Serum Thyrotropin Levels Following Levothyroxine Administration at Breakfast

Perez, Camila Luhm Silva; Araki, Fernanda Sumire; Graf, Hans; de Carvalho, Gisah Amaral

doi:10.1089/thy.2012.0435

Cited by 63Thyroid Disorders and TreatmentsMedication Adherence and ComplianceThyroid and Parathyroid Surgery

Serum Thyrotropin Levels Following Levothyroxine Administration at Breakfast

Perez, Camila Luhm Silva, Araki, Fernanda Sumire, Graf, Hans, de Carvalho, Gisah Amaral·2013·Thyroid

DOI 10.1089/thy.2012.0435

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Abstract

BACKGROUND: Hypothyroidism is treated with oral levothyroxine. Some patients fail to attain adequate control because of poor compliance. Delaying breakfast to take levothyroxine on an empty stomach can decrease adherence to hypothyroidism treatment. The objective of this study was to evaluate whether administering levothyroxine with breakfast can maintain thyrotropin (TSH) levels in the therapeutic range, without major clinical changes. METHODS: A prospective, randomized, open-label, crossover study was conducted to compare usual levothyroxine administration while in a fasting state with administration during breakfast. From September 2008 to April 2009, 45 patients with primary hypothyroidism who received levothyroxine were recruited. The patients completed 180 days of the protocol and were randomized to 90 days of each levothyroxine administration regimen (while fasting or with breakfast). Clinical and biochemical analyses were performed at baseline and on days 45, 90, 135, and 180. The primary outcome was TSH level. RESULTS: Forty-two patients completed the protocol. The TSH level was higher for levothyroxine administration with breakfast than while fasting (2.89 vs. 1.9 mIU/L, p=0.028). Uncontrolled hypothyroidism (TSH ≥3.5 mIU/L) occurred regardless of the type of levothyroxine administration (p=0.26). No risk factors were identified for TSH elevation. CONCLUSIONS: Levothyroxine administration with breakfast could be an alternative regimen for patients who have adherence difficulties due to the need for delaying intake, and is more likely to cause variability in the TSH level, meaning the patient should be followed more closely. For patients in whom a specific serum TSH goal is important, taking levothyroxine while fasting is recommended.

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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 [126]
Four of six studies examining timing of LT4 administration showed that timing influences serum TSH values in hypothyroid patients receiving treatment.
“Four studies (121,126,128,129), out of the six studies examining this issue (121,128-131), have shown that the timing of LT4 administration influences the serum TSH values of hypothyroid patients receiving treatment.”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [126]
A third cross-over study found higher, more variable TSH values when LT4 was consumed with breakfast compared with 60 minutes before breakfast, although TSH values remained within the reference range even with the nonfasting regimen.
“A third cross-over study found higher, more variable TSH values when LT4 was consumed with breakfast, compared with when it was taken 60 minutes before breakfast (126), although TSH values remained within the reference range even with the nonfasting regimen.”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [126]
Silva Perez et al. prospective randomized open-label crossover study found TSH level was higher in the breakfast group than in the fasting group (2.89 vs 1.9 mIU/L, p=0.028).
“The TSH level was higher in the breakfast group than in the fasting group (2.89 vs. 1.9 mIU/L, p = 0.028) [ 34 ].”
From Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults (2022) · cites this paper as [34]

Thyroxine in Goiter, Helicobacter pylori 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
Levothyroxine Therapy in Patients with Thyroid Disease
Mandel, S. J., Brent, G. A., & Larsen, P. R. (1993) · Annals of Internal Medicine · doi:10.7326/0003-4819-119-6-199309150-00009 · Cited by 324 · 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
Conditions and drugs interfering with thyroxine absorption
Liwanpo, L., & Hershman, J. M. (2009) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2009.06.006 · Cited by 222 · see citing works
Effect of calcium carbonate on the absorption of levothyroxine
Singh, N. (2000) · JAMA · doi:10.1001/jama.283.21.2822 · Cited by 219 · see citing works
Timing of levothyroxine administration affects serum thyrotropin concentration
Bach-Huynh, T.-G., Nayak, B., Loh, J., Soldin, S., & Jonklaas, J. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-0860 · Cited by 198 · 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
Thyroxine Therapy
Wood, A. J. J., & Toft, A. D. (1994) · New England Journal of Medicine · doi:10.1056/nejm199407213310307 · Cited by 166 · 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
Aspects of the absorption of oral L-thyroxine in normal man
Wenzel, K. W., & Kirschsieper, H. E. (1977) · Metabolism · doi:10.1016/0026-0495(77)90121-4 · Cited by 151 · 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
Localization of human thyroxine absorption
HAYS, M. T. (1991) · Thyroid · doi:10.1089/thy.1991.1.241 · Cited by 138 · see citing works
Evidence for a clinically important adverse effect of fiber-enriched diet on the bioavailability of levothyroxine in adult hypothyroid patients.
Liel, Y., Harman-Boehm, I., & Shany, S. (1996) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.81.2.8636317 · Cited by 129 · see citing works
Effects of Evening vs Morning Levothyroxine Intake: A Randomized Double-blind Crossover Trial
Bolk, N. (2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2010.436 · Cited by 128 · see citing works
Use Of Soy Protein Supplement And Resultant Need For Increased Dose Of Levothyroxine
Bell, D. S. H., & Montanya, E. (2001) · Endocrine Practice · doi:10.4158/ep.7.3.193 · Cited by 124 · see citing works
Absorption of oral thyroxine in man
HAYS, M. T. (1968) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-28-6-749 · Cited by 111 · 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
Pseudomalabsorption of levothyroxine
Ain, K. B. (1991) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1991.03470150090036 · Cited by 100 · see citing works
Effects of evening vs morning thyroxine ingestion on serum thyroid hormone profiles in hypothyroid patients
Bolk, N., Visser, T. J., Kalsbeek, A., van Domburg, R. T., & Berghout, A. (2006) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2006.02681.x · Cited by 96 · see citing works
<scp>l</scp>-Thyroxine Requirement in Patients with Autoimmune Hypothyroidism and Parietal Cell Antibodies
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
Are Bioequivalence Studies of Levothyroxine Sodium Formulations in Euthyroid Volunteers Reliable?
Blakesley, V., Awni, W., Locke, C., Ludden, T., Granneman, G. R., & Braverman, L. E. (2004) · Thyroid · doi:10.1089/105072504773297867 · Cited by 85 · 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
New medications which decrease levothyroxine absorption
John-Kalarickal, J., Pearlman, G., & Carlson, H. E. (2007) · Thyroid · doi:10.1089/thy.2007.0060 · Cited by 82 · see citing works
Raloxifene Causing Malabsorption of Levothyroxine
Siraj, E. S., Gupta, M. K., & Reddy, S. S. K. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.11.1367 · Cited by 76 · see citing works
Effects of grapefruit juice on the absorption of levothyroxine
Lilja, J. J., Laitinen, K., & Neuvonen, P. J. (2005) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.2005.02433.x · Cited by 74 · see citing works
Systematic review: Heliocobacter pylori infection and impaired drug absorption
Lahner, E., Annibale, B., & Fave, G. D. (2008) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2008.03906.x · Cited by 72 · see citing works
Lactose intolerance revealed by severe resistance to treatment with levothyroxine
Muñoz-Torres, M., Varsavsky, M., & Alonso, G. (2006) · Thyroid · doi:10.1089/thy.2006.16.1171 · Cited by 54 · see citing works
Celiac Disease Presenting as Resistant Hypothyroidism
McDermott, J. H., Coss, A., & Walsh, C. H. (2005) · Thyroid · doi:10.1089/thy.2005.15.386 · Cited by 48 · see citing works
Effect of phosphate binders upon TSH and l-thyroxine dose in patients on thyroid replacement
Diskin, C. J., Stokes, T. J., Dansby, L. M., Radcliff, L., & Carter, T. B. (2007) · International Urology and Nephrology · doi:10.1007/s11255-006-9166-6 · Cited by 36 · see citing works
Gluten-Induced Enteropathy (Coeliac Disease) Revealed by Resistance to Treatment with Levothyroxine and Alfacalcidol in a Sixty-Eight-Year-Old Patient: A Case Report
DESTEVEBONETTI, L., Bennet, A., Malet, D., Hoff, M., Jp, L., & Caron, P. J. (2002) · Thyroid · doi:10.1089/105072502320288519 · Cited by 35 · see citing works
Treating primary hypothyroidism with weekly doses of levothyroxine: a randomized, single-blind, crossover study
Bornschein, A., Paz-Filho, G., Graf, H., & de Carvalho, G. A. (2012) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302012000400006 · Cited by 28 · see citing works
Self-citation
Pseudomalabsorption of levothyroxine
Ain, K. B. (1991) · JAMA · doi:10.1001/jama.266.15.2118 · Cited by 28 · see citing works
Noncompliance with medical treatment: pseudomalabsorption of levothyroxine.
Eledrisi, M. S., Szymajda, A., Alshanti, M., & Urban, R. J. (2001) · PubMed · Cited by 24 · see citing works
Noncompliance With Medical Treatment
Eledrisi, M. S., SZYMAJDA, A., Alshanti, M., & Urban, R. J. (2001) · Southern Medical Journal · doi:10.1097/00007611-200194080-00017 · Cited by 23 · see citing works
A Study in Normal Human Volunteers to Compare the Rate and Extent of Levothyroxine Absorption from Synthroid® and Levoxine®
Berg, J. A., & Mayor, G. H. (1992) · The Journal of Clinical Pharmacology · doi:10.1177/009127009203201213 · Cited by 22 · see citing works

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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 third cross-over study found higher, more variable TSH values when LT4 was consumed with breakfast, compared with when it was taken 60 minutes before breakfast (126), although TSH values remained within the reference range even with the nonfasting regimen.”
Treatment with thyroid hormone
Biondi, B., & Wartofsky, L. (2014) · Endocrine Reviews · doi:10.1210/er.2013-1083 · Cited by 259 · 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
Optimal thyroid hormone replacement
Jonklaas, J. (2022) · Endocrine Reviews · doi:10.1210/endrev/bnab031 · Cited by 89 · see citing works
Understanding Treatment Adherence in Chronic Diseases: Challenges, Consequences, and Strategies for Improvement
Patel, S., Huang, M., & Miliara, S. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14176034 · Cited by 115 · see citing works
Levothyroxine interactions with food and dietary supplements – a systematic review
Wiesner, A., Gajewska, D., & Paśko, P. (2021) · Pharmaceuticals · doi:10.3390/ph14030206 · Cited by 85 · see citing works
A double-blind placebo-controlled trial of liquid thyroxine ingested at breakfast: results of the TICO study
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
The emergence of levothyroxine as a treatment for hypothyroidism
Hennessey, J. V. (2017) · Endocrine · doi:10.1007/s12020-016-1199-8 · Cited by 66 · see citing works
Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults
Caron, P., Grunenwald, S., Persani, L., Borson-Chazot, F., Leroy, R., & Duntas, L. (2022) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-021-09691-9 · Cited by 53 · see citing works
Diagnosis and Management of Hypothyroidism in Gulf Cooperation Council (GCC) Countries
Alzahrani, A. S., Mourad, M. A., Hafez, K. K., Almaghamsy, A. M., Alamri, F. A., Aljuhani, N. R., Alhazmi, A. S., Saeedi, M. Y., Alsefri, S. S., Alzahrani, M. D. A., et al. (2020) · Advances in Therapy · doi:10.1007/s12325-020-01382-2 · Cited by 53 · see citing works
Advancements in the treatment of hypothyroidism with L-T4 liquid formulation or soft gel capsule: an update
Fallahi, P., Ferrari, S. M., Ruffilli, I., Ragusa, F., Biricotti, M., Materazzi, G., Miccoli, P., & Antonelli, A. (2016) · Expert Opinion on Drug Delivery · doi:10.1080/17425247.2016.1227782 · Cited by 48 · see citing works
Oral levothyroxine therapy postbariatric surgery: Biopharmaceutical aspects and clinical effects
Azran, C., Porat, D., Fine‐Shamir, N., Hanhan, N., & Dahan, A. (2019) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.01.001 · Cited by 42 · 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
Precision Medicine in Autoimmune Thyroiditis and Hypothyroidism
Ferrari, S. M., Ragusa, F., Elia, G., Paparo, S. R., Mazzi, V., Baldini, E., Benvenga, S., Antonelli, A., & Fallahi, P. (2021) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.750380 · Cited by 41 · see citing works
Hypothyroidism and levothyroxine therapy following bariatric surgery: a systematic review, meta-analysis, network meta-analysis, and meta-regression
Azran, C., Hanhan-Shamshoum, N., Irshied, T., Ben-Shushan, T., Dicker, D., Dahan, A., & Matok, I. (2021) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2021.02.028 · Cited by 40 · see citing works
MANAGEMENT OF ENDOCRINE DISEASE: Pitfalls on the replacement therapy for primary and central hypothyroidism in adults
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Self-citation
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Tablet and oral liquid L-thyroxine formulation in the treatment of naive hypothyroid patients with Helicobacter pylori infection
Ribichini, D., Fiorini, G., Repaci, A., Castelli, V., Gatta, L., Vaira, D., & Pasquali, R. (2017) · Endocrine · doi:10.1007/s12020-016-1167-3 · Cited by 35 · see citing works
Oral liquid formulation of levothyroxine is stable in breakfast beverages and may improve thyroid patient compliance
Bernareggi, A., Grata, E., Pinorini, M., & Conti, A. (2013) · Pharmaceutics · doi:10.3390/pharmaceutics5040621 · Cited by 30 · see citing works
Thyroid hormone profile in patients ingesting soft gel capsule or liquid levothyroxine formulations with breakfast
Cappelli, C., Pirola, I., Gandossi, E., Cristiano, A., Daffini, L., Agosti, B., Casella, C., & Castellano, M. (2016) · International Journal of Endocrinology · doi:10.1155/2016/9043450 · Cited by 29 · see citing works
Medications and Food Interfering with the Bioavailability of Levothyroxine: A Systematic Review
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Effect of <scp>l</scp>‐thyroxine administration before breakfast vs at bedtime on hypothyroidism: A meta‐analysis
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TSH evaluation in hypothyroid patients assuming liquid levothyroxine at breakfast or 30 min before breakfast
Pirola, I., Gandossi, E., Brancato, D., Marini, F., Cristiano, A., Delbarba, A., Agosti, B., Castellano, M., & Cappelli, C. (2018) · Journal of Endocrinological Investigation · doi:10.1007/s40618-018-0867-3 · Cited by 21 · see citing works
Treatment of hypothyroidism: all that glitters is gold?
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A Questionnaire-Based Survey to Assess the Level of Knowledge and Awareness about Drug–Food Interactions among General Public in Western Saudi Arabia
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Investigating Levothyroxine Use and Its Association with Thyroid Health in Patients with Hypothyroidism: A Community Pharmacy Study
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Effect of gastrointestinal disorders in autoimmune thyroid diseases
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A novel levothyroxine solution results in similar bioavailability whether taken 30 or just 15 minutes before a high-fat high-calorie meal
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An Overview on Different L-Thyroxine (l-T4) Formulations and Factors Potentially Influencing the Treatment of Congenital Hypothyroidism During the First 3 Years of Life
Stagi, S., Municchi, G., Ferrari, M., & Wasniewska, M. G. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.859487 · Cited by 14 · see citing works
Patients’ persistent symptoms, clinician demographics and geo-economic factors are associated with choice of therapy for hypothyroidism by European thyroid specialists: The “THESIS”* collaboration (*Treatment of Hypothyroidism in Europe by Specialists, an International Survey)
Attanasio, R., Žarković, M., Papini, E., Nagy, E. V., Negro, R., Perros, P., Akarsu, E., Alevizaki, M., Ayvaz, G., Bednarczuk, T., et al. (2024) · Thyroid® · doi:10.1089/thy.2023.0580 · Cited by 11 · see citing works
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Morning vs. bedtime levothyroxine administration: what is the ideal choice for children?
Akın, O. (2018) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2018-0168 · Cited by 10 · see citing works
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Approach to adult patients with primary hypothyroidism in some special situations: a position statement from the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM)
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Self-citation
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Willems, J. I. A., van Twist, D. J. L., Helmich, F., Sluiter, T., Medici, M., Peeters, R. P., & van Wijngaarden, R. F. A. T.-D. L. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaf686 · Cited by 4 · see citing works
Liquid L-T4 therapy in hypothyroid patients with gastric diseases, an observational study
Fallahi, P., Ragusa, F., Patrizio, A., Mazzi, V., Botrini, C., Elia, G., Balestri, E., Barozzi, E., Rugani, L., Palmisano, E., et al. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1386629 · Cited by 4 · see citing works
Levothyroxine personalized treatment: is it still a dream?
Cappelli, C., Gatta, E., & Ippolito, S. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1334292 · Cited by 4 · see citing works
Evaluation of evening versus morning levothyroxine intake in elderly (MONIALE)
Giassi, K. D. S., Piccoli, V., Rodrigues, T. D. C., & de Mello, R. G. B. (2019) · Trials · doi:10.1186/s13063-019-3816-3 · Cited by 5 · see citing works
Evaluation of adherence to levothyroxine and out‐of‐range thyroid‐stimulating hormone levels in pregnant women with primary hypothyroidism
Topaloğlu, Ö., Yavuz, A., & Aylıkcı, A. B. T. (2021) · International Journal of Clinical Practice · doi:10.1111/ijcp.14312 · Cited by 4 · see citing works
Breakfast Habits in Patients Using Levothyroxine: Patient Experiences and Preferences
Willems, J. I. A., van Twist, D. J. L., Luu, I. H. Y., Bianchi, R., Peeters, R. P., & van Wijngaarden, R. F. A. T.-D. L. (2024) · Journal of the Endocrine Society · doi:10.1210/jendso/bvae180 · Cited by 3 · see citing works
Are liquid levothyroxine formulations comparable? The LETI study
Gatta, E., Maltese, V., Pirola, I., Gandossi, E., Silvestrini, I., Ugoccioni, M., Morandi, R., Casella, C., & Cappelli, C. (2025) · Thyroid Research · doi:10.1186/s13044-025-00236-9 · Cited by 3 · see citing works
Clinical Practice Recommendations for Assessment and Management of Hypothyroidism
Alsifri, S. N., Aljuhani, N. R., Al-Jedai, A. H., Nasser, T., Alsabaan, F., Almudaiheem, H., Amir, A., Baissa, E., Ghannam, N., Aldawish, M., et al. (2022) · International Journal of Clinical Medicine · doi:10.4236/ijcm.2022.1312046 · Cited by 4 · see citing works
Comparative Bioavailability of a Novel Solution and a Tablet Formulation of Levothyroxine
Vandse, S., Psarrakis, Y., Washington, K., & Baron, M. A. (2023) · Clinical Pharmacology in Drug Development · doi:10.1002/cpdd.1233 · Cited by 3 · see citing works
One sip of water with LT-4 supplementation—a key to euthyroidism in Hashimoto’s thyroiditis
Schnedl, W. J., Michaelis, S., Mangge, H., & Enko, D. (2024) · Endocrine · doi:10.1007/s12020-024-03829-w · Cited by 1 · see citing works
Effects of timing and scheduling in levothyroxine adherence to hypothyroidism control: Meta-analysis with trial sequential analysis of Randomized Clinical Trials
da Rocha, B. S., Silveira, V. B., Rados, D. R. V., Zanella, A. B., Scheffel, R. S., Maia, A. L., & Dora, J. M. (2025) · Endocrine · doi:10.1007/s12020-025-04229-4 · Cited by 2 · see citing works
Levothyroxine Administration Techniques Audit and Utility of its Assessment at Each Visit: A Hospital-based Mixed Model Study
Singh, R., & Tandon, A. (2025) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/ijem.ijem_525_24 · Cited by 1 · see citing works
TSH suppression therapy from an individualized perspective: from mechanism to clinical decision-making
Li, Z., Wang, T., & Liu, J. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1842060 · Cited by 1 · see citing works
Schilddrüsenerkrankungen
Seifert, R. (2023) · Springer eBooks · doi:10.1007/978-3-662-68371-2_37 · Cited by 1 · see citing works
Cryopreserved Thyroid Tissue Autotransplant in Pediatric Age Patients: A Feasibility Study and Literature Review
Spinelli, C., Ghionzoli, M., Sahli, L. I., Visintainer, S., Guglielmo, C., Cordola, C., Lapi, S., Biagi, E., Pucci, A., Morganti, R., et al. (2024) · Cancers · doi:10.3390/cancers16112112 · Cited by 1 · see citing works
Dysthyronemia in normal concentrations of thyrotropin – analytical and clinical consequences
Bílek, R., Stárka, L., & Zamrazil, V. (2013) · Hormone Molecular Biology and Clinical Investigation · doi:10.1515/hmbci-2013-0006
Guidelines for the Postoperative Treatment of Thyroid Cancer: Levothyroxine and Calcium/Vitamin D Supplements
Ha, J., & Lim, D. J. (2017) · Korean Journal of Medicine · doi:10.3904/kjm.2017.92.3.245
Hypothyroidism
Luíz, H. V., Manita, I., & Portugal, J. (2016) · Springer eBooks · doi:10.1007/978-3-319-25871-3_7
Schilddrüsenerkrankungen
Seifert, R. (2025) · Springer eBooks · doi:10.1007/978-3-662-70594-0_37
Food-Drug Interactions: Navigating the Complex Relationship
Ewis, D. K., & El-Sayed, O. S. (2025) · Nutritional neurosciences · doi:10.1007/978-981-95-1983-5_14
Schilddrüsenerkrankungen
Seifert, R. (2026) · Springer eBooks · doi:10.1007/978-3-662-72738-6_37
Subcutaneous Levothyroxine as a Viable Strategy for Difficult-to-Manage Malabsorption: Analysis of a Case Report
Hennessey, J. V. (2026) · Clinical Thyroidology · doi:10.1177/23299711261425099

A double-blind placebo-controlled trial of liquid thyroxine ingested at breakfast: results of the TICO study
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
Timing of levothyroxine administration affects serum thyrotropin concentration
Bach-Huynh, T.-G., Nayak, B., Loh, J., Soldin, S., & Jonklaas, J. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-0860 · Cited by 198 · see citing works
Administration of Levothyroxine 45 - 60 Minutes before Breakfast Improves Biochemical Availability as Evidenced by Reduced Thyrotropin Levels
Seechurn, S. B., Sharma, S., & Oyibo, S. O. (2012) · Open Journal of Endocrine and Metabolic Diseases · doi:10.4236/ojemd.2012.23005 · Cited by 11 · see citing works
Alternative schedules of levothyroxine administration
Geer, M., Potter, D. M., & Ulrich, H. (2015) · American Journal of Health-System Pharmacy · doi:10.2146/ajhp140250 · Cited by 7 · see citing works
TSH evaluation in hypothyroid patients assuming liquid levothyroxine at breakfast or 30 min before breakfast
Pirola, I., Gandossi, E., Brancato, D., Marini, F., Cristiano, A., Delbarba, A., Agosti, B., Castellano, M., & Cappelli, C. (2018) · Journal of Endocrinological Investigation · doi:10.1007/s40618-018-0867-3 · Cited by 21 · see citing works

Authors: Perez, C. L. S., Araki, F. S., Graf, H., & de Carvalho, G. A.
Affiliations: Hospital de Clínicas Universidade Federal do Paraná (BR)
Service of Endocrinology and Metabolism, Clinic's Hospital, Federal University of Paraná, Curitiba, Brazil.
ORCID: Graf, Hans
Venue: Thyroid
Publisher: SAGE Publications
Published: 2013-07
Volume: 23
Issue: 7
Pages: 779-784
ISSN: 1050-7256 (ISSN-L)
1557-9077
DOI: 10.1089/thy.2012.0435
OpenAlex: W1984967604
Cited by: 63
References: 34
Citations by year: 2026: 3 · 2025: 7 · 2024: 7 · 2023: 5 · 2022: 4 · 2021: 10 · 2020: 3 · 2019: 2 · 2018: 4 · 2017: 2 · 2016: 8 · 2015: 2 · 2014: 3 · 2013: 3
FWCI: 4.19
Type: journal article
Language: en
Open access: closed
Licence: www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/ (tdm)
Locations: Thyroid (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Keywords: levothyroxine, thyroid-stimulating hormone, TSH levels, primary hypothyroidism, meal timing, medication adherence
MeSH terms: Adult, Fasting, Female, Humans, Hypothyroidism, Male, Middle Aged, Thyrotropin, Thyroxine, Cross-Over Studies, Breakfast

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Serum Thyrotropin Levels Following Levothyroxine Administration at Breakfast

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