MRS.D-?? on Thyroid Meds

[tic chick]

mrsdoubtfyre,

i don't know if my body is changing or if the levothyroxine is. let me explain.

I was dx'ed with hypothyroidism around 1990. i started out taking .1mcg. of levothyroxine, eventually titrating up to .175mcg where i stabilized until about 2 years ago. at that time, i had my tsh checked at my yearly checkup and the doctor told me i was now hyperthyroid. so we titrated down until i was taking .137mcg and .150mcg on alternate days. i've been feeling rather tired lately and i took my basal temperature and it averaged 97.0F. so, i went and asked my doctor to check my tsh again, even though i was not due for a check until october. my tsh was borderline high, so my doctor is now letting me take .150mcg levothyroxine daily.

my questions are:

is the dosage of levothyroxine consistent through generic brands?

i know that generics have to be bioequivalent to the name brand med. i know they can use different fillers in generics. there was a drug, i believe it was for epilepsy, that was found to be inferior in it's generic brand because the amount of active drug in the generic varied too much and people were either getting too much or too little of the active med.

can levothyroxine be like that?

i don't know what % (+) or (-) a generic's active ingredient has to be from the brand name's or even from batch to batch of generic drug. if the difference is even 10%, that would be the difference between .137 and .150mcg of levothyroxine.

i have asked my doctor about taking armour thyroid, which i have read is a more consistent brand of thyroid. my doctor said he has heard things about armour thyroid not being available at times.

i'm just tired of wondering why i feel too tired or have insomnia when it's my thyroid medication dosage that isn't right anymore....or is it my body?

is the solution getting my tsh checked every 6 months?
is there anything i should know about generic thyroid brands at the pharmacy level?

thank you for any help you can give me.
jeannie

[mrsdoubtfyre]

It is best to keep to one brand if possible. I think the generics are as good as
the name brands. (there has been terrible problems with name brands anyway over the years).

You have to take levothyroxine on an empty stomach. If you take it with food, it will not be absorbed properly. This is one reason you may have changing levels.

Also, the trend today is to keep the levothyroxine as low as possible.
Your doses are high, even for people with thyroids removed by surgery.

I do notice a slight change in my TSH levels. They are 1 number higher in winter than summer. But I never go over 2.0 (and I am still on .075mg)

If you are not converting the hormone in the tissues properly, then you would be having problems. Zinc and Selenium are necessary for the conversion of T4 to T3 in the tissues.

Fatigue may also be a sign of hyperthyroidism. I know someone who had
these up and down events....she is at NeuroTalk. So PM her there.
I will PM you her name.
She may be able to help you with it too.

[sarahin]

There is a brand called Unithroid. http://www.fda.gov/cder/drug/infopage/unithroid/unithroid.htm
Levothyroxine dosages tend not to be consistent. This is the first brand to meet FDA approval due to it's lack of stability and potency problems. I believe that Armour is a natural thyroid hormone, but is not known for it's consistency in potency. Hope this helps

[Naominjw]

We were told (and I read it on the American Thyroid Association website at one time) that the brands are NOT interchangeable. We have had trouble with thyroid levels from not having Dispense as Written on the prescription.

I just messed up again, and we got a generic instead of name-brand Cytomel when my daughter had been taking the name brand. I am not sure what to do now. We've been burned before with others.... She is getting a blood test next week. Last one was great... if she then switches brands in a couple weeks, that means the level can be different and she'll need yet another blood test a month from then.....

So the big dilemma is do I end up throwing away the generic liiothyronine and quickly getting another DAW prescription for Cytomel (which is what she had) or do I do we just go ahead and use the generic? I've had to throw away (AKA "waste money") before because we were sent generics of things we KNOW she cannot have.

I wish so badly we can just tell the pharmacy ONCE never substitute for meds x, y, and z, and they won't ever substitute for them, rather than us trying to be careful but sometimes we screw up, and yes... it happenes... one sluips through now and then without the DAW, or the box on the form is not checked....

[mrsdoubtfyre]

Because of insurance rules... DAW has to be on the RX, itself. Auditors come in and check for it. The pharmacy cannot just put it in your file to apply to all of your Rxs. This is a huge pain for the pharmacies too. They don't want angry customers!

I was a bit hesitant to use generic when they first came out. But after finding out that one BRAND name company was having problems themselves with
keeping batches consistant, I figured...I'd do the generic. I stick with one company only. Mylan

I see only one generic brand for Cytomel in the FDA Orange book.
In fact, the Brand name is really not a brand anymore. It apparently was sold to King Pharmaceuticals. (Previously was SKF).
Now these small companies IMO are not much more than a generic house anyway, charging brand prices.
They would argue that however.

I think it is important to stick with one manufacturer...so the blood work is consistent. Mine has been pretty good with Mylan...the weather (temperature) seems more the variable causer for me.

T3 is fast acting. I'd think it would be easier to tell if you were getting variable results than with the T4 products like levothyroxine.

See what your doctor thinks. Trust today in any drug company is not great.
Brand companies are getting recalled all the time now.

When Levothroid changed manufacturers back when the FDA was mandating
all levothyroxines to have new drug applications, the new company sent inserts for all RXs for the people to have NEW doctor Rxs for it. Just because
it changed manufacturers! So changing from Rorer to Lloyd was considered as important as changing to a GEQ in that case.

[Naominjw]

Thanks, Mrs. D. I think I'll relax about the liiothyronine for now and see how it goes.

I really do not need this stress. But stress is the reason I do it -- so that my daughter doesn't have the stress. She trusts me to worry about it and make things "right." Slowly, she is taking over some of the medical stuff but ugh... it is so complicated and she lost so much of her life to illness. Time for her to enjoy feeling somewhat better. Disfrutar la vida.

Thanks again. Really and truly. Thank you for taking the time and sharing information, accrued wisdom, and doing a little hand-holding now-and-then.

"Naomi"