In thyroxine-replaced hypothyroid postmenopausal women under simultaneous calcium supplementation, switch to oral liquid or softgel capsule l-thyroxine ensures lower serum TSH levels and favorable effects on blood pressure, total cholesterolemia and glycemia
Abstract
Purpose In postmenopausal women under L-T4 therapy, which was subsequently accompanied by calcium carbonate (CC) supplementation taken 6-8 h after tablet L-T4, TSH levels were greater than prior to adding CC. Total cholesterolemia [CHOL], fasting glycemia [FG], systolic and diastolic blood pressure [SBP, DBP] were also greater than baseline. Our aim was to explore the effects of either liquid or softgel capsule L-T4, while maintaining CC ingestion 6-8 h, later on TSH levels, CHOL, FG, SBP, and DBP.Methods We proposed to 50 hypothyroid postmenopausal women under tablet L-T4 therapy, to switch to either liquid or softgel capsule L-T4 at the same daily dose while maintaining CC ingestion 6-8 h later. Sixteen women accepted [group I; liquid (n = 9), capsule (n = 7)], while 34 continued tablet L-T4 [group II, (n = 34)].Results After 3 months, in group I, TSH decreased significantly (1.23 ± 0.49 vs. 1.80 ± 0.37 mU/L, P < 0.01), as did FG (80.7 ± 7.9 vs. 83.4 ± 6.3 mg/dL, P < 0.05); CHOL, SBP, and DBP decreased, though insignificantly. In contrast, in group II, TSH, FG, CHOL, SBP increased insignificantly, and DBP increased borderline significantly (69.7 ± 9 vs. 66.3 ± 6.5, P < 0.10). Compared to baseline (before adding CC), in group I, TSH was significantly lower (P < 0.01) and the other indices similar; in group II, TSH, FG, and SBP were significantly higher (P < 0.05), DBP borderline significantly higher (P < 0.10) and CHOL insignificantly higher. Performance of liquid L-T4 and capsule L-T4 was similar.Conclusion Delaying CC ingestion even by 6-8 h after taking tablet L-T4 is not entirely satisfactory, unlike liquid or softgel L-T4.
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Novel LT4 preparations are designed to reduce the high TSH levels induced by malabsorption due to calcium and iron supplements, PPIs, coffee, and breakfast.
“Furthermore, novel LT4 preparations are designed to reduce the high TSH levels induced by malabsorption due to calcium and iron supplements, PPIs, coffee, and breakfast (97–101).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [99]
A 2019 retrospective study in 50 patients revealed a similar result to the 2017 study.
“Two years later, a retrospective study conducted by the same researchers in 50 patients revealed a similar result (99).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [99]
Malabsorption due to calcium supplements, PPIs, breakfast, H. pylori infection, and gastroparesis was eradicated after switching from tablets to capsules.
“Malabsorption due to calcium supplements (99), PPIs (226), breakfast (206), H. pylori infection (227), and gastroparesis (202) was eradicated after switching from tablets to capsules.”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [99]
Our data agree with other data outside of the interfering medication setting, which show that as TSH levels increase within its euthyroid range, metabolic and cardiovascular outcomes worsen progressively.
“As summarized elsewhere (100), our data (23, 44) agree with other data outside of the IM setting, which show that as TSH levels increase within its euthyroid range, metabolic and cardiovascular outcomes worsen progressively.”
From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [100]
Ingestion of calcium carbonate supplements is associated with lower total T4 (TT4) levels and elevated TSH levels relative to baseline.
“The ingestion of calcium carbonate supplements is associated with lower total T4 (TT4) levels and elevated TSH levels, relative to baseline [ 65 – 67 ].”
From Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults (2022) · cites this paper as [65]
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Levothyroxine: conventional and novel drug delivery formulations.
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Benvenga, S. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.607446 · Cited by 13 · see citing works
“As summarized elsewhere (100), our data (23, 44) agree with other data outside of the IM setting, which show that as TSH levels increase within its euthyroid range, metabolic and cardiovascular outcomes worsen progressively.”
ResultSelf-citationGietka-Czernel, M., Hubalewska-Dydejczyk, A., Kos-Kudła, B., Lewiński, A., Ruchała, M., Syrenicz, A., & Zgliczyński, W. (2020) · Endokrynologia Polska · doi:10.5603/ep.a2020.0065 · Cited by 13 · see citing works
- Authors
- Morini, E., Catalano, A., Lasco, A., Morabito, N., & Benvenga, S.
- Affiliations
- University of Messina (IT)
- Corresponding author
- Benvenga, Salvatore
- Venue
- Endocrine
- Published
- 2019-03-27
- Volume
- 65
- Issue
- 3
- Pages
- 569-579
- ISSN
- 0969-711X (ISSN-L)
- 1355-008X
- 1559-0100
- OpenAlex
- W2923037665
- Cited by
- 12
- References
- 39
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 4 · 2021: 1 · 2020: 4 · 2019: 1
- FWCI
- 2.03
- Type
- journal article
- Language
- en
- Update notices
- correction (2019-06-28)
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Endocrine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- levothyroxine, hypothyroidism, postmenopausal women, calcium carbonate supplementation, serum TSH, fasting blood glucose, total cholesterol, blood pressure, drug formulation switching
- MeSH terms
- Aged, Blood Glucose, Blood Pressure, Calcium Carbonate, Capsules, Cholesterol, Drug Interactions, Female, Humans, Hypothyroidism, Middle Aged, Thyrotropin, Thyroxine, Cohort Studies, Postmenopause, Dietary Supplements, Hormone Replacement Therapy
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