Oral liquid levothyroxine treatment at breakfast: a mistake?
Abstract
OBJECTIVE: Taking levothyroxine (L-T₄) with coffee or with water followed by coffee intake within a few minutes results in poor TSH response in many patients. T₄ is available in tablet form worldwide, but novel formulations in soft gel capsule or liquid form are now available. DESIGN: We fortuitously identified a euthyroid patient who wrongly consumed liquid L-T₄ with coffee at breakfast; after changing the time of consumption to 30 min before breakfast, no change in TSH, free T₄ (fT₄), and free tri-iodothyronine (fT₃) concentrations was observed. Once the first patient was identified, additional stable euthyroid patients who consumed liquid L-T₄ with coffee were identified. METHODS: Patients were recruited by searching our 'thyroid patients' database. All the patients on liquid L-T₄ treatment were contacted by phone to ask them whether they took L-T₄ at breakfast. We identified 54 patients who were submitted to TSH, fT₄, and fT₃ evaluation, with the indication that the same dosage of L-T₄ be consumed 30 min before breakfast. We determined their TSH, fT₄, and fT₃ concentrations after 3 and 6 months again. RESULTS: no significant difference in thyroid hormone concentrations was observed in patients when they consumed L-T₄ at breakfast or when they consumed it 30 min before breakfast for 3 and 6 months (TSH: 2.5±1.1 vs 2.5±1.1 and 2.4±1.1 mIU/l respectively, fT₄: 12.4±2.4 vs 12.5±2.4 and 12.3±2.1 pg/ml respectively, and fT₃: 3.4±0.6 vs 3.4±0.6 and 3.3±0.5 pg/ml respectively). CONCLUSION: Oral liquid L-T₄ formulations could diminish the problem of L-T₄ malabsorption caused by coffee when using traditional tablet formulations.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A liquid formulation of LT4 packaged in polyethylene ampoules, not available within the United States, has been suggested, based on case reports or uncontrolled studies only, to be better absorbed than tablets if there is malabsorption following bariatric surgery or if LT4 is consumed with breakfast.
“A liquid formulation of LT4 that is packaged in polyethylene ampoules, and that is not available within the United States, has been suggested, based on case reports or uncontrolled studies only, to be better absorbed than tablets if there is malabsorption following bariatric surgery or if LT4 is consumed with breakfast (115,116).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [115]
In a 2014 prospective, pre-post study in 54 patients followed up for >6 months after switching the dosing time from breakfast to 30 minutes before breakfast, FT3, FT4, and TSH did not differ between patients taking liquid LT4 with or 30 minutes prior to breakfast.
“In 2014, Cappelli et al revealed for the first time that FT3, FT4, and TSH did not differ between patients taking liquid LT4 with or 30 minutes prior to breakfast (205). Their study was a prospective, pre–post study in 54 patients who were followed up for >6 months after switching the dosing time from breakfast to 30 minutes before breakfast.”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [205]
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 [205]
Cappelli et al. reported that a move to taking LT4 30 min before breakfast for 3 and 6 months did not significantly modify serum TSH level.
“Cappelli et al. reported that a move to taking the LT4 30 min before breakfast for 3 and 6 months did not significantly modify the serum TSH level [ 79 ].”
From Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults (2022) · cites this paper as [79]
Cites
Zhang, H., Zhang, J., & Streisand, J. B. (2002) · Clinical Pharmacokinetics · doi:10.2165/00003088-200241090-00003 · Cited by 413 · see citing works
Thyroxine in Goiter, <i>Helicobacter pylori</i> 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
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
Hypothyroidism: etiology, diagnosis, and management
Almandoz, J. P., & Gharib, H. (2012) · Medical Clinics of North America · doi:10.1016/j.mcna.2012.01.005 · Cited by 216 · 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
Influence of extraction temperature on the final quality of espresso coffee
Andueza, S., Maeztu, L., Pascual, L., Ibáñez, C., de Peña, M. P., & Cid, C. (2003) · Journal of the Science of Food and Agriculture · doi:10.1002/jsfa.1304 · Cited by 100 · see citing works
Vita, R., Saraceno, G., Trimarchi, F., & Benvenga, S. (2013) · Endocrine · doi:10.1007/s12020-012-9772-2 · Cited by 91 · see citing works
Yue, C., Scarsi, C., & Ducharme, M. P. (2012) · Arzneimittelforschung · doi:10.1055/s-0032-1329951 · Cited by 81 · see citing works
Approach to and Treatment of Differentiated Thyroid Carcinoma
Pacini, F., & Castagna, M. G. (2012) · Medical Clinics of North America · doi:10.1016/j.mcna.2012.01.002 · Cited by 77 · see citing works
Pirola, I., Formenti, A. M., Gandossi, E., Mittempergher, F., Casella, C., Agosti, B., & Cappelli, C. (2013) · Obesity Surgery · doi:10.1007/s11695-013-1015-y · Cited by 74 · see citing works
Kinetics of degradation of levothyroxine in aqueous solution and in solid state
Won, C. M. (1992) · Pharmaceutical Research · doi:10.1023/a:1018952415732 · Cited by 69 · see citing works
Serum Thyrotropin Levels Following Levothyroxine Administration at Breakfast
Perez, C. L. S., Araki, F. S., Graf, H., & de Carvalho, G. A. (2013) · Thyroid · doi:10.1089/thy.2012.0435 · Cited by 63 · see citing works
Improved Levothyroxine Pharmacokinetics After Bariatric Surgery
Gkotsina, M., Michalaki, M., Mamali, I., Markantes, G., Sakellaropoulos, G. C., Kalfarentzos, F., Vagenakis, A. G., & Markou, K. B. (2013) · Thyroid · doi:10.1089/thy.2011.0526 · Cited by 57 · see citing works
Influence of Formulation and Processing Factors on Stability of Levothyroxine Sodium Pentahydrate
Collier, J. W., Shah, R. B., Gupta, A., Sayeed, V. A., Habib, M. J., & Khan, M. A. (2010) · AAPS PharmSciTech · doi:10.1208/s12249-010-9434-8 · Cited by 56 · see citing works
Compliance with drug therapy—new answers to an old question
Düsing, R., Lottermoser, K., & Mengden, T. (2001) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/16.7.1317 · Cited by 54 · see citing works
Stability of an extemporaneously compounded levothyroxine sodium oral liquid
Boulton, D. W., Fawcett, J. P., & Woods, D. J. (1996) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/53.10.1157 · Cited by 24 · see citing works
Bariatric surgery (obesity surgery)
Pekkarinen, T. (2009) · EBM Guidelines · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
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 liquid formulation of LT4 that is packaged in polyethylene ampoules, and that is not available within the United States, has been suggested, based on case reports or uncontrolled studies only, to be better absorbed than tablets if there is malabsorption following bariatric surgery or if LT4 is consumed with breakfas…”
Vita, R., Saraceno, G., Trimarchi, F., & Benvenga, S. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-2684 · Cited by 99 · see citing works
“A facilitating role of ethanol has been proposed (26).”
BackgroundResultInfluentialThe administration of l -thyroxine as soft gel capsule or liquid solution
Vita, R., Fallahi, P., Antonelli, A., & Benvenga, S. (2014) · Expert Opinion on Drug Delivery · doi:10.1517/17425247.2014.918101 · Cited by 93 · see citing works
“Ethanol has been proposed as having an enhancing role in L-T4 intestinal absorption [51].”
BackgroundInfluentialLevothyroxine 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
“Coffee (espresso, drip coffee, barley coffee) case report [63], case series [61,62], uncontrolled clinical study [65], non-randomized cross-over study [64] the sequestration of L-T4 by coffee malabsorption of L-T4, impaired efficacy of treatment advise to delay coffee intake by 1 h after L-T4 administration consider c…”
BackgroundResultCappelli, 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
Self-citationLiquid and softgel levothyroxine use in clinical practice: state of the art
Virili, C., Trimboli, P., Romanelli, F., & Centanni, M. (2016) · Endocrine · doi:10.1007/s12020-016-1035-1 · Cited by 71 · see citing works
“A further study examined the interference due to coffee consumption in patients taking liquid LT4 [34].”
BackgroundVirili, C., Giovanella, L., Fallahi, P., Antonelli, A., Santaguida, M. G., Centanni, M., & Trimboli, P. (2018) · Frontiers in Endocrinology · doi:10.3389/fendo.2018.00010 · Cited by 61 · see citing works
Levothyroxine: conventional and novel drug delivery formulations.
Liu, H., Li, W., Zhang, W., Sun, S., & Chen, C. (2023) · Endocrine Reviews · doi:10.1210/endrev/bnac030 · Cited by 63 · see citing works
Guglielmi, R., Grimaldi, F., Negro, R., Frasoldati, A., Misischi, I., Graziano, F., Cipri, C., Guastamacchia, E., Triggiani, V., & Papini, E. (2018) · Endocrine, Metabolic & Immune Disorders - Drug Targets · doi:10.2174/1871530318666180125155348 · Cited by 57 · see citing works
“This finding is in agreement with the previous studies which did not show any significant difference in thyroid hormone levels in patients either taking liquid L-T4 at breakfast or 30 minutes before breakfast, in a fasting state [32-35].”
BackgroundResultCaron, 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
“reported that a move to taking the LT4 30 min before breakfast for 3 and 6 months did not significantly modify the serum TSH level [79].”
BackgroundFallahi, 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
“patients on liquid L-T4 therapy, whether they consumed L-T4 at breakfast or 30 min before it [79].”
BackgroundPirola, I., Daffini, L., Gandossi, E., Lombardi, D., Formenti, A., Castellano, M., & Cappelli, C. (2014) · Journal of Endocrinological Investigation · doi:10.1007/s40618-014-0082-9 · Cited by 47 · see citing works
Guglielmi, R., Frasoldati, A., Zini, M., Grimaldi, F., Gharib, H., Garber, J. R., & Papini, E. (2016) · Endocrine Practice · doi:10.4158/ep161308.or · Cited by 39 · see citing works
Antonelli, A., Elia, G., Ragusa, F., Paparo, S. R., Cavallini, G., Benvenga, S., Ferrari, S. M., & Fallahi, P. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.633587 · Cited by 32 · see citing works
“The food interference with L-T4 absorption has been evaluated also by other studies, for example the assumption of tablet L-T4 with coffee, or with water and then coffee within few minutes, can lead to an improper TSH response (39).”
BackgroundBernareggi, A., Grata, E., Pinorini, M., & Conti, A. (2013) · Pharmaceutics · doi:10.3390/pharmaceutics5040621 · Cited by 30 · see citing works
“Prompt bioavailability of T4 is even more expected in case T4 is administered as an oral solution [13,15,16].”
Laurent, I., Tang, S., Astère, M., Wang, K. R., Deng, S., Xiao, L., & Li, Q. F. (2018) · Endocrine · doi:10.1007/s12020-018-1574-8 · Cited by 30 · see citing works
Timing of breakfast does not influence therapeutic efficacy of liquid levothyroxine formulation
Morelli, S., Reboldi, G., Moretti, S., Menicali, E., Avenia, N., & Puxeddu, E. (2016) · Endocrine · doi:10.1007/s12020-015-0788-2 · Cited by 30 · see citing works
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
“We have previously observed that taking L-T4 at 30 minutes before having breakfast was not associated with alterations in optimal TSH, fT4, and fT3 concentrations in a group of patients taking their dose of a liquid L-T4 formulation (Tirosint, IBSA, Italy) with coffee [20].”
BackgroundMedications and Food Interfering with the Bioavailability of Levothyroxine: A Systematic Review
Liu, H., Lu, M., Hu, J., Fu, G., Feng, Q., Sun, S., & Chen, C. (2023) · Therapeutics and Clinical Risk Management · doi:10.2147/tcrm.s414460 · Cited by 29 · see citing works
Hypothyroidism and Nephrotic Syndrome: Why, When and How to Treat
Mario, F. D., Pofi, R., Gigante, A., Rivoli, L., Rosato, E., Isidori, A. M., Cianci, R., & Barbano, B. (2017) · Current Vascular Pharmacology · doi:10.2174/1570161115999170207114706 · Cited by 27 · see citing works
“Due to its 28% ethanol content, it is not recommended during pregnancy and breastfeeding or in children and high-risk patients [66].”
BackgroundUpdate on the treatment of hypothyroidism
Jonklaas, J. (2015) · Current Opinion in Oncology · doi:10.1097/cco.0000000000000242 · Cited by 25 · see citing works
Levothyroxine liquid solution versus tablet form for replacement treatment in pregnant women
Cappelli, C., Negro, R., Pirola, I., Gandossi, E., Agosti, B., & Castellano, M. (2016) · Gynecological Endocrinology · doi:10.3109/09513590.2015.1113518 · Cited by 24 · see citing works
“Many recent reports have clearly demonstrated that liquid LT4 formulation circumvents these problems, in patients taking proton pump inhibitors, those suffering from gastric related T4 malabsorption, those assuming T4 with coffee or fed by enteral tube, and also those submitted to bariatric surgery [24-28].”
BackgroundLedeți, I., Romanescu, M., Cîrcioban, D., Ledeți, A., Vlase, G., Vlase, T., Suciu, O., Murariu, M., Olariu, S., Matusz, P., et al. (2020) · Pharmaceutics · doi:10.3390/pharmaceutics12010058 · Cited by 23 · see citing works
Lombardi, C. P., Bocale, R., Barini, A., Barini, A., D’Amore, A., Boscherini, M., & Bellantone, R. (2017) · Endocrine · doi:10.1007/s12020-016-1003-9 · Cited by 23 · see citing works
“In this regard, it has been demonstrated that mere consumption of coffee at breakfast can impair tablet L-T4 absorption by binding to L-T4 [18], whereas the efficacy of liquid L-T4 on thyroid hormones does not significantly change when the drug is consumed with water shortly before coffee, or poured into the coffee, o…”
BackgroundFriedrich, N., Pietzner, M., Cannet, C., Thuesen, B. H., Hansen, T., Wallaschofski, H., Grarup, N., Skaaby, T., Budde, K., Pedersen, O., et al. (2017) · PLOS ONE · doi:10.1371/journal.pone.0173078 · Cited by 23 · see citing works
L-T4 Therapy in Enteric Malabsorptive Disorders
Fallahi, P., Ferrari, S. M., Elia, G., Ragusa, F., Paparo, S. R., & Antonelli, A. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.626371 · Cited by 23 · see citing works
“Other studies have investigated food interference with L-T4 absorption (44, 45).”
BackgroundCappelli, C., Pirola, I., Daffini, L., Gandossi, E., Agosti, B., & Castellano, M. (2014) · European Geriatric Medicine · doi:10.1016/j.eurger.2014.09.006 · Cited by 22 · see citing works
“when using traditional tablet formulations [17].”
Environmental photochemical fate and UVC degradation of sodium levothyroxine in aqueous medium
Parizi, M. P. S., Lastre-Acosta, A. M., Ishiki, H. M., Rossi, R. C., Mafra, R. C., & Teixeira, A. C. S. C. (2018) · Environmental Science and Pollution Research · doi:10.1007/s11356-018-2907-0 · Cited by 18 · see citing works
Guzmán-Prado, Y., Vita, R., & Samson, O. (2021) · Journal of General Internal Medicine · doi:10.1007/s11606-020-06403-y · Cited by 15 · see citing works
Liquid levothyroxine and its potential use
Formenti, A. M., Daffini, L., Pirola, I., Gandossi, E., Cristiano, A., & Cappelli, C. (2015) · HORMONES · doi:10.14310/horm.2002.1579 · Cited by 15 · see citing works
Gietka-Czernel, M., Hubalewska-Dydejczyk, A., Kos-Kudła, B., Lewiński, A., Ruchała, M., Syrenicz, A., & Zgliczyński, W. (2020) · Endokrynologia Polska · doi:10.5603/ep.a2020.0065 · Cited by 13 · see citing works
“…of liquid levothyroxine ingested before breakfast and at breakfast Study design First author, year of publication Number of patients Study setting Results Prospective Cappelli et al., 2014 [33] 54 Patients on liquid LT4 taking drug wrongly at breakfast were asked to take drug 30’ before breakfast.”
BackgroundInfluentialLiquid levothyroxine formulations in patients taking drugs interfering with L-T4 absorption
Gatta, E., Bambini, F., Buoso, C., Gava, M., Maltese, V., Anelli, V., Delbarba, A., Pirola, I., & Cappelli, C. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1080108 · Cited by 13 · see citing works
Oteri, V., Volpe, S., Lopes, M., Sceusa, G., Tumminia, A., Belfiore, A., Frasca, F., & Gullo, D. (2024) · Endocrine · doi:10.1007/s12020-024-04016-7 · Cited by 9 · see citing works
“T 4 t h e r a py t a k e n a t b r ea k f a s t c ou l d i m p r ov e p a ti e n t c o m p li a n ce a nd qu a lit y o f li f e [ 6 , 28 , 30 , 42 , 43 ] M o d er a t e Endocrine (2025) 87:48 – 58 time elapsed between L-T4 administration and the and the type of meal [28, 31, 39, 42, 44, 46].”
InfluentialJonklaas, J. (2019) · Springer eBooks · doi:10.1007/978-3-319-72102-6_19 · Cited by 6 · see citing works
Cappelli, C., Pirola, I., & Castellano, M. (2020) · Case Reports in Endocrinology · doi:10.1155/2020/8858887 · Cited by 5 · see citing works
“Differently, many reports showed that liquid formulations circumvent gastric acidity, improving their absorption even if ingested with breakfast [7–11].”
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
Gatta, E., Maltese, V., Cavadini, M., Anelli, V., Bambini, F., Buoso, C., Facondo, P., Pirola, I., Delbarba, A., & Cappelli, C. (2023) · Endocrine Practice · doi:10.1016/j.eprac.2023.08.009 · Cited by 2 · see citing works
Simultaneous Intake of Liquid L-T4 Formulation and Iron Salt: Fact or Fiction?
Maltese, V. (2023) · Acta Endocrinologica (Bucharest) · doi:10.4183/aeb.2023.54 · Cited by 1 · see citing works
Springer-Verlag (2014) · CME · doi:10.1007/s11298-014-1446-3 · Cited by 1 · see citing works
Pharmacological Interactions of Levothyroxine in Multiple-Treated Patients
Marco, F. D., & Cusini, C. (2025) · Springer eBooks · doi:10.1007/978-3-032-01700-0_14
Farhan, M., Patel, T., Obais, M. A.-H. N., Taslimi, H., Hanif, M., Khalid, K., Qaqour, A., Waisi, J., Khalid, H., Husain, A. H. A. A., et al. (2026) · World Journal of Clinical Cases · doi:10.12998/wjcc.v14.i16.119700
- Authors
- Cappelli, C., Pirola, I., Gandossi, E., Formenti, A., & Castellano, M.
- Affiliations
- Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
- Corresponding author
- Cappelli, Carlo
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-01
- Volume
- 170
- Issue
- 1
- Pages
- 95-99
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2100948030
- Cited by
- 41
- References
- 18
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 5 · 2020: 3 · 2019: 1 · 2018: 4 · 2017: 2 · 2016: 5 · 2015: 5 · 2014: 6 · 2013: 1
- FWCI
- 4.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- 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, coffee, drug absorption, TSH response, free thyroxine, free triiodothyronine, euthyroid patients, thyroid hormone replacement
- MeSH terms
- Administration, Oral, Adult, Coffee, Drug Administration Schedule, Female, Humans, Hypothyroidism, Intestinal Absorption, Italy, Male, Middle Aged, Thyrotropin, Thyroxine, Time Factors, Triiodothyronine, Cohort Studies, Food-Drug Interactions, Hormone Replacement Therapy, Breakfast
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
