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Cited by 18Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryAdrenal Hormones and Disorders

Alternative routes of levothyroxine administration for hypothyroidism

Ritter, Megan J., Gupta, Suruchi, Hennessey, James V.·2020·Current Opinion in Endocrinology, Diabetes & Obesity
DOI 10.1097/med.0000000000000558
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Abstract

PURPOSE OF REVIEW: The aim of the article is to present the basics of oral levothyroxine (LT4) absorption, reasons why patients may have persistently elevated serum thyroid stimulation hormone (TSH) levels, and alternative strategies for LT4 dosing. RECENT FINDINGS: Although oral LT4 tablets are most commonly used for thyroid hormone replacement in patients with hypothyroidism, case studies report that liquid oral LT4, intravenous, intramuscular, and rectal administration of LT4 can successfully treat refractory hypothyroidism. SUMMARY: Hypothyroidism is one of the most common endocrine disorders encountered by primary care physicians and endocrinologists. LT4 is one of the most widely prescribed medications in the world and it is the standard of care treatment for hypothyroidism. Generally, hypothyroid patients will be treated with LT4 tablets to be taken orally, and monitoring will occur with routine serum thyroid tests, including TSH concentrations. However, many patients fail to maintain serum TSH levels in the target range while managed on oral LT4 tablets. A subset of these patients would be considered to have poorly controlled hypothyroidism, sometimes termed refractory hypothyroidism. For these patients, optimization of ingestion routines and alternative formulations and routes of administration of LT4 can be considered, including oral liquid, intravenous, intramuscular, and even rectal formulations.

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Crossref · 10.1097/med.0000000000000558

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  • The appropriate IV equivalent dose is estimated to be 48% to 74% of a previously adequate oral LT4 dose.

    “Of note, the appropriate IV equivalent dose is estimated to be 48% to 74% of a previously adequate oral LT4 dose (237).”

    From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [237]

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Authors
Ritter, M. J., Gupta, S., & Hennessey, J. V.
Affiliations
  • Weill Cornell Medicine (US)
  • Beth Israel Deaconess Medical Center (US)
Corresponding author
  • Ritter, Megan J.
  • Gupta, Suruchi
ORCID
Venue
Current Opinion in Endocrinology, Diabetes & Obesity
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2020-07-28
Volume
27
Issue
5
Pages
318-322
ISSN
  • 1752-296X (ISSN-L)
  • 1752-2978
DOI
10.1097/med.0000000000000558
OpenAlex
W3046269416
Cited by
18
References
32
Citations by year
2026: 2 · 2025: 5 · 2024: 3 · 2023: 5 · 2022: 2 · 2021: 1
FWCI
1.51
Type
journal article
Language
en
Open access
closed
Locations
  • Current Opinion in Endocrinology Diabetes and Obesity (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 › Adrenal Hormones and Disorders
Keywords
levothyroxine, hypothyroidism, refractory hypothyroidism, alternative routes of administration, thyroid-stimulating hormone, thyroid hormone replacement, dose optimization
MeSH terms
Administration, Oral, Dosage Forms, Drug Administration Routes, Drug Compounding, Gels, Humans, Hypothyroidism, Tablets, Thyrotropin, Thyroxine

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