thyroid meds and lansoprazole

[Moonriver]

I take thyroxine and also heart meds. When is it best to take lansoprazole proton pump since my thyroxine needs to be absorbed as do the heart meds. I usually take the thyroid med in the morning and a beta blocker and two other heart meds at night.

[GlowCoach Administrator]

PPIs lower absorption all the time, not just a certain time after you take them, so best take it as far away from Levo as possible.

Have you posted thyroid results recently to see if you are optimally replaced?

How are your vitamin levels and what supplements do you take?

[Moonriver in reply to GlowCoach]

TSH 0.41 should be bit lower since I had thyroid cancer but now have AF so keep it a bit higher so heart is not aggravated

Free t 4 is 20

Free t3 is 4.1

Havent tested yet for D3 or B12

Ferritin tested today but usually very high since I store iron and have venesections.

I take magnesium and D. Can’t take K2 because on blood thinner, says chemist.

I also take Osteocare tablets.

I had TOE recently for heart ablation and have acid reflux so taking the proton pump for short period to stop that.

I am hypothyroid because I had a Thyroidectomy after thyroid cancer,

Thanks for info

[SlowDragon Administrator in reply to Moonriver]

Free t 4 is 20

Free t3 is 4.1

Please add ranges

Was test early morning and last dose levothyroxine 24 hours before test

Do you normally get same brand Levo at each prescription

Get folate, B12 and vitamin D checked

[Moonriver in reply to SlowDragon]

Tested while fasting early in morning, and 24 hrs after last dose. I don’t usually use same brand but am starting now. Does that make huge difference?

[SlowDragon Administrator in reply to Moonriver]

Free T4 (fT4) 20 pmol/L (12 - 22) 80.0%

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

So currently very poor conversion rate of Ft4 to Ft3

Aiming for both Ft4 and Ft3 at similar % through range, usually at least 50-60% through range

As conversion rate improves Ft4 level should reduce a little as Ft3 improves

Next step get vitamin levels tested and improved to GOOD Levels

Why are you taking osteocare. Is your heart specialist aware

mayoclinic.org/diseases-con....

[Moonriver in reply to SlowDragon]

Yes he is aware. My calcium levels low

[Moonriver in reply to SlowDragon]

I like to keep my free t4 bit lower because sometimes it has hit 22 and more and I think tips me into AF

[SlowDragon Administrator in reply to Moonriver]

I don’t usually use same brand but am starting now. Does that make huge difference?

It can do

Teva brand often upsets many people

Many people find Levothyroxine brands are not interchangeable.

Most easily available 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, and as Hillcross brand

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 

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...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Government guidelines for GP in support of patients if you find it difficult/impossible to change brands

gov.uk/drug-safety-update/l...

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.

academic.oup.com/jcem/artic...

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).

And here

pharmacymagazine.co.uk/clin...

Discussed here too

healthunlocked.com/thyroidu...

[Moonriver in reply to SlowDragon]

The ranges were:

Tsh 0.417. From 0.27 to 4.2

Free T3. 4.1 From 3.1 to 6.8

Free T4. 20. From 12 to 22

[SlowDragon Administrator]

very important to keep close eye on vitamin levels if having to take any PPI……especially B12

gov.uk/drug-safety-update/p...

pmc.ncbi.nlm.nih.gov/articl...

pharmacytimes.com/publicati...

PPI and increased risk T2 diabetes

gut.bmj.com/content/early/2...

Iron Deficiency and PPI

medpagetoday.com/resource-c...

futurity.org/anemia-proton-...

onlinelibrary.wiley.com/doi...

sciencedirect.com/science/a...

Essential to test vitamin D, folate, ferritin and B12

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?

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

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...

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

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

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

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 if last test result serum B12 was below 500 or active B12 (private test) under 70

[Moonriver in reply to SlowDragon]

thanks for info.