Factors Affecting Gastrointestinal Absorption of Levothyroxine: A Review

Skelin, Marko; Lucijanić, Tomo; Klarić, Daniela Amidžić; Rešić, Arnes; Bakula, Miro; Liberati-Čižmek, Ana-Marija; Gharib, Hossein; Rahelić, Dario

doi:10.1016/j.clinthera.2017.01.005

Cited by 90 publications

(67 citation statements)

References 99 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, there are many conditions that can interfere with L‐T4 absorption, such as dietary fibre and coffee. Additionally, many drugs, such as cholestyramine, colesevelam, lanthanum, calcium carbonate, calcium citrate, calcium acetate, iron sulphate, ciprofloxacin, aluminum hydroxide, sevelamer or proton pump inhibitors (PPIs), have also been shown to interfere with L‐T4 absorption . Malabsorption is also reported in disorders such as atrophic gastritis, helicobacter pylori infection, inflammatory bowel disease, coeliac disease and lactose intolerance…”

Section: Introductionmentioning

confidence: 99%

Effect of l‐thyroxine administration before breakfast vs at bedtime on hypothyroidism: A meta‐analysis

Pang

et al. 2020

Clinical Endocrinology

View full text Add to dashboard Cite

Hypothyroidism is resulting from a deficiency of thyroid hormones, which is common condition with potentially devastating health consequences that affect all populations worldwide. 1 Thyroid hormones are essential for growth, neuronal development, reproduction and the regulation of energy metabolism. The prevalence of hypothyroidism varies considerably across the general population, ranging between 0.2% and 5.3% in Europe, 2 0.3% and 3.7% in the USA, 3 11% in India 4 and 17.8% in China (overt hypothyroidism: 1.1%; subclinical hypothyroidism: 16.7%). 5 Longitudinal studies from large UK cohorts report an incidence rate of spontaneous hypothyroidism of 3.5-5.0 per 1000 and 0.6-1.0 per 1000 in women and men, respectively. 6The clinical presentation of hypothyroidism is nonspecific and variable. Therefore, the diagnosis of hypothyroidism is based primarily on biochemical abnormalities. The pituitary hormone thyrotropin (TSH) has a complex inverse relationship with the thyroid hormones thyroxine (T4) and triiodothyronine (T3). 7 Accordingly, overt hypothyroidism is defined as serum TSH concentrations above the reference range with low free T4 (FT4) levels, while subclinical hypothyroidism is diagnosed when TSH levels are high and circulating Abstract Purpose: To compare the effects of l-thyroxine (L-T4) administration before breakfast and administration at bedtime on hypothyroidism. Methods: The PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang databases were searched to identify relevant articles. All prospective or randomized controlled studies (RCTs) comparing L-T4 administration before breakfast to the administration at bedtime in patients with hypothyroidism were included in the analysis. Results: Initially, 2884 articles were retrieved from the databases, and 10 articles were included in the quantitative analysis. The effect of L-T4 administration before breakfast compared with administration at bedtime had no statistically significant association with hormone thyrotropin (TSH) (Standardized mean differences [SMD] = 0.09, 95% confidence intervals (CI): −0.12, 0.30; P = .39), or free triiodothyronine (FT3) (SMD=−0.19, 95% CI: −0.53, 0.15; P = .28) in patients with hypothyroidism. However, the result of FT4 level was favourable for L-T4 bedtime administration group (SMD=−0.27, 95% CI: −0.52, −0.02; P = .03). Conclusion:Our meta-analysis revealed that L-T4 administration at bedtime is as effective as administration before breakfast for patients with hypothyroidism. Taking L-T4 at bedtime may be an attractive option for patients with hypothyroidism. K E Y W O R D Sadministration timing, hypothyroidism, l-thyroxine, meta-analysis How to cite this article: Pang X, Pu T, Xu L, Sun R. Effect of l-thyroxine administration before breakfast vs at bedtime on hypothyroidism: A meta-analysis. Clin Endocrinol (Oxf).

show abstract

Section: Introductionmentioning

confidence: 99%

Effect of l‐thyroxine administration before breakfast vs at bedtime on hypothyroidism: A meta‐analysis

Pang

et al. 2020

Clinical Endocrinology

View full text Add to dashboard Cite

show abstract

“…The antidepressant (fluoxetine), teriflunomide and fingolimod for multiple sclerosis were the only medications she has taken at the same time as her hormonal treatment. According to a recent review,6 none of these three molecules is suspected to interact with the absorption of levothyroxine.…”

Section: Discussionmentioning

confidence: 99%

Major imbalance of thyroid function after laparoscopic sleeve gastrectomy

Brutus¹,

Poupard

Glatin

2019

BMJ Case Rep

View full text Add to dashboard Cite

In patients with substituted hypothyroidism, laparoscopic sleeve gastrectomy may interfere with thyroid balance by varying body weight or by altering the absorption of hormone therapy. A 58-year-old female patient presented with a major thyroid imbalance after sleeve gastrectomy, manifesting itself in large-scale changes in thyroid stimulating hormone (TSH) levels. The transition from a tablet treatment to a liquid form alleviated burden of treatment, unfortunately without normalising TSH. Our case emphasises the importance of the understanding of hypothalamic–pituitary–thyroid feedback control mechanisms together with good galenic choice, management of associated conditions and the elimination of other causes of variations of TSH levels during the management of hypothyroid patients after sleeve gastrectomy.

show abstract

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that levothyroxine in the form of an oral solution may be less prone to the impact of some factors on the absorption of this drug compared with conventional tablets. 27,28 For instance, previous studies suggested that an oral solution was less affected than the tablet formulation with regard to levothyroxine malabsorption that could be caused by proton pump inhibitors 29 or other interfering drugs. [30][31][32] It was also reported that oral liquid levothyroxine formulations could diminish the problem of levothyroxine malabsorption caused by lactose intolerance 33 or Helicobacter pylori 34 infection or bariatric surgery when using traditional tablet formulations.…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics and Comparative Bioavailability of a Levothyroxine Sodium Oral Solution and Soft Capsule

Tanguay

Girard²,

Scarsi

et al. 2018

Clinical Pharm in Drug Dev

View full text Add to dashboard Cite

A new formulation of levothyroxine sodium has been developed in the form of an oral solution contained in unit-dose ampules. A study has been conducted to compare the bioavailability of levothyroxine sodium oral solution and levothyroxine sodium soft capsule in healthy volunteers under fasting conditions. The rate and extent of absorption of the new levothyroxine solution were also evaluated when administered on dilution in water or directly into the mouth without water. In each period, according to the randomization scheme, subjects were administered single oral doses of either test, as 4 × 150-μg unit-dose ampules, with or without water, or reference, as 4 × 150-μg capsules in a crossover design. Thirty-six subjects were randomized and dosed in this study; of these, 31 completed all study periods. When comparing the solution with the capsule (both products administered with water), the 90% confidence intervals for the ratio of log-transformed values of AUC and C were within 90.00% and 111.11%, respectively, for baseline-corrected levothyroxine. Moreover, the administration of levothyroxine oral solution without water did not affect the rate and extent of its absorption. In conclusion, levothyroxine oral solution unit-dose ampules were bioequivalent to the levothyroxine capsule when administered with or without water. All formulations were well tolerated, with no major side effects.

show abstract

Factors Affecting Gastrointestinal Absorption of Levothyroxine: A Review

Cited by 90 publications

References 99 publications

Effect of l‐thyroxine administration before breakfast vs at bedtime on hypothyroidism: A meta‐analysis

Effect of l‐thyroxine administration before breakfast vs at bedtime on hypothyroidism: A meta‐analysis

Major imbalance of thyroid function after laparoscopic sleeve gastrectomy

Pharmacokinetics and Comparative Bioavailability of a Levothyroxine Sodium Oral Solution and Soft Capsule

Contact Info

Product

Resources

About