Levothyroxine sodium

[Eyed]

Does anyone know what is the difference between Levothyroxine and Levothyroxine sodium? I have just had an increase in medication.

[helvella Administrator]

Absolutely nothing. They are the exact same medication.

ALL levothyroxine is supplied in the form of the sodium salt. (Chemists' term for with a sodium atom attached.) This enhances stability and absorption. I've never seen any levothyroxine product which is not based on levothyroxine sodium. But, because it is universal, there seems little need to highlight it.

Indeed almost the same is also true for liothyronine. Most are liothyronine sodium but ONE product, Thybon Henning, is liothyronine hydrochloride. Though we have little evidence that makes a substantial difference.

(Desiccated thyroid products such as Armour are different but the whole issue of thyroid hormone content of animal thyroid products needs a chapter to discuss.)

[Eyed in reply to helvella]

Thanks for your reply.I just wondered because also the brand name changed(Teva)I've been hypothyroid since 2009,and don't think I've ever had that brand before which confused me a bit.Thanks once again .(Due to be undertreated I think my brain isn't working properly at the moment!!)

[helvella Administrator in reply to Eyed]

When you feel together, have a look at a couple of my blogs.

The first one is a discussion of why we see mixed opinions on Teva levothyroxine.

The second one is my usual UK medicines document which has information about all the products in the UK. So you can see what is potentially available.

helvella - Teva versus the rest

A discussion of the issues surrounding Teva levothyroxine.

Last updated 10/02/2025

Link to blog:

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

helvella - Thyroid Hormone Medicines - UK

The UK document contains:

Up-to-date versions of the Summary Matrixes for levothyroxine tablets, oral solutions and liothyronine available in the UK. These include declared ingredients for all UK-licensed products.

Details of every dosage of each medicine include PL numbers, PIP numbers, tablet markings, product history and links to:

● Patient Information Leaflets

● Summary of Product Characteristics

● Product Assessment Reports

● Dictionary of Medicines and Devices (dm+d) entry and current prices

Document has links to:

● British National Formulary

● NHS Drug Tariff, etc.

PLUS how to write prescriptions in Appendix F.

Also includes links for anti-thyroid medicines (but not product details).

Direct link to PDF:

📄 dropbox.com/s/bo2jzxucgp9hl...

Blog last updated 14/02/2025 - documents are regularly updated

Link to blog:

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

[Eyed in reply to helvella]

Thankyou .I will look at a later date.Thanks for all the info you provided.Its much appreciated.😀

[SlowDragon Ambassador]

welcome to the forum

Which brand Levo were you taking before

How much levothyroxine were you taking

How much has it been increased to

Teva brand of levothyroxine upsets many people

Many people find Levothyroxine brands are not interchangeable.

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets 

Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz

Accord only make 50mcg and 100mcg tablets. Accord is also boxed as Almus via Boots, 

Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets 

July 2024

Crescent levothyroxine. Dosages: 12.5, 25, 50, 75, 100

(Not yet known if all approved dosages are or will be available).

Excipients: lactose monohydrate, maize starch, croscarmellose sodium, gelatin and magnesium stearate.

Lactose free brands - currently Vencamil or Teva

Vencamil is lactose free and mannitol free. originally only available as 100mcg only, but 25mcg, 50mcg and 75mcg tablets became available Sept 2024

Prior to March 2023 Vencamil was called Aristo

Vencamil often very well tolerated/best option for many people

How to get Vencamil stocked at your local pharmacy

healthunlocked.com/thyroidu...

Posts discussing Vencamil

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu....

Teva makes 12.5mcg 25mcg, 50mcg, 75mcg and 100mcg

Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva is lactose free, but 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 

But some people find it the best option

Helpful post about Teva

healthunlocked.com/thyroidu...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Relatively new ……Hillcross brand

This is a box, rather than a brand. 50mcg and 100mcg are Accord brand….but beware 25mcg is Teva brand

Helpful post about different brands

healthunlocked.com/thyroidu...

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

[Eyed in reply to SlowDragon]

Wow.That is alot of info you have inputted.Thankyou so much.The brands I've had in past have been accord and crescent and im not sure I think there xmas another brand also .Ive been on 50mg since 2009,but I've a feeling I've been undertreated for years.I stopped taking my biotins before my last test,which is something I didn't realise I should be doing, hence my last test showed I needed more thyroxine. They have just increased to 75mg.

[SlowDragon Ambassador in reply to Eyed]

They have just increased to 75mg.

Retest thyroid and vitamin levels again in another 2-3 months

Unless extremely petite you are likely to need further increases in levothyroxine over coming months

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

Lower vitamin levels more common as we get older

For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we must maintain GOOD vitamin levels

What vitamin supplements are you taking

Also VERY important to test TSH, Ft4 and Ft3 together

What is reason for your hypothyroidism

Autoimmune?

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...

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...

[Eyed in reply to SlowDragon]

Thankyou.I am on vit D (prescribed by Dr) I am a redhead and don't go in the sun much ) Also on iron (prescribed by dr) but unfortunately nhs has decided people only need I tablet a day instead of the 3.(at least thats that was what i was told.)My ferritin levels have always been low and I have had iron infusions in past,but they make me feel really ill,so can't have them anymore.Im also B12 deficient blood test showed but my Dr won't provide these.I have to buy myself.I take zinc and vit c also as my immune system isn't good.Yes,I have used medichecks once.I don't know if it's autoimmune thyroid ,but I'm guessing it is as I have several other autoimmune conditions(Lung disease ,interstitial cystitis sjogren's syndrome etc) I am to have another blood test in 6 weeks time Dr said.

[SlowDragon Ambassador in reply to Eyed]

Vitamin levels low BECAUSE you were left on inappropriately low dose of Levo

I don't know if it's autoimmune thyroid ,but I'm guessing it is as I have several other autoimmune conditions(Lung disease ,interstitial cystitis sjogren's syndrome etc)

Yes virtually guaranteed to be autoimmune then

have you had coeliac blood test

Are you on gluten free or dairy free diet

something to consider in few months

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

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

nice.org.uk/guidance/ng20/c...

Or buy a test online, about £20

Assuming test is negative you can immediately go on strictly gluten free diet 

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially) 

Trying gluten free diet for 6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

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

nuclmed.gr/wp/wp-content/up...

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

restartmed.com/hashimotos-g...

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

Post discussing gluten

healthunlocked.com/thyroidu...

Recent research in China into food intolerances with Hashimoto’s

healthunlocked.com/thyroidu...

More interesting Chinese research on Hashimoto’s and leaky gut

nature.com/articles/s41598-...

[Eyed in reply to SlowDragon]

I have been tested for coeliac in past ,as I do have alot of trouble with my gut, and have food intolerancesI have bad acid reflux,and also ibs for years.I had an endoscopy years ago that showed I have a hiates hernia,so I'm not sure if the acid problem is due to that or the thyroid.Maybe a bit of both? Interestingly enough the endoscopy showed many inflamed areas in my stomach.The same with the colonoscopy I had showed the same thing(inflammation)at the far end of my bowel.I have heard of the gluten free diet.Definitely something to consider.Thankyou so much for all this info.I really appreciate you taking the time to give me all this info.You are very obviously very knowledgeable. Thankyou.😀

[Tina_Maria]

Thyroid hormones are large organic molecules, which are insoluble in water. If you were to take them in the original form, your body would not be able to make much use of it, as it does not dissolve.

The sodium salts (or hydrochloride salts for liothyronine) are produced to increase the solubility and absorption, so our body can process them better and use them accordingly.

Many medicines are actually produced as salts to increase their solubility.

[Eyed in reply to Tina_Maria]

Thankyou for your reply. Do you happen to know if you can take levo with zinc iron and vit D please?

[SlowDragon Ambassador in reply to Eyed]

Never take anything at same time as your levo

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

markvanderpump.co.uk/blog/p...

markvanderpump.co.uk/blog/p...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

[Tina_Maria in reply to Eyed]

As slowdragon has mentioned, levothyroxine should be taken on its own with just water away from any food or supplements for at least 1h.

If you take anything with your levothyroxine, this will decrease the absorption of your levothyroxine, so your body has less hormone available and you may feel hypothyroid, even though you may be on an optimal dose.

[SlowDragon Ambassador]

Testing of Zinc, selenium and copper

bluehorizonbloodtests.co.uk...