Brand changed from Wockhardt to Teva 25mcg - Thyroid UK

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Brand changed from Wockhardt to Teva 25mcg

NotAllWhoWonder profile image
14 Replies

As per title, I collected my script earlier today, saw the packaging was different, and didn't really think much of it - because it seems to happen quite a lot with my other meds - until I popped out some pills to put into my dispenser. They're much larger than what I'm used to, so did a quick Google and found the main difference is that Wockhardt contains lactose and Teva contains mannitol. Never heard of the latter before, so did a search and WOW, there's a lot of controversial stuff about it online (from the major issues in France, to the UK government outright banning it and then reinstating it a few years ago).

I'm aware that everyone reacts differently to different meds, but just wondering if I should go back to my pharmacist and ask for the old brand or give this one a go? Some have reported actually feeling better on it - something I've never really noticed on Wockhardt (I don't feel better, but I don't feel worse, either). I've just had a lot of crap with medications not agreeing with me over the years, and I'm headed down under for a 2 week break in January and don't want to be feeling worse than I currently do because of Teva. My kidney function isn't great (currently around 70) and as mannitol is sold as a diuretic, I'm actually a bit concerned I may start losing too much water. There's also the issue with palpitations due to salt/mineral imbalances, and as I already have a heart issue...

Thoughts? Advice?

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NotAllWhoWonder
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14 Replies
Jaydee1507 profile image
Jaydee1507Administrator

How long have you been on just 25mcgs Levo?

Many people dont get on with Teva brand but equally there are others that love it. Its very marmite.

In future your GP can write the brand of Levo you prefer in the first line of the prescription so you always get the same brand you prefer. Either that or switch to Vencamil which again is written in a way they can only give you that brand. Its lactose & mannitol free which suits many.

Have you tested key vitamin levels and now supplementing to optimal levels?

What are your latest thyroid results with ranges?

NotAllWhoWonder profile image
NotAllWhoWonder in reply toJaydee1507

Been on the 25mcg for about a year now. Getting vitamin levels tested, etc, from my GP is a PITA, but everything last time I managed to get it done was "within range". Went for bloods last week to check TSH (even though I asked for it, they apparently don't do T4 unless TSH is an issue, and definitely won't ever do T3 because of the cost).

SlowDragon profile image
SlowDragonAdministrator in reply toNotAllWhoWonder

What exactly were your last test results and ranges BEFORE starting on Levo

And at last test

Standard STARTER dose Levo is 50mcg

Having been left on only half the standard starter dose vitamin levels likely low

Low vitamin levels will tend to lower TSH, making it harder to get dose Levo increases

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 somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)

cks.nice.org.uk/topics/hypo...

bnf.nice.org.uk/drugs/levot...

nhs.uk/medicines/levothyrox...

Adults usually start with a dose between 50 micrograms and 100 micrograms taken once a day. This may be increased gradually over a few weeks to between 100 micrograms and 200 micrograms taken once a day.

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).

sciencedirect.com/science/a...

The optimal daily dose in overt hypothyroidism is 1·5–1·8 μg per kg of bodyweight, rounded to the nearest 25 μg.

ESSENTIAL to test vitamin D, folate, ferritin and B12 at least annually

What vitamin supplements are you taking

Have you had thyroid antibodies tested ?

Jaydee1507 profile image
Jaydee1507Administrator in reply toNotAllWhoWonder

25mcgs is just a starter dose. If you're male then likely you need far more than that.

Theres a rough calculation to work out approx how much you might need.

1.6 x weight in kilos = approx final dose of Levo.

Suggest you push your GP for an increase on a 'trial' basis which often goes down better. You can point out that the calculation I have given is used as a guide in the NICE guidelines.

nice.org.uk/guidance/ng145

If one GP refuses then dont give up, keep trying different GPs.

Always book blood test for 9am or earlier when TSH is highest. Fast before the test and take Levo that day AFTER he test, to allow 24hrs between last dose of Levo & test. Stop any biotin comtaining supplement 4-7 days before the test.

Do you have a copy of the vitamin results? You are legally entitled to a printed copy of your results, ask at GP reception. In England you can get the NHS app and ask for permission to see your blood results on that by asking at GP’s reception.

Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/testing/priva...

There is also a new company offering walk in& mail order blood tests in London, Kent, Sussex & Surrey areas. Check to see if there is a blood test company near you. onedaytests.com/products/ul...

Only do private tests on a Monday or Tuesday to avoid postal delays.

SlowDragon profile image
SlowDragonAdministrator

previous post

healthunlocked.com/thyroidu...

Results show inadequate dose levothyroxine

Levothyroxine doesn’t “top up” your own thyroid, it replaces it

So it’s essential once you start on Levo you retest 2-3 months after each increase, including Ft4 and Ft3

ALWAYS test early morning, ideally before 9am, only drinking water between waking and test and last dose levothyroxine 24 hours before test

Aiming for Ft4 (levothyroxine) at least 60-70% through range and Ft3 (active hormone) not far behind

For GOOD conversion of Ft4 to Ft3 we need GOOD vitamin levels

Ferritin at least over 80

Vitamin D at least over 80nmol

Folate towards top of range

Serum B12 over 500

Active B12 over 70

When hypothyroid we develop low stomach acid and this results in poor nutrient absorption and low vitamin levels as DIRECT result

It’s likely the cause is autoimmune thyroid disease also called Hashimoto’s ……..as giving up smoking exacerbated your issues

pubmed.ncbi.nlm.nih.gov/226...

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)

NHS only tests TG antibodies if TPO are high

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)

Retest thyroid including thyroid antibodies and vitamin levels 6-8 weeks after being on 25mcg Levo

what vitamin supplements are you taking

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...

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

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

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

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

Monitor My Health (NHS private test service) offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65

(Doesn’t include thyroid antibodies)

monitormyhealth.org.uk/full...

10% off code here

thyroiduk.org/testing/priva...

Randox FULL thyroid test including both thyroid antibodies just £29

Test at home or in clinic

randoxhealth.com/en-GB/at-h...

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

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) and continue separate B12

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

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

NotAllWhoWonder profile image
NotAllWhoWonder in reply toSlowDragon

Was about to link to my previous post to save me having to go through all of it again lol, so thanks!

helvella profile image
helvellaAdministrator

I rather doubt that the amount of mannitol in a tablet would be sufficient for any diuretic effect to be noticeable.

helvella - Teva versus the rest

A discussion of the issues surrounding Teva levothyroxine.

Last updated 29/11/2024

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

NotAllWhoWonder profile image
NotAllWhoWonder in reply tohelvella

Thanks for that. So just wing it and see how I get on?

helvella profile image
helvellaAdministrator in reply toNotAllWhoWonder

Pretty much!

It is good to have a path of retreat, if possible. But that is not always possible.

NotAllWhoWonder profile image
NotAllWhoWonder

Right, so I've decided I'm probably going to have to go for private blood tests to get everything I need to make an informed decision. This one (onedaytests.com/products/ul... looks quite decent so will start there.

Re: Teva, should I just see how I get on with it?

Edit: and where to after my blood work, as the general consensus appears to be that the NHS is clueless?

Jaydee1507 profile image
Jaydee1507Administrator in reply toNotAllWhoWonder

You can use the code HEALTHY10 for One day tests to get 10% off that price.

Follow the preparation instructions carefully for a finger prick test.

See how you go ith the Teva. You should know within a few weeks if its having any adverse effects. That said, you are likely very hypo on only 25mcgs Levo so unwanted effects sometimes can be related to being hypo.

SlowDragon profile image
SlowDragonAdministrator in reply toNotAllWhoWonder

Ideally Test 6-8 weeks after being on constant brand and dose levothyroxine

How long have you been back on 25mcg Wockhardt

If still got Wockhardt for next few days suggest you order test kit NOW and do test next Monday or Tuesday morning

If already changed to Teva …..I would probably still do test ASAP even though not ideal

Very likely to show you need dose increase to 50mcg and low vitamin levels

NotAllWhoWonder profile image
NotAllWhoWonder in reply toSlowDragon

Last Wockhardt was taken this morning (repeat was ordered on Sunday evening and collected today).

Re: vitamin levels, will they stabilise as I increase the levo?

Good morning, just thought I would send a quick reply as I was changed from Accord to Teva a few months ago and they do not agree with me at all. The palpitations have been debilitating along with headaches and dizzy spells. I have stopped taking them and currently waiting to pick up a new prescription for Accord. As soon as I stopped taking them, the palpitations subsided so it must have been the medication. Just thought I would share my experience but obviously everybody is different.

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