Please advise I've been hypothyroid since 2008 treated no issues with accord 100mg 25mg Teva, until last year started feeling nauseous everyday worked out it was the 25mg Teva brand. My thyroid levels have been all over the place from untreated to overtreated I'll post recent results. I'm currently taking 112.5mg 100mg accord 12.5mg Teva again starting to feel nauseous. My ferritin in below range. Full blood Cound seems OK but platelets under observation. My gp hasn't contacted me to try see what going on just to change thyroid meds.
Hypothyroidism plus low ferritin so tired 😫 - Thyroid UK
Hypothyroidism plus low ferritin so tired 😫
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Deehh28
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SlowDragonAdministrator
welcome to the forum
Teva brand upsets many people
If you know Accord suits you get 50mcg tablets prescribed and cut into 1/2 for 25mcg or into 1/4 for 12.5mcg
Use a sharp craft scalpel to cut…..mop up any crumbs with damp finger
ALWAYS test 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)
Is your hypothyroidism autoimmune?
Have you had TPO and Thyroglobulin thyroid antibodies tested
Please add most recent results and ranges for thyroid and vitamin levels
Also ESSENTIAL to test and maintain GOOD vitamin D, folate and B12
What’s your actual ferritin result?
Testing options and includes money off codes for private 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...
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before ALL BLOOD TESTS , as biotin can falsely affect test results
endocrinenews.endocrine.org...
In days 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
Full bloods
Black white
There’s no ferritin, folate, B12 or vitamin D Results there
Nor thyroid test results
I'm sorry not great at posting my results
Pathology Investigations
Blood haematinic levels per nj
Serum vitamin B12 level 475 ng/L [211.0 - 911.0]; Measurement of vitamin B12 to monitor people being
treated with B12 or folic acid is generally
considered unnecessary (CKS 2004).
Serum folate level 13.8 ug/L [5.4 - 24.0]
General Information
Service Type: New
Status: Unspecified
Provider Report ID: 87769816
Report Date: 19 Mar 2025
Message Recipient
GP - GP Practice Nurse 3
Position: Healthcare Professional
Message Recipient
GP Practice
Position: Healthcare Organisation
Ordering Party
GP - GP Practice Nurse 3
Position: Healthcare Professional
Serum vitamin B12 level 475 ng/L [211.0 - 911.0]
Serum folate level 13.8 ug/L [5.4 - 24.0]
What B vitamins are you currently taking….if any?
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement
A week later add a separate vitamin B Complex
Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.
If Vegetarian or vegan likely to need ongoing separate B12 few times a week
Highly effective B12 drops
natureprovides.com/products...
Or
B12 sublingual lozenges
uk.iherb.com/pr/jarrow-form...
cytoplan.co.uk/shop-by-prod...
In-depth article on different forms of B12
perniciousanemia.org/b12/fo...
B12 range in U.K. is too wide
Interesting that in this research B12 below 400 is considered inadequate
healthunlocked.com/thyroidu...
perniciousanemia.org/b12/le...
And why aiming to keep B12 over 500 recommended
perniciousanemia.org/b12/le...
Great reply by @humanbean on B12 here
healthunlocked.com/thyroidu...
Low folate
supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)
This can help keep all B vitamins in balance and will help improve B12 levels too
Difference between folate and folic acid
healthline.com/nutrition/fo...
B vitamins best taken after breakfast
Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose and may need 2 per day and/or may need separate methyl folate couple times a week
Post discussing different B complex
healthunlocked.com/thyroidu...
Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 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
Thank you I will take all advice on board and hope to get back on track
Serum ferritin level per njSerum ferritin level 16.70 ug/L [30.0 - 337.0];
Below low reference limit
General Information
Service Type: New
Status: Unspecified
Provider Report ID: 87769816
So ferritin is deficient
But other iron tests look ok
Will flag up to our “iron experts”
humanbean and FallingInReverse
Are you vegetarian or vegan
Pre or Post menopause
I'm menopausal on HRT for suffer with low ferritin on off. Not to vegetarian or vegan eat healthy diet
What are your thyroid test results
TSH, Ft4 and Ft3
ALWAYS test early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
Test both TPO and TG thyroid antibodies at least once a
No vitamin D test result here
How much vitamin D are you taking
Test twice year ideally
NHS easy postal kit vitamin D test £31 via
Aim to maintain at least over 80nmol
Many find it better to maintain at 100-125nmol
Are you taking a separate magnesium supplement in afternoon or evening
Pathology Investigations
Serum TSH level After dose change
Serum TSH level 3.26 mIU/L [0.2 - 4.3]; Assuming patient on thyroxine for treatment of
primary hypothyroidism, adequate replacement
therapy indicated by TSH 0.2-2.0 miu/L. Results
suggest under replacement, poor adherence or
malabsorption of thyroxine (e.g. Calcium or iron
supplements, PPIs), or a recent change in
formulation of thyroxine.
General Information
Service Type: New
Status: Unspecified
Provider Report ID: 87771511
Report Date: 19 Mar 2025
I take a magnesium citrate Tablet once a day 300mg plus one vitamin D3 10,000 a day plus zinc with copper and selenium
That’s a very high dose vitamin D
Strongly recommend you test now
Ideally test selenium, copper and zinc at least every year or two is taking supplements
Blue horizon can test
I only take the vit D once a week but I'll get a full panel of vitamins appreciate all your input very very helpful
thyroid levels need retesting 6-8 weeks after any changes in HRT dose/brand etc
Oh really as they added an extra estrogen to my HRT could explain the levels getting thrown out
Can I ask what does testing the TPO and TG antibodies show up
TPOab ( thyroid peroxidase antibodies)
and/ or TGab ( thyroglobulin antibodies )
if results are over range / positive , it confirms the cause of hypothyroidism is autoimmune . NHS usually only look at TPOab .
doesn't make much difference from GP's point of view once you have already been prescribed levo, as the treatment for hypothyroidism is the same whatever the cause .
positive antibodies can help to get treatment earlier eg . if TSH is only a little bit over range because positive antibodies show GP that the hypothyroidism is not transient and is likely to get worse over time as the autoimmune damage to thyroid gland will be ongoing, meaning treatment would likely be needed at some point anyway .
so if already on levo , no real need to test antibodies unless you are curious. but if the cause is autoimmune , it helps you understand why results may sometimes go haywire even on same dose, because when the autoimmune damage is happening thyroid blood levels can swing up and down again as ready made T4/T3 is 'spilled' into blood from thyroid .
tattybogle has answered you re testing of antibodies
Important for you to know if cause is autoimmune
a) because there’s things you can do yourself to improve symptoms
Eg gluten free diet and/or dairy free diet
B) if autoimmune, then other autoimmune diseases are more likely
Especially Pernicious Anaemia, vitiligo, psoriasis, coeliac, rheumatoid arthritis, endometriosis etc etc
SlowDragonAdministrator
Different brands of levothyroxine
Many people find Levothyroxine brands are not interchangeable.
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 prescription written for Vencamil
healthunlocked.com/thyroidu...
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 and makes some people extremely unwell
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.
If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.
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
SlowDragonAdministrator
Low ferritin
How old are you….(helpful if add on your profile)
Pre or post menopause
Vegetarian or vegan
Low ferritin is common if dose levothyroxine is inadequate
Autoimmunity
If your hypothyroidism is autoimmune GP should have tested for coeliac at diagnosis…..did they?
as per NICE Guidelines
nice.org.uk/guidance/ng20/c...
If you have tested negative…
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
I'm 55 years my gp has said nothing there's a strong history of celiac but I test negative. I'm very tired feel absolutely shattered.
Ok so next step is to trial absolutely strictly gluten free diet
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.
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.
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-...
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
If dairy is beneficial look at changing to lactose free Levo as well - Vencamil brand
I'll give the gulten free diet a go I don't have lactose as it cause terrible stomach issues anyway
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