dairy free too.
Approx 50-60% find dairy free beneficial
With loads of vegan dairy alternatives these days it’s not as difficult as in the past
I have no idea whether my hypothyroidism is autoimmune or not. When I last spoke to my GP recently I asked her whether I had ever had my antibodies tested and whether my hypothyroidism was autoimmune. She told me that only hyperthyroidism is autoimmune but hypothyroidism isn’t, so I wouldn’t need antibodies tested as I had hypothyroidism.
I think the only way I will ever find out is to get a private blood test done but I have to save up to be able to do that first.
These are my recent NHS blood test results done this month.
TSH: < 0.02 (0.27-4.20)
FT4: 20.4 (11.9-21.6)
FT3: 4.1 (3.1-6.8)
My GP has asked me to book a telephone appointment with her. There was a note by my TSH result saying they recommended that my levothyroxine dose is lowered so I expect that is what she wants to talk to me about. Is there anything I should be asking her in relation to my above results?
NHS blood test results done in May this year
Serum vitamin B12: 623 (145-569)
Serum Folate: 18.3 (8.8-60.8)
Serum Ferritin: 120 (13-150)
Serum 25-OH vit D3: 99 nmol/L (no range)
I have had hypothyroidism for over 20 years but until I found this forum 6 months ago I just listened to the GP who me told to either increase or reduce my levothyroxine. I was never given my blood test results.
Since joining here I have realised that I should know my actual blood test results, so I always ask for them now.
I have suffered for years with symptoms but they have always been either put down to my CFS/ME or I have just been told you are always like that it is just the way you are.
I have been tested for Coeliac disease in the past and it was negative.
I haven’t tried gluten free.
I have a basically dairy free diet as I have an intolerance to dairy and it aggravates my IBS.
GP obviously was not paying attention at medical school..... autoimmune hypothyroidism is by far the most common cause of hypothyroidism in the developed world , ( in some other parts of the world it is iodine deficiency)....... so it's rather shocking that a GP thinks "hypothyroidism is never autoimmune"
An underactive thyroid (hypothyroidism) is when your thyroid gland does not produce enough of the hormone thyroxine (also called T4).
Most cases of an underactive thyroid are caused by the immune system attacking the thyroid gland and damaging it, or by damage that occurs as a result of treatments for thyroid cancer or an overactive thyroid.
Immune system
An underactive thyroid often occurs when the immune system, which usually fights infection, attacks the thyroid gland. This damages the thyroid, which means it's not able to make enough of the hormone thyroxine, leading to the symptoms of an underactive thyroid.
A condition called Hashimoto's disease is the most common type of autoimmune reaction that causes an underactive thyroid."
Starting to think I’d do better to see if she will refer me to an endocrinologist, at least they might know a bit more about hypothyroidism than she does.
Many thanks for the quote from NHS website, it’s really helpful. I will try again to get my GP to test my antibodies and I quote the NHS website. Surely she can’t ignore that.
She told me that only hyperthyroidism is autoimmune but hypothyroidism isn’t, so I wouldn’t need antibodies tested as I had hypothyroidism.
Good grief …..how ignorant
Almost all primary hypothyroidism is autoimmune
The fact you are lactose intolerant strongly suggests autoimmune
definitely worth trying strictly gluten free
think I’d do better to see if she will refer me to an endocrinologist, at least they might know a bit more about hypothyroidism than she does.
Vast majority of endocrinologists are diabetes specialists and frequently pretty useless for Hashimoto’s
First step get FULL thyroid testing including thyroid antibodies
If both antibodies are negative, look at getting ultrasound scan of thyroid
Only then consider booking consultation with thyroid specialist
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 who will prescribe T3 if necessary
Ideally choose an endocrinologist to see privately initially and who also does NHS consultations
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 5-7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
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
Many thanks for your reply, I’ll try a gluten free diet as you suggest and save up for a private blood test to test antibodies.
My Thyroid blood test was done at 11.45am and levothyroxine was taken approx 11-12 hours before blood test. I have a district nurse out so never know what day or what time they will be out to do blood test. I had breakfast before the blood test.
I take B12 at the moment , my GP said to reduce them to one a week, once I have finished this box I will change to a B complex as you suggest. I also take Fultium D3, Ferrous Sulphate, Magnesium, Vit C+ Zinc and Calcium. (Have to take calcium as without it my calcium levels drop too low).
Would it be worth asking my GP whether she can trial me on T3 along with Levothyroxine as my conversion is poor? I am post menopause.
I hadn’t realised GP wasn’t allowed to initiate T3. I am speaking to her in a couple of weeks, so I will try again to get her to test my antibodies, quoting the NHS site which says about hypothyroidism being autoimmune. Failing that I will get a private blood test done.
Unfortunately I am unable to use a private endocrinologist as the only way I can get to hospital appointment is to use the NHS Hospital transport.
Many thanks for all the help I really appreciate it.
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