Thyroid hormone profile in patients ingesting soft gel capsule or liquid levothyroxine formulations with breakfast
Open accessAbstract
Background. Recently, it has been shown that liquid L-T4 formulation can be ingested with breakfast. This study looked to extend these findings by investigating whether a soft gel capsule formulation of L-T4 could also be ingested at breakfast time. Methods. 60 patients (18-65 yrs), previously submitted to thyroidectomy for proven benign goitre in stable euthyroidism receiving liquid L-T4 therapy ingested with breakfast, were enrolled. TSH, fT4, and fT3 levels were assessed in all the patients who were switched from liquid L-T4 to a soft gel capsule formulation at the same dosage of L-T4. After 6 months, TSH, fT4, and fT3 levels were determined again. Results. There were no differences in TSH levels, but fT3 and fT4 levels during treatment with the soft gel capsule were significantly lower than those at enrolment with the liquid L-T4 formulation (TSH median (min-max): 1.9 (0.5-4.0) versus 2.2 (0.5-4.5) mIU/L, fT3: 2.5 (2.4-3.1) versus 2.7 (2.4-3.3) pg/mL, p < 0.05, and fT4: 9.9 (8.0-13) versus 10.6 (8.6-13.8) pg/mL, p < 0.0001). Conclusion. Both liquid and soft gel formulations of L-T4 can be taken with breakfast. However, liquid L-T4 would be the preferred formulation for patients in whom even small changes in fT4 and fT3 levels are to be avoided.
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One RCT found a higher efficacy of LS than tablet LT4 in terms of TSH control in patients ingesting LT4 concomitant with breakfast.
“One RCT found a higher efficacy of LS than tablet LT4 in terms of TSH control in patients ingesting LT4 concomitant with breakfast (130).”
From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [130]
The Introduction and Discussion report that liquid levothyroxine can be taken with breakfast without materially changing thyroid hormone profiles. But the randomized trial they describe compared liquid levothyroxine taken with breakfast versus fasting, not liquid versus tablets. This paper’s own comparison was liquid versus soft-gel capsules and found no difference in TSH (Results; page unavailable). (LLM, conf=0.88)
Experimental — accuracy not yet measuredSeveral prospective or retrospective studies also showed similar results to the 2016 trial.
“Several prospective or retrospective studies also showed similar results (206–209).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [206]
Taken together, the convenience of the liquid preparation improves patient compliance.
“Taken together, these data show that the convenience of the liquid preparation improves patient compliance.”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [206]
Malabsorption due to calcium supplements, PPIs, breakfast, H. pylori infection, and gastroparesis was eradicated after switching from tablets to capsules.
“Malabsorption due to calcium supplements (99), PPIs (226), breakfast (206), H. pylori infection (227), and gastroparesis (202) was eradicated after switching from tablets to capsules.”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [206]
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- Authors
- Cappelli, C., Pirola, I., Gandossi, E., Cristiano, A., Daffini, L., Agosti, B., Casella, C., & Castellano, M.
- Affiliations
- Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
- Corresponding author
- Cappelli, Carlo
- ORCID
- Venue
- International Journal of Endocrinology
- Publisher
- Hindawi Limited
- Published
- 2016
- Volume
- 2016
- Pages
- 1-5
- ISSN
- 1687-8337 (ISSN-L)
- 1687-8345
- PMC
- PMC4904100
- OpenAlex
- W2411466813
- Cited by
- 29
- References
- 19
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2 · 2023: 4 · 2022: 5 · 2021: 4 · 2020: 3 · 2019: 1 · 2018: 3 · 2017: 2
- FWCI
- 2.01
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- International Journal of Endocrinology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion, other-oa)
- 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, thyroid hormone levels, free thyroxine, free triiodothyronine, thyroid-stimulating hormone, thyroidectomy, euthyroidism
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