[Bobbi]

#1066818

Did your doctor change your prescription to the generic? Or did the pharmacy/your insurance company? It makes a difference. If your doctor changed it, you might want to ask about it. If your pharmacy or insurance company did it, they should not have. It is becoming automatic, with insurance companies paying less for brand drugs, for our pharmacies to fill with generics, but many of our endos are not convinced that the generics truly work exactly the same as the brands.

Our docs will sometimes look at different aspects of things (i.e. look at Free T4 as opposed to regular T4) to give them clues about what is going on. For example, I remember when I was symptomatic, early on in my diagnosis, and my doctor looked carefully at the free thyroid levels. Since adjusting to replacement hormone, the tests have been exclusively for TSH levels unless I am symptomatic again, in which case, sometimes it is a complete thyroid panel.

Looking at FreeT4, for example, tells the doctor how much of the T4 that is in your blood is "available" to be converted to T3 and used in the cells. Not all of the T3 and T4 that is in our blood is available for use. Some of it — a good percentage a lot of times — is tied to other protein compounds and the cells cannot use it. So the lab tests involved are complicated. None of us here can begin to do anything other than explain what the test looks for, and perhaps why it is looked for. Interpreting the results, or being qualified to judge which tests are "best" is not something we can do.

[kareng]

#1066819

I’m not sure how I was changed to the generic -have to admit I didn’t notice. I think I was just happy to be paying so little.
The last time my levels were checked it reads TSH, 3rd generation with reflex to FT4. That is the first time I’ve seen this. It would be nice if there was a standardized test – it would be easier to monitor levels. I notice that on a lower dosage of 1mg (compared to 112.5mg) I feel less anxious and don’t have fast heart rate but get restless legs at night. Doc says can’t go by how I feel, have to go by levels and so insists I stay at the higher dose.
He is willing to get me on a "brand" name and I’ll try that – I need to let the pharmacy know so now I need to decide which "brand". Do some people notice a difference between "brands"?

[enough3]

#1066820

I notice that I feel better with less anxiety when my T4 is on the lower end of normal. That is just me personally.

I know everyone is different along with different doctors. I hope everything gets adjusted for you and that you find the right dose:)

[Ski]

#1066821

Kareng ~ we are typically discouraged from experimenting among "brands," so I’m not sure you’ll get much feedback on that specific question. The fact is that all of the thyroid hormone replacement pills are supposed to be "chemically equivalent" in terms of the thyroid hormone replacement they deliver, but the specific issue we have is that our body can react slightly differently to the fillers that bind it, make it into a pill, or that make it a color, and that reaction can result in our body metabolizing the thyroid hormone replacement just a little differently, which means you can’t always say that if you’ve been regulated at "X" dose of "Brand A," that "X" dose will work exactly the same if you’re taking "Brand B." So oftentimes a switch either between brands or from brand to generic can result in an entirely new process of figuring out which dose gets you to YOUR perfect point.

The real issue with thyroid hormone is just keeping your levels at the normal point you need ~ some doctors will target the same point for each patient, and that’s really not fair. The reason the range of normal is so large is because different people feel normal at different points along that range, so saying "aha, green light, normal range, you’re fine" is premature. You would still need to evaluate your symptoms and experiment a little to be sure you’ve found YOUR normal, and that way you’ll feel the best you can every day from now on. It takes time to dial that in, but it’s so very worth it!

[kareng]

#1018740

Good morning all! Question: My labs (at least two years now) have consistently come back with the TSH at low normal but the Free T4 at high normal – couple to a few points below the max high end. The T3 runs normal to low normal but that doesn’t get checked often. Because I struggle with anxiety I wonder if running high T4 could be contributing. I also just noticed that my Rx was changed over to the generic. Also – sometimes docs will check all (TSH, T3, T4) but most often just TSH. One doc only ordered and went by the Free T4. I’m confused – which to go by?

[Bobbi]

#1066822

One other reason why using the generics for replacement hormone bothers me — the generic that your pharmacy buys one year, or one month, might be different from the generic that they buy the next. Yes, the active ingredients are the same, but what about all the other stuff, and how is it absorbed? Our endos will have us in after six weeks to three months if we change BRANDS to double check that our levels are appropriate. And sometimes they need to make adjustments. How much more complicated is it if the generics are changing?

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