Conditions and drugs interfering with thyroxine absorption
Abstract
Food, dietary fibre and espresso coffee interfere with the absorption of levothyroxine. Malabsorptive disorders reported to affect the absorption of levothyroxine include coeliac disease, inflammatory bowel disease, lactose intolerance as well as Helicobacter pylori (H. pylori) infection and atrophic gastritis. Many commonly used drugs, such as bile acid sequestrants, ferrous sulphate, sucralfate, calcium carbonate, aluminium-containing antacids, phosphate binders, raloxifene and proton-pump inhibitors, have also been shown to interfere with the absorption of levothyroxine.
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Ingestion of one or more interfering substances at or close to the time of levothyroxine dosing can significantly change the dose requirement in individual patients, especially when done regularly.
“The ingestion of one or more of these at, or close to, the time of levothyroxine dosing can significantly change the dose requirement in individual patients, especially when done regularly [49].”
From Diagnosis and management of treatment-refractory hypothyroidism: an expert consensus report (2017) · cites this paper as [49]
Not waiting at least 30 minutes before breakfast after levothyroxine, or taking it with a beverage other than water, may reduce levothyroxine absorption.
“Failing to observe a minimum interval of 30 min before having breakfast after administering the LT4 dose, 33 or consuming it not solely with water, but alongside another beverage, [34][35][36][37] are circumstances that may impede the absorption of LT4.”
From Refractory hypothyroidism: unraveling the complexities of diagnosis and management (2023) · cites this paper as [35]
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- Authors
- Liwanpo, L., & Hershman, J. M.
- Affiliations
- VA Greater Los Angeles Healthcare System (US)
- Corresponding author
- Liwanpo, Llanyee
- Venue
- Best Practice & Research Clinical Endocrinology & Metabolism
- Publisher
- Elsevier BV
- Published
- 2009-12
- Volume
- 23
- Issue
- 6
- Pages
- 781-792
- ISSN
- 1521-690X (ISSN-L)
- OpenAlex
- W2073346341
- Cited by
- 222
- References
- 45
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 11 · 2023: 10 · 2022: 12 · 2021: 12 · 2020: 10 · 2019: 10 · 2018: 23 · 2017: 22 · 2016: 20 · 2015: 21 · 2014: 17 · 2013: 16 · 2012: 12
- FWCI
- 1.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Best Practice & Research Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- levothyroxine, drug interactions, dietary fiber, espresso, celiac disease, inflammatory bowel disease, lactose intolerance, Helicobacter pylori infection, atrophic gastritis, bile acid sequestrants, ferrous sulfate, sucralfate, calcium carbonate, phosphate binders, raloxifene, proton pump inhibitors
- MeSH terms
- Aluminum Hydroxide, Animals, Antacids, Biological Availability, Calcium Carbonate, Celiac Disease, Coffee, Dietary Fiber, Drug Interactions, Female, Food, Gastritis, Atrophic, Humans, Intestinal Absorption, Lactose Intolerance, Malabsorption Syndromes, Thyroxine, Helicobacter Infections
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