Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients; the 2019 Italian Survey

Negro, Roberto; Attanasio, Roberto; Nagy, Endre; Papini, Enrico; Perros, Petros; Hegedűs, László

doi:10.1159/000502057

Cited by 44 publications

(107 citation statements)

References 37 publications

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“…The world-wide obesity epidemic and increasing use of bariatric surgery may pose an important cause of levothyroxine malabsorption in the future. In fact, liquid levothyroxine is preferentially chosen by endocrinologists for specific clinical conditions like malabsorption, interfering drugs, or inability to take the drug in the fasting state, as was reported in the 2019 Italian survey [58]. Our review confirmed that the use of liquid levothyroxine allowed to overcome the problems of malabsorption caused by drugs and supplements including polypharmacy, PPI, iron, and calcium supplements, and by bariatric surgery.…”

Section: Discussionsupporting

confidence: 77%

“…W przyszłości ważnymi powodami zaburzeń wchłaniania LT4 mogą stać się ogólnoświatowa epidemia otyłości i coraz częstsze wykonywanie operacji bariatrycznych. Podczas badania przeprowadzonego w 2019 r. we Włoszech wykazano, że endokrynolodzy chętniej sięgają po płynną LT4 w określonych sytuacjach klinicznych, takich jak upośledzenie wchłaniania, stosowanie leków zaburzających wchłanianie lub niemożność przyjmowania leku na czczo [58]. Wnioski nasuwające się z niniejszego przeglądu potwierdziły, że podawanie LT4 w postaci płynnej pozwoliło na przezwyciężenie zaburzeń wchłaniania wywołanego lekami i suplementami, w tym polipragmazją, stosowaniem IPP, suplementów żelaza i wapnia, a także przebytymi operacjami bariatrycznymi.…”

Section: Reviewunclassified

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Expert opinion on liquid L-thyroxine usage in hypothyroid patients and new liquid thyroxine formulation — Tirosint SOL [Opinia ekspertów dotycząca stosowania płynnej postaci lewotyroksyny oraz nowego preparatu Tirosint SOL u chorych na niedoczynność tarczycy]

Gietka-Czernel

Hubalewska‐Dydejczyk

Kos–Kudła

et al. 2020

Endokrynologia Polska

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Section: Discussionsupporting

confidence: 77%

Section: Reviewunclassified

Expert opinion on liquid L-thyroxine usage in hypothyroid patients and new liquid thyroxine formulation — Tirosint SOL [Opinia ekspertów dotycząca stosowania płynnej postaci lewotyroksyny oraz nowego preparatu Tirosint SOL u chorych na niedoczynność tarczycy]

Gietka-Czernel

Hubalewska‐Dydejczyk

Kos–Kudła

et al. 2020

Endokrynologia Polska

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“…In the Italian THESIS investigation [ 21 ], 75% recommended soft-gel capsules or liquid solution to patients established on LT4 but having poor biochemical control of their hypothyroidism. Interestingly, only 14.5% of the Danish endocrinologists agree with this strategy.…”

Section: Discussionmentioning

confidence: 99%

Use of thyroid hormones in hypothyroid and euthyroid patients: A 2020 THESIS questionnaire survey of members of the Danish Endocrine Society

Riis

Frølich

Negro

et al. 2021

J Endocrinol Invest

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Purpose The standard treatment of hypothyroidism is levothyroxine (LT4), which is available as tablets or soft-gel capsules in Denmark. This study aimed to investigate Danish endocrinologists’ use of thyroid hormones in hypothyroid and euthyroid patients. Methods An e-mail with an invitation to participate in an online survey investigating practices about substitution with thyroid hormones was sent to all members of the Danish Endocrine Society (DES). Results Out of 488 eligible DES members, a total of 152 (31.2%) respondents were included in the analysis. The majority (94.1%) of responding DES members use LT4 as the treatment of choice. Other treatment options for hypothyroidism are also used, as 58.6% prescribe combination therapy with liothyronine (LT3) + LT4 in their clinical practice. LT4 + LT3 combination is preferred in patients with persistent symptoms of hypothyroidism despite biochemical euthyroidism on LT4 treatment. Over half of the respondents answered that thyroid hormone therapy is never indicated for euthyroid patients, but 42.1% will consider it for euthyroid infertile women with high antibody levels. In various conditions that could interfere with the absorption of LT4, most responding Danish endocrinologists prefer tablets and do not expect a significant difference when switching from one type of tablet formulation to another. Conclusion The treatment of choice for hypothyroidism is LT4. Combination therapy with LT4 + LT3 is considered for patients with persistent symptoms. Even in the presence of conditions affecting bioavailability, responding Danish endocrinologists prefer LT4 tablets rather than newer LT4 formulations, such as soft-gel capsules. Supplementary Information The online version contains supplementary material available at 10.1007/s40618-021-01555-y.

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“…The burden of separating tablets from breakfast and coffee may also be reduced. Should this be the case, this may prove to be a safer and more efficacious strategy than the use of various com-binations of LT4 and LT3 (108). Further robust studies with sufficient power are needed to address these questions to provide evidence-based guidelines.…”

Section: Discussionmentioning

confidence: 99%

New Formulations of Levothyroxine in the Treatment of Hypothyroidism: Trick or Treat?

Nagy

Perros

Papini

et al. 2021

Thyroid

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Background: Levothyroxine (LT4) as a medication is used by up to 5.3% of the adult population. For optimal efficacy, the traditional tablet formulation (LT4tab) requires that patients avoid concomitant ingestion with food, drinks, and certain medications, as well as excellent patient compliance. Some comorbidities influence bioavailability of LT4 and may mandate repeated dose adjustments. Summary: New LT4 formulations (soft gel [LT4soft] and liquid [LT4liq]) containing predissolved LT4 are claimed to improve bioavailability, presumably by facilitating absorption. Thus, these formulations may well be more suitable than LT4tab for patients whose daily requirements are subjected to variations in bioavailability. Here, we review the evidence and indications for use of new LT4 formulations and highlight areas of uncertainty that are worthy of further investigation. While bioequivalence is established for LT4soft and LT4liq administered to healthy volunteers compared with LT4tab in pharmacokinetic (PK) studies, therapeutic equivalence of the new formulations seems to be different in several clinical settings. Some evidence suggests that new formulations of LT4 may mitigate against the strict requirements relating to concomitant ingestion with food, drinks, and certain medications, which apply to traditional LT4 tablets. The principal indication is in selected patients with disease fluctuations and intermittent therapies with interfering medications, where the need for frequent dose adjustments and office visits may be diminished. Whether the use of LT4soft or LT4liq in patients with impaired gastric acid secretion results in better control of hypothyroidism than LT4tab remains unclear. Conclusions: The evidence in favor of using LT4soft and LT4liq in clinical practice over LT4tab is weak, and the underlying putative PK mechanisms unclear. Additional studies to investigate these potential benefits, define the cost-effectiveness, and understand the PK mechanisms involved with new LT4 formulations are needed.

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Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients; the 2019 Italian Survey

Cited by 44 publications

References 37 publications

Expert opinion on liquid L-thyroxine usage in hypothyroid patients and new liquid thyroxine formulation — Tirosint SOL [Opinia ekspertów dotycząca stosowania płynnej postaci lewotyroksyny oraz nowego preparatu Tirosint SOL u chorych na niedoczynność tarczycy]

Expert opinion on liquid L-thyroxine usage in hypothyroid patients and new liquid thyroxine formulation — Tirosint SOL [Opinia ekspertów dotycząca stosowania płynnej postaci lewotyroksyny oraz nowego preparatu Tirosint SOL u chorych na niedoczynność tarczycy]

Use of thyroid hormones in hypothyroid and euthyroid patients: A 2020 THESIS questionnaire survey of members of the Danish Endocrine Society

New Formulations of Levothyroxine in the Treatment of Hypothyroidism: Trick or Treat?

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