Thyroid UK

Review showing liquid T4 superior to tablet if by tablet you cannot take in enough to lower your TSH

Anoher review downloadable which demonstrates that if a patient cennot take in sufficient T4 by tablet, liquid formulation gives better uptake and reduces TSH more.

Front. Endocrinol. | doi: 10.3389/fendo.2018.00010

LEVOTHYROXINE THERAPY: CHANGES OF TSH LEVELS BY SWITCHING PATIENTS FROM TABLET TO LIQUID FORMULATION. A SYSTEMATIC REVIEW AND META-ANALYSIS.

Camilla Virili1*, Luca Giovanella2, Poupak Fallahi3, Alessandro Antonelli3, Maria Giulia Santaguida1, Marco Centanni1 and Pierpaolo Trimboli2

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Can you get liquid T4 in uk?

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Unfortunately the wretched company Concordia (AmCo) are suppliers of 100 ug T4 in liquid form. But their prices, like all the other drugs may be extortionate. Possibly TEVA also do it

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Just another form of medication we won’t have access to then.

Will this help non convertersat all?

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No not poor converters. But there are significant numbers of patients with poor intestinal absorption. Liquid T4 will start to enter the body direct in the stomach, so better intake freer from food interference should happen.

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There is also Tirosint-SOL which has recently been given the go-ahead but I think that is only in Europe.

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Thanks for posting and it could help lots of people if they cannot cope with levothyroxine.

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TEVA do a oral solution LT4 which is vegetarian and has the sickly sugar syrup glycol in it - so ok to take in small doses e.g. < 5ml [= 25mcg] but perhaps not in large doses if you have gut problems... I have had SIBO and candidasis so had to go over to tablets and the equivalent dose caused my FT4 value to slump as I absorb the tablets badly!

Its about £90 for a 100ml bottle

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Diogenes, I can't find this paper - do you have a link for it please?

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Write " Frontiers in Thyroid Endocrinology". The site will come up and look for the recent papers file.

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Thanks! Very strange, though, that it didn't come up in any Google search I did! :-)

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diogenes,

Many levothyroxine products state in their patient information that it is acceptable for those who cannot swallow tablets to disperse the tablets in water, and swallow that. I wonder if doing so would have some of the benefit of the "official" liquid formulations - but without the cost implications?

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The trouble is that T4 is quite insoluble in water, so is unlikely to leave the bits of solid still floating about. The liquid formulation has additives that help solubility.

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diogenes,

In what substances is levothyroxine soluble?

Is there anything we could sensibly use to really dissolve it rather than just disperse? I am thinking of the Italian Liotir (liothyronine) which contains a significant amount of ethanol.

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ethanol or even perhaps glycerol might help. Another way is to mix it with albumin to which it will bind. Then the stomach will destroy the albumin releasing the T4. This is like using albumin as a tablet.

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