a bottle of Synthroid 50 mcg tablets, T3 with T4

Q. I have taken levothyroxine for several years but my insurance keeps changing the brand (from Synthroid to Levothroid to several generics). I have had progressively deteriorating hypothyroid symptoms (weight gain, fatigue, muddled thinking, high cholesterol, low sex drive, constipation, brittle nails and painful joints).

Where can I find the information I need to convince my doctor I need a better approach? I did well on Armour Thyroid years ago when I was first diagnosed, but my current doctor doesn’t like it.

A. Although the FDA has approved many generic levothyroxine products as bioidentical to Synthroid or Levothroid, physicians and patients report that not all generic products seem to be identical to each other.

A person taking generic levothyroxine might need to have the dose re-calibrated every time a different generic was dispensed. Because this requires blood tests and a doctor visit, the insurance company’s savings from the generic could be wiped out.

We are sending you our Guide to Thyroid Hormones, with a discussion of Armour Thyroid as well as the finer points of adjusting the dose of levothyroxine. After shortages that had many patients frantic, the company that makes Armour Thyroid reports that it is once again shipping common dosages.

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  1. Dianne

    I have been taking the Mylan brand of Levothyroxine for at least 30 years. In June of last year, my pharmacy filled my prescription with a different brand. I experienced a Thyroid Storm for the next five days which almost killed me before I realized that the change in manufacturers was the culprit. My doctor rejects the notion that I experienced a Thyroid Storm…….citing stress, virus, or “a hundred other things”……but I know it was a Thyroid Storm, and don’t understand his insistence that it wasn’t. The symptoms were severe, acute, and very scary…….comparable to a heart attack. It makes me wonder how many people die of heart attacks or strokes who were in reality the victim of a doctor or pharmacist who prefers a cheaper brand that suits their own pocketbook.

  2. Ana

    I was just switched from Synthroid to the generic brand. My doses is very small 25, but I just noticed that I am having way to many of the same symptoms i had before taking Synthroid to begin with. I see a lot of allergies from switching, but can it be that the generic does not work the same as Synthroid? I am losing hair, depressed, exhausted, dry skin, irritability, gaining weight, super dry skin, and can’t seem to focus at all. It’s been over a month and half with the generic and I scheduled an appointment with the doctor, but that’s in another month. Please desperately seeking advice…

  3. Janice

    After reading all of this and hearing how some doctors don’t believe the generics to be equivalent to Synthroid, I wonder a few things:
    1) why the FDA approved the generics in the first place?
    2) why, as consumers and patients in combination with our Doctors, can’t rally together to get the government and insurance companies to remove the restrictions on the prescribing and payment for the brand drug of Synthroid.
    It is not right for an insurance company to require its insureds to go through a “trial & error” session of using a generic drug that could potentially worsen their condition when there are numerous records proving it does not work for a good majority of people. We are being guinea pigs for the BIG pocketed insurance companies which is just not right!

  4. Carol

    I have been on Levothyroxin for 22 years.No problem until about 3 months ago I changed pharmacies which use a different manufacturer and now I have high BP. Can this be related? I am on 88mcg and am on the third different BP med. I have never had bp problems before. Also I am 71 years old and been really healthy so this is hard for me. Also I lost my husband 1 and1/2 years ago and went through so much stress and emotions I am wondering if that affected my adrenal glands. Thank you in advance for any advice

  5. Shannon

    I have been on Levothyroxine for over 10 years and blood tests always come back the same — that all is ok and WHEN I had insurance my doc would write a Rx for it and all was fine. Recently I got laid off due to company going under and it seems the only way to find Levothyroxine without having to go pay $300.00 to see my doc and then God knows how much for the blood tests.

    Does anyone know of a way to get Levothyroxine online? They all seem scammy and I need my meds! :/ God bless you all and thank you ahead of time for any suggestions.

  6. Maryann

    I’m glad to have come across these comments. I just started taking a generic levothyroxine earlier this year and was doing fine with it. I switched to a mail order pharmacy associated with my insurance and received a different manufacturer’s brand. I had some sort of an allergic reaction, my eyes felt irritated and the skin around them got red. It was so bad that I went to an ophthamologist. At first I wasn’t sure if it was the levothyroxine or the vitamin supplement I had just started, so I went off both and started back up on the levothyroxine. I did this twice. Each time I was off the levothyroxine and started back up the eye irritation returned, so I knew that it had to be that. During this period, like another commentor, I, too, had that sharp pain as if passing a kidney stone. However, I actually think I may have passed one, because there was blood in my urine after that pain. But after that once everything was normal.

  7. DW

    My internist explained that the way Armour Thyroid “absorbs” versus the way another type of thyroid medication (like Synthroid or levothyroxin) absorbs is different. He drew a chart showing Amour Thyroid gradually going up hill and then suddenly dropping off until the next dose. The levothyroxin type had a different type chart… the line went uphill but then stayed at a stead level (and didn’t have the drop-off). It made me feel a bit better about stopping Armour Thyroid as Humana actually wrote a letter to him telling him Armour Thyroid was not good for patients over the age of 65. He said he had never received a letter like that before. (I am now trying Mylan brand of levothyroxine which is the only gluten-free one I know of. It did help with GI problems.)

    • Carla

      Hi! I just read your post. I have been in levothyroxine for almost a year. The same than you, the sharp pain in the right side of the pelvis and then blood in the urine that were detected by my doctor. I was thinking about changes in my life and the only thing that I was able to think was the levothyroxine

  8. Holly

    If I’m taking 200 mgs of Levothyroxine (cannot afford Synthroid, noticed no difference between the two) how many milligrams of Armour thyroid do I take? The mgs etc. are totally different. Does anyone know?

    Know why they don’t push Armour? Because it’s cheap and makes them no money, that’s why. People did fine for 100 years on Armour, these ‘fake’ pills? Do not work as efficiently as Armour type drugs. Doctor WILL NOT give it to me. Guess he likes the free lunches he gets from they Synthroid sales rep.

  9. JC

    A little over one month ago I was switched from levothyroid to levothyroxine – I have developed pain – aching and nerve sensitivity – in primarily my right knee and leg with occasional discomfort in my left leg also. I also have developed a sensitivity to sugar – moderate amounts – makes me sick to my stomach (not nausea) – also I have started shaking when nervous in social situations. my doctor feels there is no relation with the thyroid medication changes and my symptoms – do you feel there could be. Thank you JC

  10. Pharmacy Student

    I know I’m late to the show here, but I will chime in. Many generic drugs are bio-equivalent (work the same in the body) to brand drugs and thus are deemed to be interchangeable. Thyroid medications generally, are not. The only manufacture which is AB equivalent (or bio-equivalent, and works the same in the body) with all brand levothyroxine medications is the Mylan brand. Other brands are not interchangeable.
    Almost all clinical pharmacists will recommend that you stay on whatever brand/generic manufacture of levothyroxine you start out on. There is a term called the therapeutic window, and this means that slight variations of a dose of medication can have substantial effects on the body. Since not all brands are AB equivalent, you should try to stay on the brand that you started out on as long as your blood work comes back good. Don’t let physicians tell you otherwise who may have been coerced by pharmaceutical reps.

  11. jd

    Generics are not the same as name brands. It took me several tries but I am finally feeling back to normal. I am back on name brands of Celexa ($140.00 a month) and Synthroid ($30.00 a month). It’s killing me financially. You would think the Pharma companies would lower the costs to encourage sales. Just saying

  12. jgp

    what is the amount of cranberry juice to help with urinary tract infection?

  13. VQ

    I have been on Synthroid and generic brands (depends on insurance) for several years and my doctor informed me that my body “got used to it” and has lost it’s effectiveness. I now also take Cytromel with my Synthroid.
    I did better with the Synthroid/Cytromel and have gained 8 pounds with the generic Synthroid and generic Cytromel.
    Hope this helps.

  14. Dolores

    I, too, need to find a doctor who will put me back on Armour Thyroid. I was diagnosed in the ’60’s, taken off Armour when I changed doctors and he said Synthroid was easier. BIG MISTAKE! Same problems, big loss of hair, split nails, tired, weight gain, joint problems with replacements, etc. A neurologist, who was testing me for nerve damage, told me a lot of my problems were due to the thyroid problems and the Synthroid.
    I got on the internet and read the same thing. At least I was able to get my present doctor to write an exception letter to my insurance company to allow the Synthroid. It is criminal that insurance companies can dictate what your treatment should be. Of course, if you die they don’t have to pay any more.

  15. Andy

    My 89 year old mother has required thyroid medication for about 60 years, since her thyroidectomy. She has been prescribed various generic thyroid medications by her current primary care doctor over the past several years. When I took her to her endocrinologist for a checkup about two years ago, he was adamant that she not receive any generic! In fact he had a sign on his examining room wall stating why generics were inferior. His position is that generics are not the same as Levoxyl, the brand her wants her to take. He writes her scripts making it clear that no generic is permitted.

  16. ebm

    BRAVO, PK – you spelled it out correctly. If your doc is ignorant and will not listen
    (which is most of them in the HMO’s), find another one and interview them and how they feel about listening and trying new things. And, for heavens sake, inform yourselves about meds, illnesses and be aware of changes in your body.
    I am 70 now and am proud to say I take NO MEDS at all, lots of vit. and minerals and occasionally aspirin or aleve for headaches, when I eat something that has sneakily MSG or other junk added to foods. I do read labels before buying anything, and yes, it takes time, but so does sitting for 2 hours in a dr’s office, waiting for an audience with his highness the doc.
    I have read/studied up on nutrition, meds and side effects since 1975 and until Medicare always went to holistic MD’s. Chiropractors know more about natural remedies and supplements than the majority of MD’s.

  17. Constance G.

    Would like more info on Synthroid – been taking it for years. With regular blood tests (every 3months) Dosage changed as needed.

  18. PK

    Your doctor won’t allow you to have it, or won’t put you back on the more effective and always superior Armour Thyroid? My advice? That doctor is ignorant. Get rid of that co-opted doctor and find one who knows about the superior effectiveness of Armour. They are out there and there are more and more of them who bother to educate themselves about Armour Thyroid.
    Most doctors are governed by the faulty ethical attitude, “It is easier for me (us) if everyone is on the same drugs” = doctors first (screw the patients), not the more ethical, “whatever is the most effective for each patient” = patients first!!
    YOU know what is most effective for you and your body (because you LIVE in it), not the doctor. Demand it! Doctors typically base their negative attitude about Armour Thyroid on only ONE single really shoddy historical report from 60 years ago about the inability to control dosages in Armour Thyroid. That report and the tests conducted at the time are severely outdated and should be deleted/destroyed, as they are dangerously irrelevant and incorrect. Not to mention the FACT that Armour Thyroid is manufactured by pharmaceutical company, Forest Laboratories, the SAME company that manufactures synthetics, Levothroid and Thyrolar, so how uncontrolled can Armour BE today?

    • Roger
      Columbus, Ohio

      I have been taking thyroid medications for eight years. I had problems with synthroid so I began taking armour thyroid. I took it for about a year and half. It definitely made me feel different. I was having some GI problems with synthroid. Those all went away with Armour. But I had other problems on Armour.

      At least three times I went to the hospital, swearing I was passing a kidney stone. The pain in my lower back was excruciating. Whenever it came on, it buckled me to my knees and I would fall to the floor. I could not move without feeling like knives were being stuck into my side. Each time I went to the hospital they ran all kinds of test and found nothing.

      On a lesser note, it also changed my personality. I felt indifferent about things. On a number of occasions I said something that was totally inappropriate only to later return and apologize. After I went off Armour both of these things went away. I never had the back pain again, and my personality returned to normal.

      • Carla

        Roger thanks for sharing. That happened to me too! I feel so much relief that it’s no me thinking that I’m crazy. Also doctor has found blood in my urine.

  19. Alex

    I switched from Synthroid, after about 25 years, to a generic levothyroxine. My pharmacist had long been telling me that it would save money and would work as well. So I decided to give it a try. (For the record, I am a 66 year old woman, and my overall health is, knock on wood, excellent.)
    Generic levothyroxine definitely didn’t work anywhere near as well as Synthroid. And considering the effects of lousy thyroid replacement, it wasn’t worth saving a few dollars on a prescription. What’s any amount of money when you feel crappy?
    I gave it about eight months or so, and the progressively worsening effects were, to put it mildly, awful. Near the end of this experiment, I was tired all the time, and it was an effort to do anything. I had lost a great deal of hair, my finger nails and toenails split and chipped, and my leg muscles were weak and sometimes had fine tremors. I felt almost as ill as I had when I was first diagnosed with Graves’ disease.
    So I returned to Synthroid. I have a wonderful primary care doctor. After a few weeks, I was myself again. I’ve returned to doing all the usual things in my life, feeling my normal energy and interest and happiness.
    My advice to anyone on thyroid replacement meds who has problems with what you’re taking: trust your feelings and experience, and if you don’t have a doctor who listens, cares, and responds with help, find another doctor.

  20. SM

    My mom has been through hell with her thyroid meds, to the point where she sometimes thinks she’d rather just give up and die. One month you CAN get one manufacturer, the next you CANNOT. Switching is like a roller-coaster ride. And the doctors just keep parroting that old “they are all the same” line. As if they care!
    By the way, generics and brand-name drugs are definitely NOT THE SAME in all cases. How many people have to die to prove this? But just tell your insurance company you’ve had trouble with a generic, and the call-center representative (who apparently thinks she/he is a physician) will treat you like you’re stupid or crazy.
    Thanks for letting me vent; no one at any medical facility or insurance office will!

  21. SL

    I take synthroid and have also had weight gain, hair loss, constipation, etc., etc.
    What is “Armour”? I’ve never heard of it.

  22. s.h.

    I used thyroid meds since the early 1960’s; had used synthetics with little success; then I got Armour; wonderfully effective; then, when I could not get it any more I was put onto synthroid; arggggggg. Hair loss; weight gain; thin nails; dry skin; tiredness; morning hoarseness and the last tsh showed normal; my doctor will not put me back on the REformulated ARMOUR.
    We pay for brand name Rx out of pocket; I asked the pharmacist if I would be able to get a month of generic and a month of synthroid and alternate daily… etc. to save money (SINCE THE GOVERNMENT SAYS generics are identical; LOL) she said an emphatic, “NO!” then said something like, “They are not abc” or something like that a-c something like that; I asked her what she meant and she said that generic thyroid meds do not work the same as synthroid and they are not compatible and she refused to let me get both and do that to save money; she was emphatic about the fact that they are not the same and did not work the same… hmmmmmm. I hate synthroid but to try to get back on ARMOUR means blood tests every two months for a long time and that costs $$$$$$$$! we pay for office calls.

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