Article on storage of T4 tablets

[diogenes]

Here is a very recent case study article showing the need to take care in storing T4 tablets. It's one more thing to look out for, but I would think that only rarely would someone routinely mis-store tablets.

CASE REPORT ARTICLE

Front. Endocrinol., 10 July 2017 | doi.org/10.3389/fendo.2017....

Refractory Hypothyroidism Due to Improper Storage of Levothyroxine Tablets

Salvatore Benvenga, Giampaolo Papi and Alessandro Antonelli

The article is easily available for anyone interested - just go to Articles in the site "Frontiers in Thyroid Endocrinology".

[cwill]

Goodness this patient worked quite hard to add light, heat and humidity to the medication.

[diogenes Remembering in reply to cwill]

I think it's just wise to a) keep the bottle top tightly screwed on, and b) keep the bottle in the dark and not on an open shelf.

[Clutter]

I wonder whether decanting into weekly pill dispensers speeds up degradation?

[SlowDragon Administrator in reply to Clutter]

I find it does noticeably for vitamin B complex so I don't decant that

I think I shall have to move my Levo weekly dispenser storage from on top of bedside table into a drawer

[Rapunzel]

Dark and dry seems to be the order of the day. My Nature Throid is kept in its opaque canister with the silica packet and my T3 in the wardrobe, only removed to my bedside drawer 1 ten pill blister pack at a time.

I'd imagine so long as your hands were dry and clean when dispensing into the compartments and then the box was kept clean dark and dry, all would be well over the course of a week.

[helvella Administrator]

Am surprised that the paper suggests there is so little information, and so few reports.

Reason: In Australia a few years ago, everyone is told to store levothyroxine in the refrigerator. This was to ensure that the product had an acceptably long time to expiry. Apparently they had the choice of shortening expiry dates or requiring refrigeration.

There simply must have been reported issues in Australia for this to have become such an issue. Maybe they didn't get reported outside the country?

[Note: Storage in refrigerator does not mean frequent moving of opened containers between the refrigerator and ambient conditions. The trouble is that a cold item coming into warm and humid air will cause condensation - one of the other major degradation factors. If in a pot, leave sealed until it has reached room temperature.]

[SlowDragon Administrator]

I noticed this remark about PPI's .......how many GP's here ever consider PPI as inhibiting thyroid medication, yet its obviously a well recognised issue

Twelve percent of these 1,500 patients (180 or 60 patients per year) have refractory hypothyroidism caused by pseudomalabsorption or true malabsorption (e.g., celiac disease, protonic pump-inhibitors, etc.)