Liquid levothyroxine and its potential use

Formenti, Anna Maria; Daffini, Linda; Pirola, Ilenia; Gandossi, Elena; Cristiano, Alessandra; Cappelli, Carlo

doi:10.14310/horm.2002.1579

Cited by 13 publications

(17 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Taking L-T4 with coffee, or with water followed by coffee within a few minutes, results in a poor TSH response in many patients [ 13 ]. The recent introduction of new nontablet formulations of L-T4, such as soft gel capsules and a liquid, could resolve this problem [ 5 ]. In one small study of hypothyroid patients, Vita et al observed that the absorption of a soft gel preparation of L-T4 (Tiche capsules, IBSA, Switzerland) was not impaired by taking it with coffee [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…There are many potential explanations for this. Firstly, a number of factors may interfere with intestinal absorption of L-T4, including food, dietary fibre, coffee, drugs, gastric or intestinal resection, and disease [ 5 ]. As a result, current guidelines recommend that L-T4 is taken in a fasting state at least 30 minutes before breakfast [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Secondly, it is not always reliable to follow medical advice, especially for drug therapy [ 9 ]; this is especially relevant for L-T4 therapy as a significant number of patients have problems in postponing their breakfast by 30–60 minutes to ensure that they take L-T4 in the fasting state [ 10 ]. In the therapeutic scenario the recent introduction of nontablet L-T4 formulations, such as liquid and soft gel capsules, would seem to raise doubts as to this recommendation [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Thyroid Hormone Profile in Patients Ingesting Soft Gel Capsule or Liquid Levothyroxine Formulations with Breakfast

Cappelli

Pirola

Gandossi

et al. 2016

International Journal of Endocrinology

Self Cite

View full text Add to dashboard Cite

Background. Recently, it has been shown that liquid L-T4 formulation can be ingested with breakfast. This study looked to extend these findings by investigating whether a soft gel capsule formulation of L-T4 could also be ingested at breakfast time. Methods. 60 patients (18–65 yrs), previously submitted to thyroidectomy for proven benign goitre in stable euthyroidism receiving liquid L-T4 therapy ingested with breakfast, were enrolled. TSH, fT4, and fT3 levels were assessed in all the patients who were switched from liquid L-T4 to a soft gel capsule formulation at the same dosage of L-T4. After 6 months, TSH, fT4, and fT3 levels were determined again. Results. There were no differences in TSH levels, but fT3 and fT4 levels during treatment with the soft gel capsule were significantly lower than those at enrolment with the liquid L-T4 formulation (TSH median (min–max): 1.9 (0.5–4.0) versus 2.2 (0.5–4.5) mIU/L, fT3: 2.5 (2.4–3.1) versus 2.7 (2.4–3.3) pg/mL, p < 0.05, and fT4: 9.9 (8.0–13) versus 10.6 (8.6–13.8) pg/mL, p < 0.0001). Conclusion. Both liquid and soft gel formulations of L-T4 can be taken with breakfast. However, liquid L-T4 would be the preferred formulation for patients in whom even small changes in fT4 and fT3 levels are to be avoided.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Thyroid Hormone Profile in Patients Ingesting Soft Gel Capsule or Liquid Levothyroxine Formulations with Breakfast

Cappelli

Pirola

Gandossi

et al. 2016

International Journal of Endocrinology

Self Cite

View full text Add to dashboard Cite

show abstract

“…In an ironic twist, our patient, who had a condition whose treatment is typically straightforward (hypothyroidism), posed a great therapeutic challenge in the absence of well-recognized alternatives to oral LT4. Initially, higher oral doses were administered, similar to the trend followed in certain conditions [ 2 , 3 ]. However, this failed to achieve any response, most likely because the patient had a complete obstruction preventing the drug from reaching its site of absorption.…”

Section: Discussionmentioning

confidence: 99%

Successful Management of Hypothyroidism in Gastric Outlet Obstruction Using Levothyroxine Rectal Enemas: A Case Report

et al. 2018

View full text Add to dashboard Cite

Patient: Male, 53Final Diagnosis: Gastric cancerSymptoms: Abdominal and/or epigastric pain • vomiting • weigh lossMedication: —Clinical Procedure: GastrectomySpecialty: SurgeryObjective:Unusual setting of medical careBackground:Hypothyroidism is the second most common endocrine disorder following diabetes. Appropriate hormone replacement therapy is the cornerstone of its management and is typically in the form of oral preparations of levothyroxine. Intravenous replacement is a well-known alternative in patients who are unable to take medication orally for long periods. However, effective and safe alternatives to oral preparations of levothyroxine should be sought in the absence of the parenteral alternative. The aim of this report is to describe an alternative route for levothyroxine supplementation when the oral and parenteral routes are not available.Case Report:This study reports a hypothyroid patient with symptomatic malignant gastric outlet obstruction requiring surgery. However, the patient’s surgical condition precluded oral administration of levothyroxine and the parenteral alternative was unavailable. Hormone replacement therapy was administered rectally in the form of enemas in preparing the patient for surgery.Conclusions:Rectal administration of levothyroxine using enemas can be a safe and effective alternative for patients in whom administration via the oral route is not feasible, especially when parenteral formulas are unavailable.

show abstract

“…However, data recently published in different clinical settings [27] and in part commented in this Editorial, give in our opinion a reasonable basis for re-discussing the role of this new treatment option in future guidelines.…”

mentioning

confidence: 85%

Treatment of hypothyroidism: all that glitters is gold?

et al. 2016

Self Cite

View full text Add to dashboard Cite

Levothyroxine (L-T4) is recommended worldwide for replacement therapy of hypothyroidism due to its efficacy in resolving the symptoms, long-term experience of its benefits, long serum half-life, and low cost. Since the isolation of L-T4 by Kendall in 1914 [1] and then the synthesis of T4 and its better absorbed sodium salt [2], it has become the therapy of choice, also due to the demonstration that about 80 % of biologically active tri-iodiothyronine is derived from peripheral conversion of T4 [3].The individually tailored dose of L-T4 therapy depends on different factors such as body weight, lean body mass, pregnancy status, degree of thyrotropin (TSH) elevation, age, comorbidities, etiology of hypothyroidism, and consequently amount of residual functional thyroid tissue. Therefore, thyroid hormone need may considerably vary among patients. As a matter of fact, although therapy is given correctly, over-as well as under-treatment may quite frequently be observed in clinical practice with relevant impact on different clinical outcomes. Indeed, complications of under-treatment are detrimental effects on the serum lipid profile [4], progression of atherosclerotic cardiovascular disease [5], and congestive heart failure [6].Nowadays, evidence-based guidelines recommend 1 h interval between L-T4 tablet ingestion and breakfast to achieve the best therapeutic effects [7]. The absorption of an orally daily administered dose of L-T4 is about 70-80 % under optimal fasting conditions [8]. Nevertheless, almost 50 % of treated patients show persistently abnormal thyroid functional tests 1 year after starting treatment [9]. This may be due, at least in part, as for many other chronic treatments [10], to compliance problems. Specifically, a subset of patients find difficult or even unfeasible, due for example to work requirements, to comply with the indication of assuming the tablet 1 h before breakfast. This often leads to disproportioned increase in doses of L-T4 and improper or expensive work-up [11].Moreover, different pathologic conditions, such as atrophic and Helicobacter Pylori-related gastritis or celiac disease, could reduce the rate of absorption of L-T4 via modification of the gastric acid pH, that is essential for complete dissolution of the tablet [12,13].Furthermore, soy products and several drugs, such as calcium carbonate, bile acid sequestrants, proton pump inhibitors, and ferrous sulfate, may alter L-T4 absorption [7].Trying to improve these pharmacokinetic drawbacks, recently new formulations of L-T4 have been introduced: soft gel capsules, containing T4 dissolved in glycerin, and the liquid formulation (only in a few countries). These preparations have been reported to reach the systemic circulation more quickly since gastric dissolution is not needed [14]. In a recent two-year prospective study involving hypothyroid patients without malabsorption or drug interference, Fallahi et al. reported higher effectiveness of liquid L-T4 formulation in normalizing TSH levels as compared to L-T4 tablets [15]. Indeed...

show abstract

Liquid levothyroxine and its potential use

Cited by 13 publications

References 57 publications

Thyroid Hormone Profile in Patients Ingesting Soft Gel Capsule or Liquid Levothyroxine Formulations with Breakfast

Thyroid Hormone Profile in Patients Ingesting Soft Gel Capsule or Liquid Levothyroxine Formulations with Breakfast

Successful Management of Hypothyroidism in Gastric Outlet Obstruction Using Levothyroxine Rectal Enemas: A Case Report

Treatment of hypothyroidism: all that glitters is gold?

Contact Info

Product

Resources

About