Altered intestinal absorption of L-thyroxine caused by coffee
Abstract
OBJECTIVE: To report eight case histories, and in vivo and in vitro studies showing coffee's potential to impair thyroxine (T4) intestinal absorption. DESIGN: Of eight women with inappropriately high or nonsuppressed thyroid-stimulating hormone (TSH) when T4 was swallowed with coffee/espresso, six consented to the evaluation of their T4 intestinal absorption. This in vivo test was also administered to nine volunteers. In three separate tests, two 100 microg T4 tablets were swallowed with coffee, water, or water followed, 60 minutes later, by coffee. Serum T4 was assayed over the 4-hour period of the test. Two patients and two volunteers also agreed on having tested the intestinal absorption of T4 swallowed with solubilized dietary fibers. In the in vitro studies, classical recovery tests on known concentrations of T4 were performed in the presence of saline, coffee, or known T4 sequestrants (dietary fibers, aluminium hydroxide, and sucralfate). MAIN OUTCOME: For the in vivo test, average and peak incremental rise of serum T4 (AIRST4 and PIRST4), time of maximal incremental rise of serum T4 (TMIRST4), and area under the curve (AUC) were determined. In patients and volunteers, the four outcome measures were similar in the water and water + coffee tests. In patients and volunteers, compared to water, coffee lowered AIRST4 (by 36% and 29%), PIRST4 (by 30% and 19%), and AUC (by 36% and 27%) and delayed TMIRST4 (by 38 and 43 minutes); bran was a superior interferer. In the in vitro studies, coffee was weaker than known T4 sequestrants. CONCLUSION: Coffee should be added to the list of interferers of T4 intestinal absorption, and T4 to the list of compounds whose absorption is affected by coffee.
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A summary of several case studies of increased TSH values in hypothyroid patients ingesting their LT4 with espresso coffee has been reported.
“A summary of several case studies of increased TSH values in hypothyroid patients ingesting their LT4 with espresso coffee has been reported (122).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [122]
Absorption studies performed in patients and volunteers support the role of coffee in reducing LT4 absorption.
“Absorption studies performed in these patients and in volunteers support the role of coffee in reducing LT4 absorption.”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [122]
In vitro binding studies suggested that espresso coffee acts to sequester LT4, and so it may have this action within the intestine.
“In vitro binding studies performed by the same investigators (122) suggested, as has been previously reported with fiber (123), that espresso coffee acts to sequester LT4, and so it may have this action within the intestine.”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [122]
Compared with water, coffee reduced both the maximum concentration (Cmax) and the AUC documented during absorption studies.
“Compared with water, coffee reduced both the maximum concentration (Cmax) and the AUC documented during these absorption studies.”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [122]
When LT4 is co-administered with food, absorption is reduced compared with absorption in the fasting state.
“When LT4 is co-administered with food, absorption is reduced compared with absorption in the fasting state.”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [122]
Coffee significantly decreased both incremental rise (by 36% in hypothyroid patients and 29% in healthy volunteers) and peak of serum T4 levels by 30 and 19%, respectively, and delayed time for T4 to reach maximum serum level (by 38 and 43 min, respectively).
“Coffee significantly decreased both the incremental rise (by 36% in hypothyroid patients and 29% in healthy volunteers) and the peak of serum T4 levels by 30 and 19%, respectively, and also delayed the time for T4 to reach the maximum serum level (by 38 and 43 min, respectively).”
From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [55]
Coingestion with breakfast or coffee can reduce and delay LT4 absorption.
“Coingestion with breakfast or coffee can reduce and delay absorption (21, 22).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [22]
In Benvenga et al. pharmacokinetic study, taking LT4 with expresso Italian coffee was associated with lower peak and lower AUC for serum T4, and failure to achieve target TSH levels.
“In Benvenga et al. pharmacokinetic study, taking LT4 with expresso Italian coffee was associated with a lower peak and a lower AUC for serum T4, and failure to achieve target TSH levels. [ 77 ].”
From Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults (2022) · cites this paper as [77]
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- Authors
- Benvenga, S., Bartolone, L., Pappalardo, M. A., Russo, A., Lapa, D., Giorgianni, G., Saraceno, G., & Trimarchi, F.
- Affiliations
- University of Messina (IT)
- ORCID
- Benvenga, Salvatore
- Venue
- Thyroid
- Publisher
- SAGE Publications
- Published
- 2008-03
- Volume
- 18
- Issue
- 3
- Pages
- 293-301
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W1980260349
- Cited by
- 191
- References
- 13
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 7 · 2023: 6 · 2022: 13 · 2021: 12 · 2020: 10 · 2019: 7 · 2018: 13 · 2017: 16 · 2016: 17 · 2015: 12 · 2014: 14 · 2013: 11 · 2012: 15
- FWCI
- 5.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Pharmacology › Coffee research and impacts
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmaceutical Science › Drug Solubulity and Delivery Systems
- Keywords
- coffee, levothyroxine, intestinal absorption, thyroid-stimulating hormone, serum thyroxine, dietary fiber, bran, aluminum hydroxide, sucralfate, hyperthyroidism, thyroid function tests
- MeSH terms
- Adult, Aluminum Hydroxide, Antacids, Anti-Ulcer Agents, Coffee, Dietary Fiber, Drinking, Drug Interactions, Female, Humans, Hypothyroidism, Intestinal Absorption, Male, Middle Aged, Sodium Chloride, Sucralfate, Thyroxine, In Vitro Techniques
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