This site has one of the best monographs for levothyroxine I have seen anywhere and confirms so much of what we already know or suspect about our medication - scroll down to see:
drugs.com/monograph/levothy...
It's a pity that GPS and endos don't know this stuff or ignore it anyway. Perhaps they should use the Internet a bit more!
I do agree with the part that you should always be given the same brand of Levo. My pharmacist insists that Eltroxin is the best one available here. It is more expensive and took a bit of a battle with the GP to get it, but I do feel better on it.
Yes, I thought it would be a good one to put in front of the pharmacist (and GP) when they argue that all brands are equal!
Still falls down on management by stating that TSH levels should be used as an accurate measure of checking patient health.
Yes you are right Glynisrose but it does say, several times, that clinical signs and symptoms should also be taken into account too.
If doctors did that and used TSH merely as a guide, listened to the patient and looked for signs by examining them AS WELL, then we might not need to beg for FT3 and FT4 so much because we would be on the right levels for us according to symptoms.
TSH can't even be used as a guide for those on thyroid hormone replacement because once you start using replacement hormone, the feedback loop is broken. This is so well-known, but Big Pharma doesn't want us to know it. It's not in their best interests!
Grey
You are right greygoose. This document is not perfect by any means - at least though they have said:
'If serum TSH level is not suppressed, use with caution and monitor clinical (e.g., adverse cardiovascular effects) and laboratory (i.e., thyroid function) parameters for evidence of hyperthyroidism'.
and:
General Precautions
Therapy Monitoring
Periodically perform appropriate laboratory tests (e.g., serum TSH, total or free T4) and clinical evaluations to monitor adequacy of therapy.
Levothyroxine has a narrow therapeutic index.140 141 142 161 160 Avoid undertreatment or overtreatment, which may result in adverse effects on growth and development in pediatric patients, cardiovascular function, bone metabolism, reproductive function, cognitive function, emotional state, GI function, and glucose and lipid metabolism.
They also mention T3 and rT3 too.
"Untreated adrenal insufficiency" is stated as one of the contraindications to taking T4. How interesting - especially since Dr P is constantly banging on about how adrenal exhaustion, which is not necessarily overt and diagnosable by your usual Dr Plods, is a major factor to poor T3 synthesis from T4 and/or poor T3 uptake. Which is why he treats the adrenals for a couple of weeks first (and continuously thenceforth) before addressing the T3 problem. Different to Dr S I believe, but it's helping me enormously.
Doctors are taught to ignore the patient in favour of blood tests I have yet to meet one that doesn't comply!
I disagree...GPs are taught nothing about how to treat the thyroid and due to government budgeting try to fudge their way through it without doing substantial research rather than refer patients to endo's who specialised in the condition...either way the result is poor treatment for us!
And even GP's who have been with you thus far can turn the table by saying "But you are within range!!!???" as happened to me recently. Vit D range 50 to 250 --- mine 54. Is this deficient? I believe so especially as the NHS told me I have thyroid disease. NO, adrenal fatigue more like. In any event, if you have a condition of any sort, the lower ends of ranges are far too low and play an integral part of our feeling of unwellness.
Most tolerated brand of Levothyroxine 
Brands of Levothyroxine
Change of brand of Levothyroxine tablets
Reduction year after year of Levothyroxine 
