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Thyroid Hormone Replacements

There are many different thyroid hormone replacements in the world. 

There are branded replacements and generic replacements (generics are copies of the original drug). They come in tablets, capsules and liquid form. Some are lactose free and you can also get some with minimal inactive ingredients. Some are synthetic and some are made from the glands of pigs.

Some people find one particular brand or generic better for them than another, probably due to an intolerance to one of the inactive ingredients.

You may be aware of all the problems that French patients have had with the Merck brand of levothyroxine. 
Merck substituted lactose for mannitol in their levothyroxine and many patients were suffering side effects from this - www.sciencemag.org/news/2017/09/france-brings-back-phased-out-drug-after-patients-rebel-against-its-replacement 

The French Government finally asked Merck to change back to their previous formula which they agreed to do.

The pharmaceutical company Teva have recently made the same changes and we are hearing that some patients are suffering side effects.

We would urge any patients having side effects from this brand of levothyroxine to contact the MHRA and complete a Yellow Card (see below)

Thyroid UK has put together one document with all the information you need about many of these thyroid hormone replacements including the manufacturers’ details should you need to contact them about adverse effects or supply issues.

You can access this document here: Thyroid Hormone Replacements

We are aware that liothyronine (T3) is very difficult to get on the NHS now.  NHS England held a consultation in 2017 - "Items which should not be routinely prescribed in primary care:a consultation on guidance for CCGs" because of the huge increase in the cost of T3. Their decision was that patients already on T3 should be referred to an endocrinologist for a review and that any new patients should be referred to an endocrinologist to ask for a trial of T3.

Some Clinical Commissioning Groups, however, are not adhering to this decision.  Also, many endocrinologists do not agree with treatment with T3 and therefore it would be a waste of time for patients to visit an endocrinologist such as this.

Some patients' GPs and endocrinologists are, however, prescribing T3 on a private prescription which they can then use to obtain T3 from outside of the UK at a much cheaper cost. Some hospitals and clinicians are suggesting this to their patients because they are aware that they are much better with the addition of T3.

If you obtain a private prescription you can try taking it to your local pharmacy and ask them if they can obtain T3 from outside of the UK.  It's best to take your private prescription to an independent pharmacy as the larger chains tend to have a process whereby they cannot do this.  However, do shop around as some charge much higher prices than others.

If you get no joy from your local pharmacy, you can try one of the pharmacies on our list here: www.thyroiduk.org/tuk/treatment/where_to_get_desiccated.html  Again, shop around.

Alternatively, you can try some pharmacies in Germany.  This is perfectly legal and they are much cheaper than the UK T3.

Bennewitz Pharmacywww.bennewitz.com/scat/scatpharm?command=listitems&type=search&search=thybon+20&lang=en

They have a telephone call-back system and we have been told that the pharmacist speaks good English so there won't be any language problems. The website can be viewed in English which is helpful. If you click on the bit which says the med is prescription only, it will show you the address to post your prescription to or you can wait for them to mail you an addressed envelope.

Mycare.de
www.mycare.de/online-kaufen/thybon-100-henning-tabletten-7498983
The website is not very user friendly but it is possible to work it out.

If you find other pharmacies outside of the UK where you can use a private prescription, do let us know – tukadmin@thyroiduk.org

Thyroid UK does not have a list of online pharmacies
where you can purchase medications without a prescription.

 


 

Where to report medication side effects:

YellowCard logo
yellowcard.mhra.gov.uk/

The Yellow Card Scheme is vital in helping the Medicines and Healthcare products Regulatory Agency (MHRA) to monitor the safety of the medicines and vaccines that are on the market.

You can report suspected side effects (also known as adverse drug reactions) to a medicine, vaccine, herbal or complementary remedy.


 

Where to find information online about medications:

eMC logo
The electronic Medicines Compendium (eMC)
emc.medicines.org.uk

The eMC provides electronic Summaries of Product Characteristics (SPCs) and Patient Information Leaflets (PILs).

It provides information on thousands of licensed medicines available in the UK.

The eMC is continuously updated with new and revised SPC and PIL information which, after approval by the licensing authorities, is submitted directly by pharmaceutical companies.

BNF logo
British National Formulary (BNF)
bnf.nice.org.uk

The BNF provides UK healthcare professionals with authoritative and practical information on the selection and clinical use of medicines in a clear, concise and accessible manner.
Registration (free) is required.

MHRA logo
Medicines and Healthcare products Regulatory Agency (MHRA)

www.gov.uk/government/organisations/medicines-and-healthcare-products-regulatory-agency

The MHRA is responsible for regulating all medicines and medical devices in the UK by ensuring they work and are acceptably safe.


 

Generic versus Branded Levothyroxine

UK levothyroxine boxes with glass of waterMedicines have both a trade or brand name, and a generic name. There can be several trade/brand names for a single medicine if several different companies supply it. For example, the generic name for synthetic T4 medicine is levothyroxine, but it can come with various different trade/brand names on the packaging e.g. Actavis, Teva, Eltroxin etc.

When you are officially diagnosed as hypothyroid by the NHS, you are prescribed levothyroxine. In the UK, hypothyroidism is one of a small number of medical conditions that currently entitles you to receive your medication completely free of charge. (You need to have applied for a Medical Exemption Certificate). In order to keep the cost of supplying this medication to the absolute minimum, it is usual for the prescribing doctor to simply write 'levothyroxine', with the relevant dosage, on the prescription. No 'brand' name will be specified.

This means that your pharmacy must give you the specified quantity and dosage of levothyroxine pills, as written on the prescription, but the pills can come from any manufacturer. So it is entirely possible that the packets of levothyroxine pills that you receive from your pharmacist can have a different name on the box each time your prescription is fulfilled.

The theory of generic medicine prescribing, is that whilst levothyroxine pills are made by a number of different manufacturers at various factories, the end products are all the same. So a 50 mcg pill from one manufacturer will do the same job as a 50 mcg pill from any of the other manufacturers.

However, thyroid patients often find that there is a very distinct difference between the various 'generics'. Everyone is different, and what suits one patient does not necessarily suit another. Also, swapping between the various brands on a regular basis makes some patients very unwell.

There is one official branded version of levothyroxine, which is Eltroxin (manufactured by Mercury Pharma). It is possible for your GP to write this brand name on your prescription, which will ensure that you are only supplied with the Eltroxin branded product. However, not all patients find that Eltroxin suits them.

If you have found that you feel better on tablets with a name other than Eltroxin on the box, you can ask your pharmacist to make sure that you are given levothyroxine from that supplier every time. Most pharmacies will try their best to do this for you if asked, but if necessary, shop around at different pharmacies until you find one that will accomodate your requirements.

NHS information about branded and generic medications can be found here:
http://www.nhs.uk/chq/pages/1003.aspx

 

Page last updated: 08/06/2018