Can Levothyroxine Be Taken as Evening Dose? Comparative Evaluation of Morning versus Evening Dose of Levothyroxine in Treatment of Hypothyroidism

Rajput, Rajesh; Chatterjee, Sadhana; Rajput, Meena

doi:10.4061/2011/505239

Cited by 41 publications

(54 citation statements)

References 18 publications

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“…This finding favors ingestion of L-T4 during morning fast, delaying food ingestion for 30 minutes (187) (A). Conversely, recent small European and Indian studies demonstrated similar levels of thyroid hormones and no difference in clinical parameters using evening administration (188,189) (B,B), however, alimentary habits in Latin America could make these findings less applicable in our population.…”

Section: How Should Levothyroxine Be Used?contrasting

confidence: 40%

Clinical practice guidelines for the management of hypothyroidism

Brenta

Vaisman

Sgarbi

et al. 2013

Arq Bras Endocrinol Metab

126

123

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Introduction: Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women. Objectives: In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience. Materials and methods: The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a scale from A-D was based on the Oxford Centre for Evidence--based Medicine, Levels of Evidence 2009, allowing an unbiased opinion devoid of subjective viewpoints. The areas of interest for the studies comprised diagnosis, screening, treatment and a special section for hypothyroidism in pregnancy. Results: Several questions based on diagnosis, screening, treatment of hypothyroidism in adult population and specifically in pregnant women were posed. Twenty six recommendations were created based on the answers to these questions. Despite the fact that evidence in some areas of hypothyroidism, such as therapy, is lacking, out of 279 references, 73% were Grade A and B, 8% Grade C and 19% Grade D. Conclusions: These evidence-based clinical guidelines on hypothyroidism will provide unified criteria for management of hypothyroidism throughout Latin America. Although most of the studies referred to are from all over the world, the point of view of thyroidologists from Latin America is also given. Arq Bras Endocrinol Metab. 2013;57(4):265-99

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Section: How Should Levothyroxine Be Used?contrasting

confidence: 40%

Clinical practice guidelines for the management of hypothyroidism

Brenta

Vaisman

Sgarbi

et al. 2013

Arq Bras Endocrinol Metab

126

123

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“…Children with GIT disorder, malabsorption syndrome or taking medication known to interfere with uptake of levothyroxine were excluded from the study. [3][4][5] Ethical clearance was obtained from the Institutional Review Board. Informed written consent was obtained from the parents of the study subjects.…”

Section: Methodsmentioning

confidence: 99%

“…3,4 We performed this study to assess the effectiveness of bedtime levothyroxine administration as compared to morning levothyroxine administration.…”

mentioning

confidence: 99%

Effectiveness of bedtime levothyroxine intake as compared to morning levothyroxine intake in children

Radhakrishnan¹,

Venkatasamy

Pyarejan

et al. 2017

Int J Contemp Pediatr

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Background: The study was conducted to assess the effectiveness of bedtime Levothyroxine administration as compared to morning Levothyroxine administration in thyroid profile, renal and lipid parameters, anthropometric and vital parameters in children attending endocrinology OPD at a tertiary care center in Southern India.Methods: It is an open label randomized control study. 154 children who were diagnosed to have hypothyroidism, on levothyroxine supplementation and in euthyroid state at the start of study were included. Children were randomly allocated into two groups. One group received levothyroxine in early morning (1hr before food) and another group received levothyroxine in bedtime (2hrs after food) up to 3 months. At baseline, 6 weeks and 12weeks, thyroid profile, renal and lipid parameters and vital parameters were measured during follow up. Anthropometric parameters were measured at baseline and 12 weeks.Results: In 6th week analysis, mean TSH level of morning group (2.35±0.38 mIU/L) and bedtime group (2.42±0.40 mIU/L) did not show any statistical difference (p=0.8). In 12th week analysis mean TSH level of morning group (2.18±0.34 mIU/L) and bedtime group (1.90±0.33 mIU/L) did not show any statistical difference (p=0.24). At 6th week analysis, mean free T4 level of bedtime group (1.45±0.08 ng/dl) is higher than morning group (1.33±0.2 ng/dl). This difference is statistically significant (p= 0.03). At 12 th week analysis, mean free T4 level of bedtime group (1.65±0.04 ng/dl) is higher than morning group (1.31±0.06 ng/dl). This difference is statistically significant (p<0.00001). A 12weeks, the difference in mean serum cholesterol of morning group (152.79±4.59 mg/dl) and bedtime group (143.58±3.059 mg/dl) is statistically significant (p=0.001). At 6 and12 weeks, other parameters like serum triglycerides, HDL cholesterol, renal parameters, anthropometry, vital parameters of morning group and bedtime group did not show any statistical significant difference.Conclusions: There is a significant improvement in free T4 level when levothyroxine was taken at bedtime. The efficacy of bedtime regimen of levothyroxine is quite comparable to the efficacy of morning regimen. There is considerable decrease in serum cholesterol level when levothyroxine was taken at bedtime. Bedtime regimen may result in good compliance in school going children. Parents should be allowed to choose either morning or bedtime regimen depending on their convenience.

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“…Therefore, standard recommendation is that levothyroxine should be taken an hour before breakfast on an empty stomach, to prevent interference of its uptake by food or medication (14). While taking levothyroxine in between or with food might not be best, taking it at bedtime is an-other option, as two studies have shown to have almost the same effect as when taken on an empty stomach (15,16). In contrast, a randomized crossover trail compared taking levothyroxine in the fasting state, with breakfast, or at bedtime in 65 thyroid cancer, patients with primary hypothyroidism found that fasting state and most beneficial than other times (17).…”

Section: Thyroid Hormone Replacementmentioning

confidence: 99%

Islamic Fasting and Thyroid Hormones

Azizi

2015

Int J Endocrinol Metab

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Can Levothyroxine Be Taken as Evening Dose? Comparative Evaluation of Morning versus Evening Dose of Levothyroxine in Treatment of Hypothyroidism

Cited by 41 publications

References 18 publications

Clinical practice guidelines for the management of hypothyroidism

Clinical practice guidelines for the management of hypothyroidism

Effectiveness of bedtime levothyroxine intake as compared to morning levothyroxine intake in children

Islamic Fasting and Thyroid Hormones

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