In past years, efforts have focused on recognizing symptoms, on performing a self-check of the thyroid/neck area, and other issues of clear public interest. But the primary thrust of the 2005 campaign appears to be the idea that, as their press release states, "many people being treated for thyroid disorders don't know the potential health impact of switching medications without physician supervision." The campaign's primary message is that, as they state in a number of places in their materials, "the doctor may change the dose of thyroid hormone, but the brand of thyroid hormone medication should always stay the same."
I think there are many pressing issues that should have been the focus of a campaign like this. [See my article, "Thyroid Awareness Month in 2005: The REAL Issues Thyroid Patients Face" for details].
But, besides skirting real and important issues that face patients, I think this campaign is misleading and self-serving, for many reasons.
First, it's irresponsible at best to base a campaign on a blanket message like" the brand of thyroid hormone medication should always stay the same." Such a broad statement simply does not apply to all thyroid patients, particularly medically. For example:
- Some thyroid patients develop allergies to fillers and dyes in one brand, and should be switched to a brand that has different fillers and dyes.
- Some patients simply cannot afford to pay out of pocket for their own thyroid drugs, and their insurers, HMOs or clinics will NOT pay for or provide higher-priced levothyroxine (usually Synthroid.) These patients may find it a financial necessity to switch to another brand, or may not be offered a choice.
- Some patients find that, despite changes in doses, they still don't feel well on one brand. For these patients, the way they absorb a particular medication may mean that they do better after being switched to another brand of levothyroxine.
- Finally, for some patients, their thyroid symptoms don't resolve on levothyroxine alone, but do resolve when they switch to one of the other prescription thyroid hormone replacement drugs, including liotrix (Thyrolar), or prescription natural desiccated thyroid, like Armour Thyroid.
It's true that each manufacturer of brand name and generic levothyroxine drugs has its own formulation and production methodology. Each levothyroxine product can have a potency that typically ranges from 90 to 110 percent of the stated dosage. If they have quality control over their production, manufacturers don't typically have wide fluctuations in their own products from batch to batch, although it does happen. Generally, however, if you get used to a particular brand at a particular dose, you'll get the same or similar potency from refill to refill, minimizing your hormone fluctuations.
So, it's been known for years that if you do brands or types of thyroid medication, you need to get retested in six weeks to see if you need a dosage adjustment, and get retested as often as needed thereafter in order to ensure proper dosage levels and symptom response.
As for generic levothyroxine, smart, concerned physicians have always told patients to avoid generic levothyroxine -- NOT because generics are, inherently flawed products, as some physicians claim. But again, because all the levothyroxine drugs are not consistent from manufacturer to manufacturer. When you take a generic levothyroxine, every time you get a refill, you can get product from any one of the generic manufacturers. Since different products may be at varying levels on the 90 to 110% potency scale, there's no way to know what level you're getting, so you can have fluctuating potency, even on the same dose. You can't specify which generic manufacturer you want or ensure that every time you get a prescription refilled you will get the same generic product. THIS is the reason why generics are considered "unreliable."
But given that we have known about these issues for years, why are they now such pressing issues that they've become the justification for a campaign based on a restrictive message regarding thyroid treatment: "the brand of thyroid hormone medication should always stay the same?"
