Splitting Thyroid Tablets

[AlphaWolf5195]

Hi Everyone

Is it ok to split thyroid tablets in half and have one half on one day and the other half 2 days later?

I have recently had my 25mcg Levothyroxine brand changed from Wockhardt to Teva and I have been getting a lot of headaches, more than usual and lightheaded and nauseous. I am wondering whether it could possibly be that I don’t tolerate the Teva band of Levothyroxine very well as this all started up when I changed brands.

I would like to try an experiment to see whether I can find out if the Teva is causing it or whether it is something else. I have Accord 50mcg tablets that I know I am ok with and have had for years so I would like to try splitting these in half instead of taking the Teva.

If the headaches etc improve when I am not on the Teva I will then try the Teva again to see if they come back.

I just wanted to check that it is ok to split Levothyroxine tablets this way.

I am on 75mcg Levothyroxine Mon, Wed, Fri and 100mcg Tues, Thurs, Sat, Sun

Thank you for all your help, I really appreciate it.

[helvella Administrator]

There are warnings about exposure to oxygen, to light, to humidity. And uneven splitting.

But, in reality, it should be absolutely fine. It's not as if you will leave the half tablets in the sun, in a damp bathroom, for days or weeks!

[The-Wasp in reply to helvella]

This is absolutely true! I think now after reading your responses to my post, I've become very worried about how difficult it will be to find a doctor in time in Sweden to prescribe the Erfa. I don't like the idea of needing to have it approved every year at all Could I please private message you about trying to source a different NDT medication from Sweden? Or would you prefer that I start a new post and ask people to private message me? Perhaps it would be best to try to switch to Levothyroxine and Liothyronine as I might have an easier time having it prescribed (or finding other sources if that's difficult). Usch, so depressing how we all get the run around.

[The-Wasp in reply to helvella]

I'm sorry. I meant to write that in response to your comments on my post yesterday! I'll go back and try to find the post. So embarrassed!

[SlowDragon Administrator]

get a weekly pill dispenser and put split pill in box for next day that you take 75mcg

Teva upsets many many people

Are you using Accord for 100mcg and 50mcg tablets

it’s absolutely fine to split tablets

Headaches can also be hypothyroid symptom

You’re not on very high dose

Retest 6-8 weeks after taking only accord brand

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)

Test day after taking a 75mcg dose

[AlphaWolf5195 in reply to SlowDragon]

I have a pill case which has 2 weeks of daily pots in, so I can sort out what tablets to take each day in advance.

Yes both my 50mcg and 100mcg are Accord.

My GP has recently been reducing my Levothyroxine dose because when I changed from taking it in the morning to taking it in the evening it completely changed my results. I have listed below my last 3 blood test results and the amount of Levothyroxine I was on above each result. I am due another blood test next month.

Jan 2024 on 100/125mcg alternate days

TSH 2.5 (0.27-4.20)

June 2024 on 100/125mcg alternate days

TSH 0.02 (0.27-4.20)

FT4 20.4 (11.9-21.6)

FT3 4.1 (3.1-6.8)

June 2024 Doctor reduced Levothyroxine to 100mcg daily

August 2024 on 100mcg daily

TSH 0.03 (0.27-4.20)

FT4 17.1 (11.9-21.6)

August 2024 Doctor reduced Levothyroxine to 75mcg Mon, Wed, Fri and 100mcg Tues, Thurs, Sat and Sun which I am now on.

Unfortunately I have no choice as to what time of day or what day I have my blood tests done as I have to have a district nurse out to my house to do them as I am housebound. They just turn up anytime between 9am and 2pm and don’t let you know which day they are coming.

[SlowDragon Administrator in reply to AlphaWolf5195]

Reducing dose levothyroxine frequently results in significant drop in vitamin levels

This results in poor conversion of Ft4 to Ft3 and then lower TSH as direct result

June results show very poor conversion rate

Was last dose levothyroxine 24 hours before test

Free T4 (fT4) 20.4 pmol/L (11.9 - 21.6) 87.6%

Free T3 (fT3) 4.1 pmol/L (3.1 - 6.8) 27.0%

Ideally aiming for both Ft4 and Ft3 at roughly 70% through range

August results obviously don’t tell you much as no Ft3

Free T4 (fT4) 17.1 pmol/L (11.9 - 21.6) 53.6%

Reducing levothyroxine has seen significant drop in Ft4 ……probably by too much

Ft3 likely to have dropped too

Absolutely definitely did not need further reduction in Levo

Likely very hypo now

All GP is incorrectly looking at is low TSH

Dose should NEVER be adjusted on basis of TSH

[AlphaWolf5195 in reply to SlowDragon]

My last dose of Levothyroxine is never 24 hours before the test as I don’t know what day it will be done. It was probably 12 hours or so before the test. I take Levothyroxine in the evening approx 10pm or so and then the nurse will be out between 9am and 2pm, often around 11-12pm.

Could it be the fact that I am likely hypo and under medicated that is causing my headaches, light headed and nausea?

Has there been long enough since my last blood test and dosage change to have another blood test now? I think having another blood test might be best so I can see what my levels are now.

Do all endocrinologists know about thyroid? I am on a waiting list to see one about my chronic Hyponatremia and wondered whether it’s worth mentioning my thyroid when I am there?

I am convinced my GP knows absolutely nothing about hypothyroidism and doubt she will let me increase my dose, as far as she is concerned as long as TSH is within the range then that’s fine and it doesn’t matter about anything else.

[SlowDragon Administrator in reply to AlphaWolf5195]

Has there been long enough since my last blood test and dosage change to have another blood test now? I think having another blood test might be best so I can see what my levels are now.

Retest 8-10 weeks after any dose reduction

Presumably you know which day nurse is coming to do test ?

If so ….don’t take evening dose night before…..take it AFTER blood test

It was probably 12 hours or so before the test. I take Levothyroxine in the evening approx 10pm or so and then the nurse will be out between 9am and 2pm, often around 11-12pm

So Ft4 was too low at 53% through range…..and that’s with last dose only 12 hours or so before test

If you had left 24 hours Ft4 would have been even lower

Do all endocrinologists know about thyroid? I am on a waiting list to see one about my chronic Hyponatremia and wondered whether it’s worth mentioning my thyroid when I am there?

yes …..most likely because of low Ft3 (hypo)

academic.oup.com/ejendo/art...

Most endocrinologists are diabetic specialists and often useless for thyroid

Very few understand the relevance of vitamin levels and Ft3

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 so that might eventually transfer to NHS

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

what vitamin supplements are you taking

If housebound likely low vitamin D

Low B vitamins common as we get older

Request GP test vitamin D, folate, ferritin and B12 alongside FULL thyroid- TSH, Ft4 and Ft3

[AlphaWolf5195 in reply to SlowDragon]

Thank you for all your help, I really appreciate it.

Unfortunately I never know which day the nurse is coming, they don’t tell me, they just turn up, usually within a 2 week period, I have asked if they could let me know when they are coming but they never do.

I take the following prescribed vitamins

Vitamin D3 1000 IU each day

B12 100mcg once a week (Dr decreased dose from daily to once a week in Jan and wants me to stop altogether once I have finished the box)

Ferrous Sulphate 200mg once a week (Dr decreased dose from alternate days to once a week in Jan)

I also take Magnesium, Omega 3 and Calcium as recommended by my GP

Blood Test Jan 2024

Serum 25-HO vit D - 99 (no range)

Serum Ferritin - 120 (12-150)

Serum Folate - 18.3 (8.8-60.8)

Serum B12 - 623 (145-569) (although I was on 100mcg daily at the time)

I don’t seem to have had a blood test for vitamins since January and in Jan after my last blood test my GP lowered my dose of B12 from daily to once a week and my ferrous sulphate from alternate days to once a week. Haven’t had them checked since.

In case it’s relevant I also have low white blood cell count and low red blood cell count although I have been referred to haematology for this and I’m waiting to hear from them.

I will ask my GP for a blood test for everything you suggest.

[Singwell]

I take 75mcg a day but need a little bit more across the week, so split a tablet in half on Wednesday and Thursday. The tablets are quite crumbly and I wouldn't store for more than 24 hours unless you are able to pop them back in their blister pack. You could always ask the pharmacist- I find they're very helpful on such matters.