Levothyroxine absorption, liquid levothyroxine, issues and questions

[helvella]

I quote from this paper:

These results strongly suggest that normal gastric acid secretion is necessary for the effective absorption of oral thyroxine

Is it any surprise that some people seem to need high doses when stomach issues are so prevalent?

Please note that the liquid levothyroxine referred to is, I think, not the same as the products available in the UK. There is mention of the product used containing alcohol which neither of the products available in the UK have.

It is also completely unclear whether DIY liquid levothyroxine might have any benefits over tablets. By that I mean crushing and dispersing tablets in water, with or without a dash of vodka. Crushing and dispersing is mentioned in some UK Patient Information Leaflets as perfectly acceptable so long as they are done just before use.

Full paper is linked at end - free access!

BMC Gastroenterol. 2016; 16: 22.

Published online 2016 Feb 24. doi: 10.1186/s12876-016-0439-y

PMCID: PMC4787146

Reversible normalisation of serum TSH levels in patients with autoimmune atrophic gastritis who received L-T4 in tablet form after switching to an oral liquid formulation: a case series

L-thyroxine (L-T4) malabsorption is a potential concern in patients with autoimmune atrophic gastritis.

Methods

We evaluated five patients with autoimmune gastritis, who showed high serum thyrotropin (TSH) levels (in the hypothyroid range) while in therapy with L-T4 in tablet. All patients were switched to receive an oral L-T4 liquid formulation maintaining the same dosage.

Results

In all patients who received L-T4 in tablet form after switching to an oral liquid formulation with the same L-T4 dosage, TSH circulating levels were normalized. In four patients who were switched back again to receive L-T4 in tablets, maintaining the dosage, TSH levels worsened again reaching levels in the hypothyroid range.

Conclusions

The fact that the change from tablets to liquid oral formulation normalised serum TSH levels, and that switching back to tablets caused thyrotropin levels to worsen, leads us to believe that absorption of L-T4 is greater with oral liquid formulations in these patients. These results suggest that the L-T4 oral liquid formulation could circumvent the pH alteration resulting from atrophic gastritis.

Keywords: L-thyroxine, Liquid L-thyroxine, Hypothyroidism, Gastritis

ncbi.nlm.nih.gov/pmc/articl...

Oral L-thyroxine liquid versus tablet in patients with hypothyroidism without malabsorption: a prospective study.

ncbi.nlm.nih.gov/pubmed/267...

IN PATIENTS WITH SUBCLINICAL HYPOTHYROIDISM WHILE IN THERAPY WITH TABLET L-T4, THE LIQUID L-T4 FORMULATION IS MORE EFFECTIVE IN RESTORING EUTHYROIDISM.

ncbi.nlm.nih.gov/pubmed/278...

TSH Normalization in Bariatric Surgery Patients After the Switch from L-Thyroxine in Tablet to an Oral Liquid Formulation.

ncbi.nlm.nih.gov/pubmed/272...

[Clutter]

Thanks for posting, Helvella.