This a somewhat odd paper. It says:
Secondly, free-T4 and free-T3 values were not available for all patients because of the use of reflex TSH in clinical practice.
But just what is an improved TSH? Lower, I understand.
The paper also says:
Secondly, free-T4 and free-T3 values were not available for all patients because of the use of reflex TSH in clinical practice.
Which yet again demonstrates the short-term, short-sighted approach of reflex testing (not doing FT3 if FT4 is in range, not doing FT4 if TSH is in range). Even when serious research is attempted it is stymied because the information was flushed away without being analysed.
And Tirosint is still not available in the UK. 
Front Endocrinol (Lausanne). 2018; 9: 118.
Published online 2018 Mar 21. doi: 10.3389/fendo.2018.00118
PMCID: PMC5871661
PMID: 29619010
Thyroxine Treatment With Softgel Capsule Formulation: Usefulness in Hypothyroid Patients Without Malabsorption
Pierpaolo Trimboli,1,*† Camilla Virili,2,† Marco Centanni,2 and Luca Giovanella1
1Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
2Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
Edited by: Alessandro Antonelli, Università degli Studi di Pisa, Italy
Reviewed by: Silvia Martina Ferrari, Università degli Studi di Pisa, Italy; Roberto Vita, Università degli Studi di Messina, Italy
†These authors have contributed equally to this work.
Abstract
Background
Levothyroxine sodium (LT4) is the therapy of choice for hypothyroidism. In the last decade, new LT4 formulations, such as liquid and softgel capsules, became available. Even if some evidence has been reached in the efficacy of liquid LT4 in patients with suboptimal TSH on tablet LT4, the usefulness of softgel LT4 has been rarely studied. This study aimed at evaluating the effect of switching from tablet to softgel LT4 patients without increased need for LT4. TSH was used as proxy of LT4 bioavailability and effectiveness.
Methods
During the period from April to August 2017, 19 patients on tablet LT4 treatment for hypothyroidism, mostly due to autoimmune thyroiditis, were enrolled. Subjects with causes of malabsorption or increased requirement of LT4 were previously excluded. Patients finally included were asked to switch from tablet to softgel LT4 formulation at unchanged dose and ingestion fashion (30 min before breakfast). TSH was measured with chemiluminescence immunoassays.
Results
According to exclusion and inclusion criteria, 19 patients were finally selected. One of these had headache 4 days later and come back to tablet LT4, and 18 of them (16W/2M; mean age = 55 years; BMI 22.7 kg/m2) completed the study. They were treated with a median LT4 dose of 88 μg/day and showed a median TSH value of 3.33 mIU/L. The rate of cases with TSH ≤ 4.0 mIU/L was 61.1% (11/18 cases). When patients were re-evaluated after 3 months of softgel LT4, we observed that TSH reached levels under 4.0 mIU/L in 16/18 (88.9%) patients, TSH was lower in 11 cases, and in 6 out of 7 patients with pre-switch TSH values over the normal range. Overall, TSH values on softgel LT4 (median 1.90 mIU/L) was significantly lower from that observed during tablet LT4 (p = 0.0039).
Conclusion
These data show that hypothyroid patients with no proven malabsorption may have an improved TSH following 3 months from the switch from tablet to softgel LT4 preparation at unchanged dose.
Keywords: hypothyroidism, thyroxine absorption, softgel, levothyroxine, drugs dissolution
Rest of paper here:
