Oral L‐thyroxine liquid versus tablet in patients submitted to total thyroidectomy for thyroid cancer (without malabsorption): A prospective study

Fallahi, Poupak; Ferrari, Silvia; Materazzi, Gabriele; Ragusa, Francesca; Ruffilli, Ilaria; Patrizio, Armando; Miccoli, Paolo; Antonelli, Alessandro

doi:10.1002/lio2.186

Cited by 19 publications

(26 citation statements)

References 33 publications

(62 reference statements)

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“…There is abundant evidence showing that under the said dietary, pharmacologic or digestive system-associated conditions of undertreated primary hypothyroidism, switch from the tablet to either liquid or softgel capsule (so-called novel formulations) normalizes serum TSH levels [2], [3], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]. Evidence for lower TSH levels, in both replacement and TSH-suppressive settings, under the novel formulations compared to the tablet formulation has also been obtained in the absence of those conditions [20], [21], [22], [23], [24], [25], [26], [27], [28] and, for sake of completeness of information, in central hypothyroidism [29]. All this evidence stems from the more favorable pharmacokinetics profile of the two novel formulations compared to the tablet formulation [3], [30], [31], [32].…”

Section: Introductionmentioning

confidence: 80%

Liquid and softgel capsules of l-thyroxine results lower serum thyrotropin levels more than tablet formulations in hypothyroid patients

Benvenga

2019

Journal of Clinical & Translational Endocrinology

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ObjectiveEvidence indicates that L-T4 in liquid and softgel capsule are absorbed better than tablets in hypothyroid patients, even when patients are under medications that impair the intestinal absorption of L-T4. However, no study has evaluated all three L-T4 formulations in the same hypothyroid patients. This study aims to fill this gap. The outcome was the degree of TSH change in the liquid and softgel formulations, using tablet L-T4 as the reference, regardless of sequence of formulation and regardless of whether patients were co-ingesting with interfering medications.MethodsWe recorded serum TSH levels in two groups of L-T4 replaced patients with primary hypothyroidism (23 subjects who did not co-ingest interfering medications, and 20 subjects who did). Either group of patients took one formulation of L-T4 at a time with variable sequences. In the first group, the median durations of exposure to tablet, liquid or softgel L-T4 were 14, 9 and 10 months, respectively. In the second group the corresponding durations were 13, 11 and 10 months, during which patients co-ingested interfering medications.ResultsIn the 23 patients, there were 78, 74 or 101 TSH determinations during liquid, softgel capsule or tablet L-T4 regimens. Serum TSH levels associated with liquid, capsule or tablet L-T4 were 1.62 ± 0.51, 1.77 ± 0.44 mU/L (P = 0.049 vs liquid) or 2.38 ± 0.69 mU/L (P < 0.0001 vs liquid or capsule). Rates of TSH ≤ 2.50 mU/L were 97.4% (liquid), 95.9% (softgel) or 64.4% (tablet, P < 0.0001 vs liquid or capsule). Rates of TSH ≤ 4.12 mU/L were 100%, 100% or 98.0%.In the 20 patients, the corresponding TSH determinations were 56, 57 and 41, and corresponding TSH levels were 2.74 ± 0.98, 2.70 ± 0.79 or 7.53 ± 2.82 mU/L. Rates of TSH ≤ 2.50 mU/L were 51.8% (liquid), 47.4% (capsule, P = 0.64) or 2.4% (tablet, P < 0.0001 vs liquid or capsule). Rates of TSH ≤ 4.12 mU/L were 92.8% (liquid), 94.7% (capsule, P = 0.68) or 12.2% (tablet, P < 0.0001 vs liquid or capsule).ConclusionsL-T4 ingested as liquid solution or softgel capsule is more bioavailable compared to L-T4 ingested as tablet, and it is slightly superior to capsule L-T4 only in the absence of co-ingestion of interfering medications.

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Section: Introductionmentioning

confidence: 80%

Liquid and softgel capsules of l-thyroxine results lower serum thyrotropin levels more than tablet formulations in hypothyroid patients

Benvenga

2019

Journal of Clinical & Translational Endocrinology

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“…Three studies with 266 participants concerned comparison of liquid and tablet LT4 effectiveness of suppressive therapy in patients with DTC [30][31][32]. Two of them including 207 patients were prospective, randomised, and concluded that the use of LT4 liquid formulation, as compared to tablets, provided better control of TSH and resulted in a significantly higher number of DTC patients maintaining TSH values within range for the ATA risk score and reducing TSH variability over time [31,32]. Conversely, Giusti et al in a small study with 59 participants did not find any differences in TSH and thyroid hormone concentrations between the tablet and liquid L-T4 groups [30].…”

Section: Comparison Of the Effectiveness Of Liquid And Tablet Levothymentioning

confidence: 99%

“…Trzy badania poświęcono porównaniu skuteczności działania LT4 stosowanej w płynie lub w tabletkach w leczeniu supresyjnym 266 chorych na ZRT [30][31][32]. Dwa z nich, w których uczestniczyło 207 chorych, były randomizowanymi badaniami prospektywnymi.…”

Section: Porównanie Skuteczności Działania Lewotyroksyny W Postaci Płunclassified

“…Dwa z nich, w których uczestniczyło 207 chorych, były randomizowanymi badaniami prospektywnymi. Uzyskane w nich wyniki ujawniły, że w porównaniu z tabletkami stosowanie płynnej LT4 zapewniało lepszą kontrolę stężenia TSH i sprawiało, że w znacznie większej grupie chorych na ZRT stężenia TSH utrzymywały się w zakresach zalecanych przez ATA, a wahania wartości tych stężeń były mniejsze [31,32]. Natomiast w niewielkim badaniu z udziałem 59 osób Giusti i wsp.…”

Section: Porównanie Skuteczności Działania Lewotyroksyny W Postaci Płunclassified

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Expert opinion on liquid L-thyroxine usage in hypothyroid patients and new liquid thyroxine formulation — Tirosint SOL [Opinia ekspertów dotycząca stosowania płynnej postaci lewotyroksyny oraz nowego preparatu Tirosint SOL u chorych na niedoczynność tarczycy]

Gietka-Czernel

Hubalewska‐Dydejczyk

Kos–Kudła

et al. 2020

Endokrynologia Polska

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“…Mistry et al achieved a predicted levothyroxine dose of 1.6 mcg/kg after total thyroidectomy (5). Also, Fallahi et al reported the mean postoperative levothyroxine dose of 1.5 for total thyroidectomy (21).…”

Section: Discussionmentioning

confidence: 99%

Levothyroxine dosage determination according to Body Mass Index (BMI) after total thyroidectomy

Maghsudi¹

2019

Erciyes Med J

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Objective: Currently, postoperative thyroid hormone replacement dosing is weight-based with adjustments and made following Thyroid Stimulating Hormone (TSH) values, which may lead to delayed achievement of euthyroidism and failure in achieving an accurate estimation of the levothyroxine dose. We aimed to evaluate the relationship between Body Mass Index (BMI) and Lean Body Mass (LBM) with levothyroxine dose. Materials and Methods: Eighty patients with thyroid disease (benign and malignant) randomly enrolled the study. BMI and LBM were calculated during the pre-operative visit. Thyroid hormone replacement was started five day after surgery for benign and after a month for malignant cases, at a dose of 1.6 mcg/kg/day based on actual body weight. When euthyroidism was achieved, the levothyroxine dose was measured, and efforts were made to analyze its relationship with weight, BMI, and LBM. Results: In the benign group, levothyroxine dose was obtained at 1.51 mcg/kg per body weight. To determine the levothyroxine dose based on BMI and LBM, Y=-0.013+0.005 BMI and Y=0.048+0.002 LBM formulas were used, respectively. In the malignant group, a levothyroxine dose of 1.56 mcg/kg was obtained based on the weight variable. To determine the levothyroxine dose based on BMI and LBM, Y=0.01+0.004 BMI and Y=0.042+0.002 LBM formulas were used, respectively. In both groups, the levothyroxine dose that was calculated was more accurate using BMI with the obtained formula. Conclusion: Weight, BMI, and LBM can be used to determine the levothyroxine dose in patients receiving total thyroidectomy, but levothyroxine can be precisely measured using BMI.

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Oral L‐thyroxine liquid versus tablet in patients submitted to total thyroidectomy for thyroid cancer (without malabsorption): A prospective study

Cited by 19 publications

References 33 publications

Liquid and softgel capsules of l-thyroxine results lower serum thyrotropin levels more than tablet formulations in hypothyroid patients

Liquid and softgel capsules of l-thyroxine results lower serum thyrotropin levels more than tablet formulations in hypothyroid patients

Expert opinion on liquid L-thyroxine usage in hypothyroid patients and new liquid thyroxine formulation — Tirosint SOL [Opinia ekspertów dotycząca stosowania płynnej postaci lewotyroksyny oraz nowego preparatu Tirosint SOL u chorych na niedoczynność tarczycy]

Levothyroxine dosage determination according to Body Mass Index (BMI) after total thyroidectomy

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