Promacta + Synthroid Question

I know some of you have mentioned being on Synthroid (or generic Levothyroxine) so I figured I'd ask here in the hopes that maybe someone has an idea.

My TSH levels have been climbing slowly in recent bloodwork, but are still considered subclinical for hypothyroidism. However, I've been having symptoms of exhaustion, difficulty in losing weight (even with significant calorie restriction), shortened menstrual cycles (24 or 25 day cycle length, creeping ever shorter over the years), and a few other symptoms of hypothyroidism as well.

I visited an endocrinologist and she felt that I would benefit from t4 supplementation and started me on a 50mcg dose. I originally tried the generic levothyroxine, and initially took it for 9 days before stopping because of increasing abdominal pain in my upper left quadrant. I couldn't figure out if the bloating was pulling on my old splenectomy scar (my scar is pretty long, because that's how they did it back in the 80s), or the pain was internal. I stopped trying the levothyroxine and waited for my follow-up appointment with the endo (there was a gap of about 1 month or so). At my next visit, she suggested that I try the generic levothyroxine again and assumed that the pain was unrelated to the medication. I went back on it, but stopped after 5 days this time. I had the same increasing pain in the upper left quadrant of my abdomen and was able to determine that it wasn't just a skin stretching type of pain, but rather internal.

My doctor then switched my medication to brand name Synthroid to see if the effect wasn't related to some kind of filler in the generic medication. I had waited for the pain to subside from my second attempt (2-3 days), then started with the Synthroid. It's day 3 and that pain/fullness is starting to return. Arghhhh darn it. Does anyone have any idea or thoughts about what this could be? I am still on promacta and am wondering about interactions between it and thyroid medication. It's probably a super-tiny subset of people who take both, so no luck in googling about potential interactions. Because of the location, I wonder about the pancreas or lack of a spleen, but am at a loss. I can't find any discussion about pain in this particular quadrant with thyroid supplementation. It is very specifically only in this area, and not throughout the entire abdomen.

Just a shot in the dark, but figured I'd ask here since I know at least one person mentioned promacta and thyroid meds before. Thanks for any thoughts or theories!

Hi momto3- I have been on thyroid supplement for 17 years. I had my thyroid removed due to thyroid cancer in 2001. I'm currently on Nplate but have been on Promacta 4 different times. Just my thoughts, of course I don't know whats causing the pain. But in my experience I'd guess your pain is due to Synthroid by itself and not the interaction.

I was put on Synthroid after my surgery and didn't like it at all. I was getting anxiety, and I believe rapid pulse but was never confirmed, hair loss. It felt like it was stimulating my adrenals- not sure, just felt as if I had way too much espresso. I was on it for about a year until I found the website "Stop the Thyroid Madness". There I was introduced to natural porcine thyroid supplement- it comes from the pharmacy with prescription. The one I like and have taken for 16 years is called "NatureThroid". Love it, no side effects and it works to keep my levels normal.

My only complaint is that it became temporarily unavailable a few months ago- arghh! And I am scrambling about trying to find something else. I tried Armour Thyroid and it made me so dizzy, the room was spinning for 6 hours every morning. They say you'll get used to it after about 6 weeks?! No thanks. My doctor then switched me to Synthroid which I started yesterday. Its not totally horrible but I was so light-headed and fatigued this morning after I took it, I felt I couldn't go to work. Yesterday after taking it I felt nervous and anxious, pressure in my chest like I was on some powerful stimulant.

I'm now interested in trying thyroid replacement called "NP Thyroid" but doctor says they haven't heard of it, its not on the list so can't prescribe it. I've called and its available in the pharmacy at CVS and Walgreens, I found the manufacturer and website- so I am frustrated with my doctor. I will keep pushing for NP Thyroid- people seem to like it, and because Synthroid is really not working for me. npthyroid.com/
For you, I wonder if there is a natural way to get your thyroid balanced? Like diet, stress reduction, yoga..? take care~hope you find your answer!

Thanks for all of your thoughts poseymint! That was very helpful to read and think about. I was leaning to the idea that I just may be one of those people for whom the synthetic thyroid hormone doesn't work out, but you always wonder about medications affecting one another.

I'm still taking the brand name synthroid. The other day when I posted I was discouraged because it felt like the pain was starting to return, but today it actually feels a little bit better. I'm going to give this a full shot to work, because it is already doing better for me than the generic (who knows why, but I've read lots of people do differently with synthroid versus generic). Unless the pain is debilitating, I'm going to see if it's not just initial adjustment issues that I can get past by sticking with it.

I have heard of lots of people doing better with the natural thyroid alternatives at the sttm website as well. I avoid pork/pig products for religious reasons, so that's why I'm not pushing my endo to go that route yet. If I can't get anything else to work and just have to try that treatment, then I'll see at that time, but things are not that dire yet

That's too bad that you aren't able to get your regular treatment that has worked so well for you, ugh! The npthyroid sounds like something that you should check out since it may be similar to your previous Nature Thyroid. Good luck working with your doctor on that one. Sometimes we really have to lead them by the hand to get them to do what we want :lol:

In the meantime, hopefully your stint with synthroid is at least tolerable Thanks again for sharing your thoughts, it is helpful!

now i'm not on n-plate or Promacta - but i am on synthroid. poseymint what you experienced sounds like your dose was too high on synthroid. i have graves - did what endo & hematologist felt best back about 14/15 years ago, then put on synthroid and was doing great - medical changed and synthroid was changed to generic and tha'tt when trouble began. took a couple years to figure it out, endo went to bat to get me synthroid at a lower copay than for brand name and have been doing all right since. had they not changed me from brand to generic i wouldn't have had the problems i did.

i have never heard of synthroid causing pain like that [but as us itpers know, never say never].

good luck to you both - that little thyroid gland can cause so much trouble!

Thanks MelA for the info and advice. Come to find out- I can't get NP Thyroid either! back-ordered. Sooo I guess I will be having to make friends with Synthroid too. YES the generic is not the same. I've heard many people, doctors, surgeons say that Synthroid is different from the generic levothyroxine. So if you are on one, you should not switch. I am on the brand name Synthroid, it only cost a few dollars more, $8. as opposed the $5. But they will try to give generic if you don't insist, or doc writes "do not substitute".

By the way, I feel better today. I split my dose- took half at 4:30 am, slept through some side effects. Then was tired in the afternoon so took the other half. I'm a little up and down but not bad. I notice that my handwriting is better, I'll take that as a good sign. I have read that the body has to convert the T4 in Synthroid to T3 as it needs it, so it can take a while for the body to sort that out. Will get my Nplate injection tomorrow, I don't anticipate any interaction problems. Hope it works for you Mom!

Momto3... Ask to try another of the name brands, or ask to lower the starting dose to 25 mcgs. Fifty might be a bit aggressive for your body. Thyroid supplementation can indeed stimulate the adrenal glands, but I don't know whether that can produce a physical pain or not. It wouldn't surprise me.

Prescription thyroid meds contain thyroid hormone - either a lab-created synthetic duplicate of your own biological T4 or an extract of multiple hormones derived from porcine thyroid glands. The rest of the tablet is comprised of binders, fillers, and waxes that form the tablet. Since people are meant to have a steady supply of thyroid hormone provided by their own glands, it's technically not possible to be "allergic" to the pill-supplied ones, nor will they interact with other meds. True allergies occur from the inert ingredients. For example, some brands contain lactose. Lactose-intolerant people will have issues from that.
The majority of problems occur when the dose is inoptimal for that person's needs. I have, however, seen reports of Synthroid brand, in particular, causing severe leg pains for some, unremitting hair loss for others. The reasons are elusive, but for most, simply switching to another brand will fix the problem. In the US, the other name brands are Unithroid, Levoxyl, Levothroid, and Tirosint. Tirosint is expensive, but contains no filler or binders, so side effects are least.
Multiple labs produce generics. The problem with generics is that your drugstore stocks whichever one gave them the best wholesale price for that order period. The price might change each time they order, they might switch to another producer, so you might get a different product each time you refill. This has the same effect as changing "brands" constantly.

There can be significant differences in the way various brands of thyroid med work for any one person due to the individual ways their bodies break down the the hormone from the inert ingredients. This is the reason people shouldn't switch brands once they find one that works. The differences aren't in the hormone, but in the inert parts of the med.

All that said... Not every patient can take every kind or brand of thyroid med. I personally was hypersensitive to Synthroid in the smallest dose. It wasn't until I tried porcine thyroid that I could tolerate treatment at all. I've been doing fine with it for about 14 years. It's getting trickier for me to get it since I've been on Medicare. The government in its "wisdom" considers it a dangerous drug for the elderly. Prior authorization is needed to fill a script. It's also extremely hard to find MDs willing to prescribe it at all, much less for the elderly.

Posey, did you check your druggist for WP thyroid? (Not NP, which is different.) I've been on most brands during my treatment, because supply problems are always rearing their ugly heads. Last year, I tried WP because of the significant cost savings it offers. It worked very well, but then they too had supply problems. Now I take whatever I can find. Fortunately, they've all pretty much interchangeable for me.

poseymint wrote: Thanks MelA for the info and advice. Come to find out- I can't get NP Thyroid either! back-ordered. Sooo I guess I will be having to make friends with Synthroid too. YES the generic is not the same. I've heard many people, doctors, surgeons say that Synthroid is different from the generic levothyroxine. So if you are on one, you should not switch. I am on the brand name Synthroid, it only cost a few dollars more, $8. as opposed the $5. But they will try to give generic if you don't insist, or doc writes "do not substitute".

By the way, I feel better today. I split my dose- took half at 4:30 am, slept through some side effects. Then was tired in the afternoon so took the other half. I'm a little up and down but not bad. I notice that my handwriting is better, I'll take that as a good sign. I have read that the body has to convert the T4 in Synthroid to T3 as it needs it, so it can take a while for the body to sort that out. Will get my Nplate injection tomorrow, I don't anticipate any interaction problems. Hope it works for you Mom!

So far so good, definitely not working up to the pain that I was feeling with the generic, so I may be able to give this a shot! I will keep your dose splitting idea in mind if this doesn't work out as something to try before totally giving up. I am already used to doing weird things with my eating times from my Promacta, and now Synthroid in the morning, so what's the harm in carving out another "no eat" window :lol:

midwest6708 wrote: Momto3... Ask to try another of the name brands, or ask to lower the starting dose to 25 mcgs. Fifty might be a bit aggressive for your body. Thyroid supplementation can indeed stimulate the adrenal glands, but I don't know whether that can produce a physical pain or not. It wouldn't surprise me.

Thank you so much for taking the time to give me such a helpful response! I had no idea about adrenal gland stimulation, and that might jive with the pains in a very specific region. Thankfully the Synthroid brand name is doing much better for me than the generic Levothyroxine that I tried before. And the problems I had with the generic definitely didn't feel like an allergy. Not systemic, and I don't have any known food alergies or sensitivities. Just that one funky pain

midwest6708 wrote: The majority of problems occur when the dose is inoptimal for that person's needs. I have, however, seen reports of Synthroid brand, in particular, causing severe leg pains for some, unremitting hair loss for others. The reasons are elusive, but for most, simply switching to another brand will fix the problem. In the US, the other name brands are Unithroid, Levoxyl, Levothroid, and Tirosint. Tirosint is expensive, but contains no filler or binders, so side effects are least.

In googling my issue, I ran across all sorts of common problems. Chest pain with people who had too high of a dose, hair loss, bloating, gi effects, etc. I just never saw any description of a pain like mine. I read that the generics are more "off" in terms of different actual amounts of the drug, based on the manufacturer, and that they can run slightly higher or lower than a true 50mcg. My doctor actually prescribed Tirosint when the generic didn't work, but my insurance wouldn't cover it, so she had to change the rx to Synthroid, which was actually covered.

midwest6708 wrote: All that said... Not every patient can take every kind or brand of thyroid med. I personally was hypersensitive to Synthroid in the smallest dose. It wasn't until I tried porcine thyroid that I could tolerate treatment at all. I've been doing fine with it for about 14 years. It's getting trickier for me to get it since I've been on Medicare. The government in its "wisdom" considers it a dangerous drug for the elderly. Prior authorization is needed to fill a script. It's also extremely hard to find MDs willing to prescribe it at all, much less for the elderly.

The joys of getting treatments to match up with insurance demands. No fun at all, especially since the collective wisdom of patients that I am reading about online seems to indicate that porcine thyroid works great for an awful lot of people! Doctors and insurance companies are often on another planet. I hope you can keep getting the medication that works best for you!

Again, thanks for your really thorough discussion. I feel like I might not be crazy and imagining pains, maybe my body is just adjusting to the t4 being bound in different ways in different pills. Periodic bouts with steroids for my ITP throughout my life probably don't make for happy adrenals either, so that is useful to know that they play a role in the process. I need to educate myself more about the biochemistry concerned in converting t4 to t3 and the various pathways involved.