Replacement thyroid hormone, brand or synthetic ?

Brand-Name vs. Generic

There are three well-tested, brand-name levothyroxine preparations available in the United States for the treatment of thyroid patients: Levothroid®, Levoxyl®, and Synthroid®. ( By the end of this year, Euthyrox®, which is marketed in twenty-nine other countries, will become the fourth brand-name levothyroxine product to be sold here.) Although there may be differences in the manufacturing, composition (dyes and fillers), and absorption rates among these prep-arations, each of these brand-name products is reliable and offers predictable results. Although changing from one brand to another does not usually cause problems, it is preferable to take the same brand consistently.

Generic levothyroxine tablets have not been widely recommended for several reasons:

Scientific studies have shown that, for some generics, the T4 content of each pill can be outside the FDA range of 90% to 110% of the stated chemical content. While a 20% range may not be a significant factor for some drugs, very small amounts of thyroid hormone can make quite a difference in the treatment of thyroid patients. For example, for some patients, a 12.5% variation in levothyroxine dosage can mean the difference between hypothyroidism or euthyroidism (having the proper amount of thyroid hormone in the body). Therefore, it is essential that patients with thyroid disease take the exact amount of prescribed levothyroxine to ensure successful treatment.

There have been additional concerns about the quality control in the production of generic levothyroxine, especially since generic manufacturers tend to come and go in the marketplace with great frequency, making them less accountable than long-standing manufacturers of levothyroxine. The 1997 Red Book, a pharmacist’s guide to prescription generic and brand-name drugs, lists twenty-five companies distributing synthetic levothyroxine. (Some of these companies manufacture and distribute levothyroxine tablets, and others just distribute them.) Since publication, many of the listed companies are not making or selling synthetic levothyroxine.

From prescription to prescription, patients may be given a different generic preparation each time, making it impractical, if not impossible, to determine if retesting patients’ thyroid hormone levels is necessary. While brand-name levothyroxine preparations come in eleven to twelve different strengths, generics have less variety of strengths from which to choose. Of the generic levothyroxine distri-butors listed in the Red Book, 44% have one to four strengths available; the remaining offer five to eight strengths. For patients whose levothyroxine dosage must be adjusted several times due to age or other medical conditions, it would be difficult to stay with the same product if certain incremental changes are made.

Thyroid Australia Ltd
http://www.thyroid.org.au/ThySoc/ThySocReplce.html

More from Australia:

A list of types of hyperthyroidism, with explanations.
http://www.mja.com.au/public/issues/180_04_160204/top10414_fm.html

More interesting links for Australia:
http://www.thyroid.org.au/

List of Thyroid Wellness newsletters , by Dr. Ridha Arem:
http://www.thyroidwellness.com/newsletter.html
He treats Hashimoto's patients, so Graves' patients need to proceed with caution, but there are interesting tidbits here and there.


Good link here,
Management of Graves’ Disease during Pregnancy: The Key Role of Fetal Thyroid Gland Monitoring
http://jcem.endojournals.org/content/90/11/6093.long

And a very bad idea here:
http://www.thyroid.org/patients/ct/volume4/issue5/ct_patients_v45_5_6.html
Taking MMI and potassium iodide together...oh my. :( Dangerous.

Thyroid Eye Disease Society:
http://thyroideyedisease.org/

Article on both hyper and hypo thyroid.
Includes a better list of hypo symptoms than some other sources.
http://www.csa.com/discoveryguides/thyroid/overview.php?SID=dpda9rlhli827fi4pe5v0nddq4

Is there a methimazole dose effect on remission rate in Graves' disease? Results from a long-term prospective study
http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2265.1998.00554.x/abstract

CONCLUSIONS

The dose of methimazole in Graves' disease therapy can safely be kept to the minimal required dose. This will provide the same chance of remission as higher doses, and provide the best balance of risk and benefit.

Note the standard problem with these studies once again. The high re-occurrence rates are caused by removing the patients from the drugs prematurely, while their antibody levels are still elevated, in order to fit within study funding guidelines. The good news is look how many did stay in remission, even without better care. Quite reassuring, but a good warning to stay on your medication until the antibodies test lower. Just stopping meds to "test " remission, is in my opinion disrespectful. Set back treatment and make the patient sick, in order to save a little bit of money. :(

Effect of long-term continuous methimazole treatment of hyperthyroidism: comparison with radioiodine

http://www.eje-online.org/content/152/5/695.full?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&fdate=5/1/2005&tdate=5/31/2005&resourcetype=HWCIT

Conclusion: Long-term continuous treatment of hyperthyroidism with MMI is safe. The complications and the expense of the treatment do not exceed those of radioactive iodine therapy.

Here is a tiny url version of that address, in case this site breaks up the lenght of the first address I posted.
http://tinyurl.com/4y9rrvc

SUMMARY. The effect of the 4bT-1 -adrenoceptor blocking agent, atenolol, on serum levels of thyroxine (T4), triiodothronine (T3) and reverse triiodothyronine (rT3) was studied in twelve hyperthyroid patients. While all patients improved symptomatically after treatment with atenolol 100 mg twice daily for 2 weeks, there were no significant changes in the serum T3 or rT3 concentrations. The serum T4 level showed a small but statistically significant fall. These data do not support the hypothesis that the beneficial clinical effects of β-adrenoceptor blocking drugs in thyrotoxicosis are mediated by an action on the peripheral metabolism of thyroid hormones.

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.1980.tb01056.x/abstract

address broke..here is the tiny url:
http://preview.tinyurl.com/3gmuhx7

Liver enzymes:
http://www.medicinenet.com/liver_blood_tests/page3.htm

What are some common reasons for abnormal liver tests?

quote:
Mild to moderate elevations of the liver enzymes are common. They are often unexpectedly encountered on routine blood screening tests in otherwise healthy individuals. The AST and ALT levels in such cases are usually between twice the upper limits of normal and several hundred units/liter. One of the most common cause of mild to moderate elevations of these liver tests is a condition referred to as fatty liver. In the United States, the most frequent cause of fatty liver is alcohol abuse. Other causes of fatty liver include diabetes mellitus and obesity.


Methimazole use while Breastfeeding

http://www.drugs.com/breastfeeding/methimazole.html

Hypothyroidism (underactive thyroid)

Complications

http://www.mayoclinic.com/health/hypothyroidism/DS00353/DSECTION=complications

Propranolol

Conclusion:
Propranolol may therefore have a clinically significant and direct action on the peripheral conversion of thyroxine to T3 and rT3.

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.1979.tb02111.x/abstract

Excellent..Thank you Nathalie !

Quote:
And psychological complaints: Have you ever read the DSM manual? Since you seem by the book: Most psychiatric diagnosis can only be made when fulfilling certain criteria. One of them that always comes back is something in the lines of: "in the absence of any physiological organic causes". So .... no, you do not send someone to the shrink until all underlying physical causes are ruled out/treated.


I think schizophrenia’s aetiology is nowhere near being understood. So many possible causes have been suggested that it may be no more than an umbrella term for a lot of different problems that just might have a more or less similar symptom set. It’s also certain that many misdiagnoses and over-diagnosing have occurred - for example,

confabulation with cultural factors
http://www.springerlink.com/content...

and hypothyroidism
http://www.psychiatrist.com/pcc/pcc...

Lingering Psychiatric Symptoms May be Due to Hyperthyroidism
http://www.schizophrenia.com/sznews...

Schizophrenia, Sub-clinical Hypothyroidism or Both?
http://www.fbhyperthyroidism.info/h...

Links above broke.
Trying again...

I think schizophrenia’s aetiology is nowhere near being understood. So many possible causes have been suggested that it may be no more than an umbrella term for a lot of different problems that just might have a more or less similar symptom set. It’s also certain that many misdiagnoses and over-diagnosing have occurred - for example,

confabulation with cultural factors
http://www.springerlink.com/content/n05180w636m7k565/

and hypothyroidism
http://www.psychiatrist.com/pcc/pccpdf/v05n06/v05n0603.pdf

Lingering Psychiatric Symptoms May be Due to Hyperthyroidism
http://www.schizophrenia.com/sznews/archives/004296.html

Schizophrenia, Sub-clinical Hypothyroidism or Both?
http://www.fbhyperthyroidism.info/hyperthyroidism/schizophrenia-sub-clinical-hypothyroidism-or-both.html

Identifying hyperthyroidism’s psychiatric presentations
http://www.jfponline.com/Pages.asp?AID=4640

Identifying hypothyroidism’s psychiatric presentations
http://www.jfponline.com/Pages.asp?AID=4570

http://www.thyroidresearchjournal.com/content

A mixed bag of thyroid research.

Thyrotropin-Blocking Autoantibodies and Thyroid-Stimulating Autoantibodies: Potential Mechanisms Involved in the Pendulum Swinging from Hypothyroidism to Hyperthyroidism or Vice Versa

http://online.liebertpub.com/doi/full/10.1089/thy.2012.0374

A Survey of Management of Uncomplicated Graves’ Disease Shows that Use of Methimazole Is Increasing and Use of Radioactive Iodine Is Decreasing

Burch HB, Burman KD, Cooper DS. A 2011 survey of clinical practice patterns in the management of Graves’ disease. J Clin Endocrinol Metab 2012;97:4549-58. Epub October 5, 2012; doi: 10.1210/jc.2012-2802.

This is a PDF file

http://www.thyroid.org/wp-content/uploads/publications/clinthy/volume25/issue2/clinthy_v252_35_36.pdf

Elaine Moore's complete class on Graves' disease.
Located by way of the WayBack Machine. Information on antibodies has increased since this was published, but all the facts are still the same, just minus the new additional tests available.

Tiny URL because DS software limits length of addresses:
http://tinyurl.com/byxbjk9