Oral Liquid l-Thyroxine (l-T4) May Be Better Absorbed Compared to l-T4 Tablets Following Bariatric Surgery
Open accessAbstract
Drug malabsorption is a potential concern after bariatric surgery. We present four case reports of hypothyroid patients who were well replaced with thyroxine tablets to euthyroid thyrotropin (TSH) levels prior to Roux-en-Y gastric bypass surgery. These patients developed elevated TSH levels after the surgery, the TSH responded reversibly to switching from treatment with oral tablets to a liquid formulation.
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A liquid formulation of LT4 packaged in polyethylene ampoules, not available within the United States, has been suggested, based on case reports or uncontrolled studies only, to be better absorbed than tablets if there is malabsorption following bariatric surgery or if LT4 is consumed with breakfast.
“A liquid formulation of LT4 that is packaged in polyethylene ampoules, and that is not available within the United States, has been suggested, based on case reports or uncontrolled studies only, to be better absorbed than tablets if there is malabsorption following bariatric surgery or if LT4 is consumed with breakfast (115,116).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [116]
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Cites
Zhang, H., Zhang, J., & Streisand, J. B. (2002) · Clinical Pharmacokinetics · doi:10.2165/00003088-200241090-00003 · Cited by 413 · see citing works
Thyroxine in Goiter, <i>Helicobacter pylori</i> Infection, and Chronic Gastritis
Centanni, M., Gargano, L., Canettieri, G., Viceconti, N., Franchi, A., Fave, G. D., & Annibale, B. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa043903 · Cited by 329 · see citing works
A systematic review of drug absorption following bariatric surgery and its theoretical implications
Padwal, R. S., Brocks, D. R., & Sharma, A. M. (2009) · Obesity Reviews · doi:10.1111/j.1467-789x.2009.00614.x · Cited by 264 · see citing works
Medication and nutrient administration considerations after bariatric surgery
Miller, A. D., & Smith, K. M. (2006) · American Journal of Health-System Pharmacy · doi:10.2146/ajhp060033 · Cited by 249 · see citing works
Ferrous sulfate reduces thyroxine efficacy in patients with hypothyroidism
Campbell, N. R. C., Hasinoff, B. B., Stalts, H., Rao, B., & Wong, N. C. W. (1992) · Annals of Internal Medicine · doi:10.7326/0003-4819-117-12-1010 · Cited by 231 · see citing works
Hypothyroidism: etiology, diagnosis, and management
Almandoz, J. P., & Gharib, H. (2012) · Medical Clinics of North America · doi:10.1016/j.mcna.2012.01.005 · Cited by 216 · see citing works
Altered intestinal absorption of L-thyroxine caused by coffee
Benvenga, S., Bartolone, L., Pappalardo, M. A., Russo, A., Lapa, D., Giorgianni, G., Saraceno, G., & Trimarchi, F. (2008) · Thyroid · doi:10.1089/thy.2007.0222 · Cited by 191 · see citing works
Bariatric surgery trends: an 18-year report from the International Bariatric Surgery Registry
Samuel, I., Mason, E. E., Renquist, K. E., Huang, Y., Zimmerman, M. B., & Jamal, M. (2006) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2006.07.006 · Cited by 159 · see citing works
Delayed Intestinal Absorption of Levothyroxine
BENVENGA, S., BARTOLONE, L., SQUADRITO, S., GIUDICE, F. L., & TRIMARCHI, F. (1995) · Thyroid · doi:10.1089/thy.1995.5.249 · Cited by 156 · see citing works
The influence of cholestyramine on thyroxine absorption
Northcutt, R. C. (1969) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1969.03160100047012 · Cited by 144 · see citing works
Sucralfate causes malabsorption of L-thyroxine
Sherman, S. I., Tielens, E. T., & Ladenson, P. W. (1994) · The American Journal of Medicine · doi:10.1016/0002-9343(94)90093-0 · Cited by 105 · see citing works
Checchi, S., Montanaro, A., Pasqui, L., Ciuoli, C., De Palo, V., Chiappetta, M. C., & Pacini, F. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2007-1544 · Cited by 89 · see citing works
Nonspecific intestinal adsorption of levothyroxine by aluminum hydroxide
Liel, Y., Sperber, A. D., & Shany, S. (1994) · The American Journal of Medicine · doi:10.1016/0002-9343(94)90303-4 · Cited by 83 · see citing works
Approach to and Treatment of Differentiated Thyroid Carcinoma
Pacini, F., & Castagna, M. G. (2012) · Medical Clinics of North America · doi:10.1016/j.mcna.2012.01.002 · Cited by 77 · see citing works
The Acute Effect of Calcium Carbonate on the Intestinal Absorption of Levothyroxine
Singh, N., Weisler, S. L., & Hershman, J. M. (2001) · Thyroid · doi:10.1089/105072501753211046 · Cited by 77 · see citing works
Malabsorption of Thyroid Hormones After Jejunoileal Bypass for Obesity
AZIZI, F., BELUR, R., & ALBANO, J. (1979) · Annals of Internal Medicine · doi:10.7326/0003-4819-90-6-941 · Cited by 61 · see citing works
Rubio, I. G. S., Galrão, A. L., Santo, M. A., Zanini, A. C., & Medeiros-Neto, G. (2012) · Obesity Surgery · doi:10.1007/s11695-011-0452-8 · Cited by 58 · see citing works
Thyroxine malabsorption following intestinal bypass surgery.
Js, B., & Jf, M. (1986) · PubMed · Cited by 51 · see citing works
Effects of Pharmacological Fiber Supplements on Levothyroxine Absorption
Chiu, A. C., & Sherman, S. I. (1998) · Thyroid® · doi:10.1089/thy.1998.8.667 · Cited by 41 · see citing works
Saraceno, G. E., Vita, R. D., Trimarchi, F., & Benvenga, S. (2012) · 15th International & 14th European Congress of Endocrinology · Cited by 5 · see citing works
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Sorted by citations
Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., Cooper, D. S., Kim, B. W., Peeters, R. P., Rosenthal, M. S., et al. (2014) · Thyroid® · doi:10.1089/thy.2014.0028 · Cited by 1,928 · see citing works
“A liquid formulation of LT4 that is packaged in polyethylene ampoules, and that is not available within the United States, has been suggested, based on case reports or uncontrolled studies only, to be better absorbed than tablets if there is malabsorption following bariatric surgery or if LT4 is consumed with breakfas…”
Mechanick, J. I., Apovian, C., Brethauer, S., Garvey, W. T., Joffe, A. M., Kim, J., Kushner, R. F., Lindquist, R., Pessah-Pollack, R., Seger, J., et al. (2020) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.10.025 · Cited by 608 · see citing works
Mechanick, J. I., Apovian, C., Brethauer, S., Garvey, W. T., Joffe, A. M., Kim, J., Kushner, R. F., Lindquist, R., Pessah-Pollack, R., Seger, J., et al. (2019) · Endocrine Practice · doi:10.4158/gl-2019-0406 · Cited by 510 · see citing works
Gastrointestinal malabsorption of thyroxine
Virili, C., Antonelli, A., Santaguida, M. G., Benvenga, S., & Centanni, M. (2019) · Endocrine Reviews · doi:10.1210/er.2018-00168 · Cited by 164 · see citing works
Factors Affecting Gastrointestinal Absorption of Levothyroxine: A Review
Skelin, M., Lucijanić, T., Amidžić Klarić, D., Rešić, A., Bakula, M., Liberati-Čizmek, A.-M., Gharib, H., & Rahelić, D. (2017) · Clinical Therapeutics · doi:10.1016/j.clinthera.2017.01.005 · Cited by 133 · see citing works
Vita, R., Saraceno, G., Trimarchi, F., & Benvenga, S. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-2684 · Cited by 99 · see citing works
Optimal thyroid hormone replacement
Jonklaas, J. (2022) · Endocrine Reviews · doi:10.1210/endrev/bnab031 · Cited by 89 · see citing works
Fallahi, P., Ferrari, S. M., Camastra, S., Politti, U., Ruffilli, I., Vita, R., Navarra, G., Benvenga, S., & Antonelli, A. (2017) · Obesity Surgery · doi:10.1007/s11695-016-2247-4 · Cited by 81 · see citing works
Cappelli, C., Pirola, I., Daffini, L., Formenti, A., Iacobello, C., Cristiano, A., Gandossi, E., Agabiti Rosei, E., & Castellano, M. (2016) · Thyroid · doi:10.1089/thy.2015.0422 · Cited by 80 · see citing works
Self-citationThyroxine softgel capsule in patients with gastric-related T4 malabsorption
Santaguida, M. G., Virili, C., Duca, S. C. D., Cellini, M., Gatto, I., Brusca, N., De Vito, C., Gargano, L., & Centanni, M. (2015) · Endocrine · doi:10.1007/s12020-014-0476-7 · Cited by 68 · see citing works
Virili, C., Giovanella, L., Fallahi, P., Antonelli, A., Santaguida, M. G., Centanni, M., & Trimboli, P. (2018) · Frontiers in Endocrinology · doi:10.3389/fendo.2018.00010 · Cited by 61 · see citing works
Fallahi, P., Ferrari, S. M., & Antonelli, A. (2016) · Endocrine · doi:10.1007/s12020-015-0836-y · Cited by 53 · see citing works
Fierabracci, P., Martinelli, S., Tamberi, A., Piaggi, P., Basolo, A., Pelosini, C., Ricco, I., Magno, S., Querci, G., Ceccarini, G., et al. (2016) · Thyroid · doi:10.1089/thy.2015.0473 · Cited by 51 · see citing works
Fallahi, P., Ferrari, S. M., Ruffilli, I., & Antonelli, A. (2016) · BMC Gastroenterology · doi:10.1186/s12876-016-0439-y · Cited by 46 · see citing works
Effect of vitamin C on the absorption of levothyroxine in patients with hypothyroidism and gastritis
Jubiz, W., & Ramirez, M. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-4360 · Cited by 45 · see citing works
Oral liquid levothyroxine treatment at breakfast: a mistake?
Cappelli, C., Pirola, I., Gandossi, E., Formenti, A., & Castellano, M. (2014) · European Journal of Endocrinology · doi:10.1530/eje-13-0693 · Cited by 41 · see citing works
Novel thyroxine formulations: a further step toward precision medicine
Virili, C., Trimboli, P., & Centanni, M. (2019) · Endocrine · doi:10.1007/s12020-019-02049-x · Cited by 41 · see citing works
Levothyroxine dosing following bariatric surgery
Gadiraju, S., Lee, C. J., & Cooper, D. S. (2016) · Obesity Surgery · doi:10.1007/s11695-016-2314-x · Cited by 39 · see citing works
Bernareggi, A., Grata, E., Pinorini, M., & Conti, A. (2013) · Pharmaceutics · doi:10.3390/pharmaceutics5040621 · Cited by 30 · see citing works
Laurent, I., Tang, S., Astère, M., Wang, K. R., Deng, S., Xiao, L., & Li, Q. F. (2018) · Endocrine · doi:10.1007/s12020-018-1574-8 · Cited by 30 · see citing works
Medications and Food Interfering with the Bioavailability of Levothyroxine: A Systematic Review
Liu, H., Lu, M., Hu, J., Fu, G., Feng, Q., Sun, S., & Chen, C. (2023) · Therapeutics and Clinical Risk Management · doi:10.2147/tcrm.s414460 · Cited by 29 · see citing works
Increased requirement of replacement doses of levothyroxine caused by liver cirrhosis.
Benvenga, S., Capodicasa, G., Perelli, S., Ferrari, S. M., Fallahi, P., & Antonelli, A. (2018) · Frontiers in Endocrinology · doi:10.3389/fendo.2018.00150 · Cited by 25 · see citing works
Levothyroxine liquid solution versus tablet form for replacement treatment in pregnant women
Cappelli, C., Negro, R., Pirola, I., Gandossi, E., Agosti, B., & Castellano, M. (2016) · Gynecological Endocrinology · doi:10.3109/09513590.2015.1113518 · Cited by 24 · see citing works
Ferrara, R., Ientile, V., Arcoraci, V., Ferrajolo, C., Piccinni, C., Fontana, A., Benvenga, S., & Trifirò, G. (2017) · Endocrine · doi:10.1007/s12020-017-1242-4 · Cited by 23 · see citing works
The performance of levothyroxine tablet is impaired by bariatric surgery
Trimboli, P., Ossola, N., Torre, A., Mongelli, F., Quarenghi, M., Camponovo, C., Lucchini, B., Rotondi, M., Ruinelli, L., & Garofalo, F. (2022) · Endocrine · doi:10.1007/s12020-022-03289-0 · Cited by 17 · see citing works
- Authors
- Pirola, I., Formenti, A. M., Gandossi, E., Mittempergher, F., Casella, C., Agosti, B., & Cappelli, C.
- Affiliations
- Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
- University of Brescia (IT)
- Corresponding author
- Cappelli, Carlo
- Venue
- Obesity Surgery
- Published
- 2013-07-04
- Volume
- 23
- Issue
- 9
- Pages
- 1493-1496
- ISSN
- 0960-8923 (ISSN-L)
- 1708-0428
- PMC
- PMC3726924
- OpenAlex
- W2043009591
- Cited by
- 74
- References
- 20
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4 · 2023: 3 · 2022: 5 · 2021: 10 · 2020: 2 · 2019: 8 · 2018: 6 · 2017: 6 · 2016: 10 · 2015: 7 · 2014: 6 · 2013: 2
- FWCI
- 8.22
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Obesity Surgery (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- levothyroxine, liquid formulation
- MeSH terms
- Adult, Female, Humans, Malabsorption Syndromes, Middle Aged, Obesity, Morbid, Suspensions, Tablets, Therapeutic Equivalency, Thyrotropin, Thyroxine, Gastric Bypass, Treatment Outcome
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