Comparison of TSH Levels with Liquid Formulation Versus Tablet Formulations of Levothyroxine in the Treatment of Adult Hypothyroidism
Abstract
Objective A great number of factors can interfere with levothyroxine (LT4) tablet absorption, leading to increased serum thyroid-stimulating hormone (TSH) levels and, accordingly, to increased LT4 requirements. LT4 oral solution (LT4-OS) is a novel formulation with a pharmacokinetics profile different from those of tablets. The aim of this study was to retrospectively evaluate whether serum TSH levels were decreased after switching adult hypothyroid patients from the tablet to LT-OS.Methods We retrospectively evaluated 53 outpatients on LT4 replacement therapy (consumed within 1 hour before breakfast) who switched from LT4 tablets to LT4-OS without changing the daily dose. We compared preswitch TSH (TSH1) with TSH level 60 to 90 days after the switch (TSH2) and examined the clinical differences between the patients whose TSH did and did not drop after the switch.Results After the switch, TSH levels decreased from a median value of 3.04 (interquartile range [IQR] 1.75-6.80) to 2.30 (IQR 1.21-3.81) μIU/mL, and the difference was significant (P = .0034). We observed a TSH reduction (TSH2/TSH1 ratio <1) in 36/53 (67.9%) of patients; the median TSH2/TSH1 ratio was 0.71 (IQR 0.37-1.14). In the group of patients whose TSH dropped, we observed an increased frequency of factors interfering with LT4 absorption (P = .014). The median TSH2/TSH1 ratios were 0.50 (IQR 0.31-0.72) and 0.85 (IQR 0.65-1.36) for patients with and without interfering factors, respectively.Conclusion Our study confirms that LT4-OS could have an increased absorption rate in comparison to LT4 tablets, especially in the presence of other factors interfering with LT4 absorption.
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There is some evidence that gel capsules are absorbed preferentially in selected circumstances, such as during consumption with coffee and during use of proton pump inhibitors (PPIs).
“There is some evidence that gel capsules are absorbed preferentially in selected circumstances, such as during consumption with coffee and during use of proton pump inhibitors (PPIs).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [113]
An uncontrolled retrospective study noted lower serum TSH concentrations in patients who were switched from LT4 tablets to the same dose of LT4 as a soft gel capsule (113).
“An uncontrolled retrospective study noted lower serum TSH concentrations in patients who were switched from LT4 tablets to the same dose of LT4 as a soft gel capsule (113).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [113]
Orally administered liquid and soft-gel LT4 formulations are associated with higher serum FT4 levels and lower TSH levels than tablet formulations, even when the overall LT4 dose level is the same.
“Other reports from both retrospective and prospective observational studies indicate that orally administered liquid and soft-gel formulations of LT4 are associated with higher serum FT4 levels and lower TSH levels than tablet formulations, even when the overall LT4 dose level is the same – perhaps due to the absence of gastric disintegration [ 38 – 44 ].”
From Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults (2022) · cites this paper as [41]
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- Authors
- Brancato, D., Scorsone, A., Saura, G., Ferrara, L., Di Noto, A., Aiello, V., Fleres, M., & Provenzano, V.
- Corresponding author
- Brancato, Davide
- ORCID
- Scorsone, Alessandro
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2014-07
- Volume
- 20
- Issue
- 7
- Pages
- 657-662
- ISSN
- 1530-891X (ISSN-L)
- OpenAlex
- W1966108960
- Cited by
- 44
- References
- 32
- Citations by year
- 2026: 1 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 1 · 2020: 2 · 2019: 6 · 2018: 7 · 2017: 6 · 2016: 7 · 2015: 2 · 2014: 3
- FWCI
- 4.83
- 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, thyroid-stimulating hormone, hypothyroidism, tablet formulation, drug formulation switching, thyroid hormone replacement
- MeSH terms
- Adult, Aged, Female, Humans, Hypothyroidism, Male, Middle Aged, Retrospective Studies, Solutions, Tablets, Thyrotropin, Thyroxine
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