Comparison between liquid and tablet levothyroxine formulations in patients treated through enteral feeding tube
Abstract
Background The majority of clinicians suggest that enteral feedings should be held 1-2 h prior to and after L-T4 administration despite lack of data for continuous enteral nutrition.Aim The aim of this study was to: (1) compare the thyroid hormonal profile in patients submitted to L-T4 treatment in tablets or liquid formulation with an enteral feeding tube; (2) evaluate the nursing compliance with the two different formulations.Subjects and methods 20 euthyroid patients submitted to total laryngectomy and thyroidectomy consecutively started L-T4 treatment in tablets (Group T) or in liquid formulation (Group L) with enteral feeding tube the day after surgery. Tablets were crushed before administration and enteral feeding was stopped for 30 min before and after L-T4 treatment, whereas liquid formulation was placed into the nasoenteric tube immediately. A questionnaire about the preparation and administration of thyroxine replacement therapy was given to the nurses.Results No difference of TSH, fT4 and fT3 before and after L-T4 treatment was observed among patients of Group L. A slightly serum TSH increase was observed in Group T, but not reaching statistical significance (2.50 ± 1.18 vs 2.94 ± 1.22 mUI/L), whereas no difference in fT4 and fT3 levels was found. Preparation and administration of liquid L-T4 was considered excellent by 12/13 nurses, whereas tablet formulation was considered poor by 10/13.Conclusions Our data showed that liquid L-T4 formulation can be administered directly through feeding tube with no need for an empty stomach, with a significant improvement in therapy preparation and administration by nurses.
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In hypothyroid patients requiring tube feeding during hospitalization in the intensive care unit, managing with tablet LT4 preparation may be difficult.
“Third, managing those hypothyroid patients requiring tube feeding during hospitalization in the intensive care unit may be difficult with tablet LT4 preparation.”
From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [134]
Liquid LT4 can be administered directly through feeding tubes in patients receiving enteral feeding, and is preferred by nurses due to convenience.
“In addition, a liquid LT4 formulation can be administered directly through feeding tubes in patients receiving enteral feeding, and thus are preferred by nurses due to their convenience (193).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [193]
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- Authors
- Pirola, I., Daffini, L., Gandossi, E., Lombardi, D., Formenti, A., Castellano, M., & Cappelli, C.
- Affiliations
- Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
- University of Brescia (IT)
- Corresponding author
- Cappelli, C.
- Venue
- Journal of Endocrinological Investigation
- Published
- 2014-05-01
- Volume
- 37
- Issue
- 6
- Pages
- 583-587
- ISSN
- 0391-4097 (ISSN-L)
- 1720-8386
- OpenAlex
- W2085925107
- Cited by
- 47
- References
- 30
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 5 · 2023: 5 · 2022: 3 · 2021: 7 · 2020: 2 · 2019: 4 · 2018: 4 · 2017: 3 · 2016: 2 · 2015: 5 · 2014: 1
- FWCI
- 3.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Endocrinological Investigation (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- levothyroxine, liquid formulation, tablet formulation, enteral feeding tubes, nasoenteric tube, thyroid hormone replacement, nursing compliance, total laryngectomy, thyroidectomy, thyroid-stimulating hormone, free thyroxine, free triiodothyronine, timing of drug administration
- MeSH terms
- Aged, Dosage Forms, Enteral Nutrition, Female, Humans, Laryngectomy, Male, Middle Aged, Tablets, Thyroidectomy, Thyroxine
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