open access

Vol 73, No 5 (2022)
Review paper
Submitted: 2022-06-14
Accepted: 2022-07-21
Published online: 2022-10-06
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Polski

Liquid levothyroxine improves thyroid control in patients with different hypothyroidism aetiology and variable adherence — case series and review

Marek Ruchała1, Artur Bossowski2, Magdalena M. Brzozka3, Małgorzata Gietka-Czernel4, Alicja Hubalewska-Dydejczyk5, Beata Kos-Kudła6, Andrzej Lewiński7, Anhelli Syrenicz8, Wojcech Zgliczyński4
·
Pubmed: 36621916
·
Endokrynol Pol 2022;73(5):893-902.
Affiliations
  1. Department of Endocrinology, Metabolism, and Internal Medicine, University of Medical Sciences, Poznań, Poland
  2. Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Białystok, Białystok, Poland
  3. Medical Department, IBSA Poland
  4. Department of Endocrinology, Medical Centre of Postgraduate Education, Warsaw, Poland
  5. Chair and Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
  6. Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
  7. Department of Endocrinology and Metabolic Disorders, Medical University of Łódź, Polish Mother’s Memorial Hospital — Research Institute, Łódź, Poland
  8. Department of Endocrinology, Pomeranian Medical University, Szczecin, Poland

open access

Vol 73, No 5 (2022)
Review Article
Submitted: 2022-06-14
Accepted: 2022-07-21
Published online: 2022-10-06

Abstract

It is estimated that hypothyroidism treatment may be either suboptimal or excessive in about 32–45% patients treated with L-thyroxine (LT4). There are multiple possible causes of poor control of hypothyroidism, including narrow LT4 therapeutic index, food and drug interactions, comorbidities, and patient non-adherence. Some of these obstacles could possibly be overcome with the novel liquid LT4 formulation. Liquid LT4 reaches maximum blood concentration about 30 minutes faster than the tablet form. Faster pharmacokinetics might lead to more efficient LT4 absorption, as suggested by a recent real-world study in patients with primary and central hypothyroidism.

Liquid LT4 treatment led to increased free thyroxine (FT4) and sex hormone binding globulin (SHBG) with decreased low-density lipoprotein (LDL) cholesterol concentration and substantially improved quality of life for the patients. Herein we present a series of 31 patients with hypothyroidism of different aetiologies treated with the novel liquid LT4 formulation in standard clinical care in light of the latest scientific publications on liquid LT4 formula. We observed normalization of thyroid function tests shortly after introduction of liquid LT4, irrespective of concurrent diseases or concomitant medications that could diminish LT4 absorption. In more detail, the treatment with liquid LT4 managed to normalize thyroid-stimulating hormone (TSH) concentrations in patients without any known causes of LT4 absorption disturbances, as well as in those with malabsorption: with gastric bypass, partial small and large intestine resection, scleroderma, gluten intolerance, celiac disease, atrophic gastritis, and polytherapy. In conclusion, considering many factors disturbing
LT4 absorption, hypothyroidism therapy with liquid LT4 seems to be a particularly effective option.

 

Abstract

It is estimated that hypothyroidism treatment may be either suboptimal or excessive in about 32–45% patients treated with L-thyroxine (LT4). There are multiple possible causes of poor control of hypothyroidism, including narrow LT4 therapeutic index, food and drug interactions, comorbidities, and patient non-adherence. Some of these obstacles could possibly be overcome with the novel liquid LT4 formulation. Liquid LT4 reaches maximum blood concentration about 30 minutes faster than the tablet form. Faster pharmacokinetics might lead to more efficient LT4 absorption, as suggested by a recent real-world study in patients with primary and central hypothyroidism.

Liquid LT4 treatment led to increased free thyroxine (FT4) and sex hormone binding globulin (SHBG) with decreased low-density lipoprotein (LDL) cholesterol concentration and substantially improved quality of life for the patients. Herein we present a series of 31 patients with hypothyroidism of different aetiologies treated with the novel liquid LT4 formulation in standard clinical care in light of the latest scientific publications on liquid LT4 formula. We observed normalization of thyroid function tests shortly after introduction of liquid LT4, irrespective of concurrent diseases or concomitant medications that could diminish LT4 absorption. In more detail, the treatment with liquid LT4 managed to normalize thyroid-stimulating hormone (TSH) concentrations in patients without any known causes of LT4 absorption disturbances, as well as in those with malabsorption: with gastric bypass, partial small and large intestine resection, scleroderma, gluten intolerance, celiac disease, atrophic gastritis, and polytherapy. In conclusion, considering many factors disturbing
LT4 absorption, hypothyroidism therapy with liquid LT4 seems to be a particularly effective option.

 

Get Citation

Keywords

hypothyroidism; Hashimoto’s thyroiditis; liquid levothyroxine; compliance; adherence; drug absorption; drug formulation; malabsorption; quality of life (QoL)

About this article
Title

Liquid levothyroxine improves thyroid control in patients with different hypothyroidism aetiology and variable adherence — case series and review

Journal

Endokrynologia Polska

Issue

Vol 73, No 5 (2022)

Article type

Review paper

Pages

893-902

Published online

2022-10-06

Page views

4811

Article views/downloads

2318

DOI

10.5603/EP.a2022.0078

Pubmed

36621916

Bibliographic record

Endokrynol Pol 2022;73(5):893-902.

Keywords

hypothyroidism
Hashimoto’s thyroiditis
liquid levothyroxine
compliance
adherence
drug absorption
drug formulation
malabsorption
quality of life (QoL)

Authors

Marek Ruchała
Artur Bossowski
Magdalena M. Brzozka
Małgorzata Gietka-Czernel
Alicja Hubalewska-Dydejczyk
Beata Kos-Kudła
Andrzej Lewiński
Anhelli Syrenicz
Wojcech Zgliczyński

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