What does *TM* mean?

[helvella]

proton pump inhibitors (such as omeprazole, esomeprazole,

pantoprazole, rabeprazole and lansoprazole) are used to reduce the

amount of acid produced by the stomach which may reduce the

absorption of levothyroxine from the intestine and thereby make it less

effective. If you are taking levothyroxine while receiving treatment with

proton pump inhibitors, your doctor should monitor your thyroid

function and may have to adjust the dose of *TM*

mhraproducts4853.blob.core....

Several recently released/updated Patient Information Leaflets have the above text. Including *TM*.

How would you interpret *TM*?

Do you think it is a reasonable/sensible thing to put in a Patient Information Leaflet?

Thinking it utter nonsense, I have put in a complaint to the MHRA. But while awaiting their response and any action, thought I ask the very people who might actually read these PILs.

[Goldengirl01]

TradeMark

[Goldengirl01 in reply to Goldengirl01]

Thyroid Meds

[tattybogle]

um ,

when i first looked i though *Trade Mark*, but that makes no sense in the context .

then i thought Thyroid Medication, and briefly wondered why they aren't writing Levothyroxine.

and if they do mean Thyroid Medication why not just write it, there's room left on the line

dunno .. ? maybe they don't want to write T3 or Liothyronine in public in case we all want some .

[helvella in reply to tattybogle]

The Summary of Product Characteristics documents (meant for prescribers who actually understand things or are supposed to!), says:

Proton pump inhibitors (PPIs):

Co-administration with PPIs may cause a decrease in the absorption of the thyroid

hormones, due to the increase of the intragastric pH caused by PPIs. Regular

monitoring of thyroid function and clinical monitoring is recommended during

concomitant treatment. It may be necessary to increase the dose of thyroid hormones.

That is, it implies that patients should somehow know to read "*TM*" as "thyroid hormones".

[Jingley]

I personally never read PIL's. Two reasons

1. I'd worry myself silly about possible side effects

2. I'd get every side effect listed (all in my head of course)

But, the problem with anything slightly 'technical' or 'medical' is that the information included is written by people who usually know what they're talking about and so don't think about the layman who has no idea. They just assume that what they've written is easily understandable just because they understand it.

In this case I think that it definitely needs highlighting to the powers that be. Especially as it's a medication involved and could have serious consequences if someone misinterprets it.

[TSH110 in reply to Jingley]

I bloomin love them and read every last word. I especially like the side effects section and the stats. It doesn’t seem to provoke imagined ones in me I take the view that knowledge is power and it’s interesting for its own sake . The rest of my family throw them in the bin unread as like you, they don’t want to know!

[Emaych61 in reply to Jingley]

I always read them, not so much because of the side effects but a) to check it is safe for me to take them given a fairly complex medical history and b) to check there are no interactions with any other medications I am taking. Side effects I don’t worry about so much unless things begin to go pear shaped for no apparent reason whilst on a new med.

[Flatfootedrunner]

I wonder if is an editing error - a left over placeholder (which is why it has the asterisks) from generating the patient info from the prescribing info, and someone forget to put in the specific drug name.

[helvella in reply to Flatfootedrunner]

My thought is close to that.

I suspect they had a whole library of predefined text - ranging from a word or two up to whole paragraphs.

And they type *TM* (or similar) meaning that they want the text called TM to be inserted at that point. But either they got the code wrong or failed to process it properly.

And I suspect it means "thyroid hormone medications" - a suitably general wording that should cover everything.

But it is appalling it got to the point of being visible to patients.

[TSH110]

Thyroid medication? That would be my guess, do you think that was what they intended? It’s not really plain English using an acronym but given the context it can’t really be anything else.

It needs changing to the proper words. It would be inclusive of Levothyroxine, NDT, liothyronine and combinations thereof, once amended.

[Singwell]

I'm guessing it's an attempt to cover the various forms of thyroid medication. But it should be specific. Surely it ought to be thyroid replacement therapy in the UK? Or have I got that wrong!

[Stills]

I always read the full PIL and look up stuff I don’t understand.

TM is known to mean trade mark but in this instance it cannot be the case.

I would make the assumption it means thyroid medication but assumption should never be left to patients where medicine is concerned. Poor show from the manufacturer.

[helvella in reply to Stills]

Poor show from the MHRA. This is present on multiple PILs. The manufacturers might be almost entirely innocent - except in not checking and then reporting issues back to the MHRA.

I suspect it is an MHRA process that has gone wrong. And certainly their QA procedures are not up to snuff.

[Milkyway88]

Very interesting information, H. I’ve recently been given Lansoprazole and have just scanned through the very long PIL. Can’t find any reference to thyroid and it seems every other eventuality is covered.

Absolutely agree - these things should NOT be patient responsibility, especially as it’s hit and miss what information is on the PILs. However, I’d still rather know than rely on my GP practice who seem to rely on me to point out if my TFTs are out of range.

As for TM, my first thought was thyroid meds.

I wonder if this is a recent thing, and if it indicates a fledgling understanding of the anomalies of living without a thyroid? I live in hope..

[helvella in reply to Milkyway88]

Have a look here:

Medications and Food Interfering with the Bioavailability of Levothyroxine: A Systematic Review

Authors Liu H, Lu M, Hu J, Fu G, Feng Q, Sun S , Chen C

Published 23 June 2023 Volume 2023:19 Pages 503—523

DOI doi.org/10.2147/TCRM.S414460

dovepress.com/medications-a...

The BNF interaction checker doesn't say anything either way round:

bnf.nice.org.uk/interaction...

bnf.nice.org.uk/interaction...

I've been working towards a comprehensive interaction checking document. It isn't really ready yet, but...

helvella - Thyroid Interactions

Many medicines, supplements and foods interact with thyroid hormones in various ways.

This document is intended to be a regularly updated list of recognised interactions from good sources.

As it is a new document, feedback would be very much appreciated - anything from typos, through incorrect information.

Direct link to document:

dropbox.com/scl/fi/2kcnc0v7...

Last updated 10/12/2024

Link to blog:

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

[CernCrystal]

Thyroid Medication - but acronyms should always be spelled out. Using undefined acronyms is unacceptable and not accessible for many. Poor communication is definitely a theme within the NHS and wider medical services.

[helvella in reply to CernCrystal]

A problem with "thyroid medication" is understanding whether that includes antithyroid medications such as carbimazole.

I could sit here all day trying to decide if it does, if it should, or not.

That is why I suggested "thyroid hormone medications" as that covers levothyroxine, liothyronine, combinations and even (though effectively no-one gets it) tetrac.

[CernCrystal in reply to helvella]

Ah yes, absolutely, and of course I always thought I was taking Thyroxine Replacement Medication.

[BB001]

I would think it means Thyroid Medication. I don't think putting an acronym in a patient information leaflet is reasonable.

[skeetbeet]

TM appears to refer to Thyroid Medication.

[helvella in reply to skeetbeet]

I mention a problem with that in an earlier reply:

healthunlocked.com/thyroidu...

[helvella]

I have now received a proper response from the MHRA.

I have been passed your email to respond to.

On looking into your query, it appears that a European procedure involving the medicinal product levothyroxine resulted in the product information (including the PIL) being updated for affected manufacturers with wording that included “……and may have to adjust the dose of levothyroxine.” or “……and may have to adjust the dose of thyroid medicine.”

However, as you have noted *TM* has been added instead and as you mention this could cause confusion.

We will contact the affected manufacturers and ask for the wording to be amended in the PIL.

Hopefully, action will be taken to ensure this issue will be made less likely in future. Across all medicines.

But it is concerning that no-one saw this and identified an issue. Did no-one see it at all? Or did anyone who saw it fail to recognise an issue? Speculation - either way.

Most importantly, it shows that we need to identify issues and raise them. Otherwise they could remain for years. That means all of us!!!