Effect of l‐thyroxine administration before breakfast vs at bedtime on hypothyroidism: A meta‐analysis
Abstract
PURPOSE: To compare the effects of l-thyroxine (L-T4) administration before breakfast and administration at bedtime on hypothyroidism. METHODS: The PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang databases were searched to identify relevant articles. All prospective or randomized controlled studies (RCTs) comparing L-T4 administration before breakfast to the administration at bedtime in patients with hypothyroidism were included in the analysis. RESULTS: Initially, 2884 articles were retrieved from the databases, and 10 articles were included in the quantitative analysis. The effect of L-T4 administration before breakfast compared with administration at bedtime had no statistically significant association with hormone thyrotropin (TSH) (Standardized mean differences [SMD] = 0.09, 95% confidence intervals (CI): -0.12, 0.30; P = .39), or free triiodothyronine (FT3) (SMD=-0.19, 95% CI: -0.53, 0.15; P = .28) in patients with hypothyroidism. However, the result of FT4 level was favourable for L-T4 bedtime administration group (SMD=-0.27, 95% CI: -0.52, -0.02; P = .03). CONCLUSION: Our meta-analysis revealed that L-T4 administration at bedtime is as effective as administration before breakfast for patients with hypothyroidism. Taking L-T4 at bedtime may be an attractive option for patients with hypothyroidism.
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The FT4 level favored bedtime administration (P = .03).
“Surprisingly, the FT4 level favored bedtime administration (P = .03).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [105]
A meta-analysis including 10 prospective and randomized controlled studies revealed no significant difference in TSH and FT3 between patients who took LT4 before breakfast and at bedtime.
“More recently, a meta-analysis including 10 prospective and randomized controlled studies revealed no significant difference in TSH and FT3 between patients who took LT4 before breakfast and at bedtime (105).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [105]
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- Authors
- Pang, X., Pu, T., Xu, L., & Sun, R.
- Affiliations
- North Sichuan Medical University (CN)
- Corresponding author
- Sun, Ru
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2020-02-16
- Volume
- 92
- Issue
- 5
- Pages
- 475-481
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W3004510198
- Cited by
- 26
- References
- 34
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 8 · 2021: 4 · 2020: 1
- FWCI
- 0.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (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, hypothyroidism, bedtime dosing, morning dosing, timing of drug administration, thyroid-stimulating hormone, free triiodothyronine, free thyroxine, thyroid hormone replacement
- MeSH terms
- Humans, Hypothyroidism, Thyrotropin, Thyroxine, Triiodothyronine, Hormone Replacement Therapy, Breakfast
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