Use Of Soy Protein Supplement And Resultant Need For Increased Dose Of Levothyroxine
Abstract
Objective To report a case of difficulty in achieving suppressive serum levels of thyroid hormone because of malabsorption of exogenous levothyroxine attributable to daily ingestion in close temporal relationship to the intake of a soy protein-containing food supplement.Methods We present the relevant history and laboratory data of the current case and provide supportive documentation from the literature.Results A 45-year-old woman who had hypothyroidism after a near-total thyroidectomy and radioactive iodine ablative therapy for papillary carcinoma of the thyroid required unusually high oral doses of levothyroxine to achieve suppressive serum levels of free thyroxine (T(4)) and thyrotropin (thyroid-stimulating hormone or TSH). She had routinely been taking a "soy cocktail" protein supplement immediately after her levothyroxine. Temporal separation of the intake of the soy protein cocktail from the administration of the levothyroxine resulted in attainment of suppressive serum levels of free T(4) and TSH with use of lower doses of levothyroxine.Conclusion Administration of levothyroxine concurrently with a soy protein dietary supplement results in decreased absorption of levothyroxine and the need for higher oral doses of levothyroxine to attain therapeutic serum thyroid hormone levels.
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Case reports show that fiber and soy products appear to be associated with impaired LT4 absorption.
“Case reports also show that fiber (123) and soy products (124) appear to be associated with impaired LT4 absorption.”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [124]
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 [124]
Even in hypothyroid individuals on thyroid replacement medication, reasonable intake of soy foods may still be acceptable if the dose of levothyroxine is either increased or timed such that it does not coincide with soy intake.
“even in this situation, the reasonable intake of soy foods may still be acceptable if the dose of levothyroxine is either increased or timed such that it does not coincide with the soy intake [150,151].”
From Plant Proteins: Assessing Their Nutritional Quality and Effects on Health and Physical Function (2020) · cites this paper as [151]
Limited case study evidence suggests that soy foods may interfere to some degree with the absorption of levothyroxine in some hypothyroid individuals.
“there is limited case study evidence that soy foods may interfere to some degree with the absorption of levothyroxine in some hypothyroid individuals [151].”
From Plant Proteins: Assessing Their Nutritional Quality and Effects on Health and Physical Function (2020) · cites this paper as [151]
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Correlation between Soy Phytoestrogens and Thyroid Laboratory Parameters
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- Authors
- Bell, D. S. H., & Montanya, E.
- Affiliations
- University of Alabama at Birmingham (US)
- Corresponding author
- Bell, David S.H.
- ORCID
- Montanya, Eduard
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2001-05
- Volume
- 7
- Issue
- 3
- Pages
- 193-194
- ISSN
- 1530-891X (ISSN-L)
- OpenAlex
- W1992094005
- Cited by
- 124
- References
- 9
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 5 · 2022: 3 · 2021: 6 · 2020: 5 · 2019: 6 · 2018: 8 · 2017: 5 · 2016: 3 · 2015: 8 · 2014: 6 · 2013: 10 · 2012: 5
- FWCI
- 3.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrine Practice (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, drug malabsorption, hypothyroidism, thyroid hormone suppression, free thyroxine, thyroid-stimulating hormone, papillary thyroid carcinoma, thyroidectomy, radioiodine therapy, dose adjustment
- MeSH terms
- Absorption, Dose-Response Relationship, Drug, Drug Interactions, Female, Humans, Middle Aged, Thyrotropin, Thyroxine, Dietary Supplements, Soybean Proteins
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