Novel thyroxine formulations: a further step to... - Thyroid UK

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Novel thyroxine formulations: a further step toward precision medicine

helvella profile image

An interesting little paper. Rather limited but possibly worth a few minutes of reading.

Novel thyroxine formulations: a further step toward precision medicine

• Authors

• Camilla Virili

• Pierpaolo Trimboli

• Marco Centanni

• Camilla Virili

First Online: 15 October 2019


Levothyroxine (T4) is a critical-dose drug, because little variations in the blood concentration may cause treatment failure as well as iatrogenic thyrotoxicosis. Despite the dose response of this drug being more carefully titrated nowadays, several papers still report that a significant fraction of patients treated with levothyroxine demonstrate a TSH which is not on target. Moreover, some widespread gastrointestinal disorders as well as interfering drugs and foods may cause the “refractoriness” of a significant number of patients to an expected dose of thyroxine. The increasing awareness of the mechanisms interfering with the oral thyroid hormone bioavailability and the body of evidence regarding the complexity of treatment in certain classes of patients prompted pharmaceutical research to identify new hormonal formulations to optimize the performance of this drug. In this brief review, the progression of the scientific knowledge of novel T4 formulations use has been analyzed.


Liquid levothyroxine Softgel thyroxine Thyroxine absorption Thyroxine malabsorption Drugs dissolution Gastrointestinal disorders

Full paper freely available here:


10 Replies

haven't read it all, but this leapt out at me! "a significant fraction of patients treated with levothyroxine demonstrate a TSH which is not on target. "

They still insist that TSH is the "Target"!!!

helvella profile image
helvellaAdministrator in reply to

I very much agree about that - it was more the rest of the paper that had some interest.

in reply to helvella

Yes. It's just that one tends to notice the TSH brainwashing in even good research papers and articles!

NWA6 profile image
NWA6 in reply to

I agree I’m peeved at this TSH business ruling our lives. Even my private Endo who prescribed me T3 has said a couple of time’s ‘well your TSH is not completely suppressed (it’s 0.003) so we’ll carry on’ Although it may be that he’s thinking of how he can justify himself if anyone cane asking. That’s what I’m hoping anyway. That it’s not him, it’s what others in his field will say.

Murphysmum profile image
Murphysmum in reply to NWA6

I agree. I was very impressed with my endo until the end of the conversation when she said something about suppressed TSH and I said “but that’s to be expected on T3, isn’t it?” And she said “well, it’s not ideal, it’s bad for your bones. Problem is we just don’t know yet”.

I felt like saying “I’ll take the risk, thanks” which is exactly what I’ll say if the subject is raised again! 🙄

Interesting paper though, thanks helvella

Thank you helvella for your post . While there is some validity that different T4 formulas work better for some than others . And Gut /digestion /liver/gallbladder are important to work *Optimally* for our T4 to help convert to T3 to benefit us better. TSH is still *Not* the way to treat thyroid patients sole. TSH is a pituitary marker and not a thyroid marker. Therefore TSH can *Not* be the *Target*as they would want us to believe.

helvella profile image
helvellaAdministrator in reply to jgelliss

As my reply above, I agree about the TSH target being the wrong approach.

jgelliss profile image
jgelliss in reply to helvella

helvella I think thou I can be wrong that by now most thyroid meds depended patients are clear that dosing by TSH Only is the wrong way to dose and they can not feel *Optimal*. Thank you for the awareness of this point. Very Valuable.

Very interesting especially for me he ppi references.

Thanks for posting this, I'm really interested by it. My entire endocrine system started going 'wonky' (seems as accurate a diagnosis as I'm going to get from anyone tbf) steadily getting worse over the last two years. Also over the last four or five years my gut has been causing me serious problems. I also had bariatric surgery in 2009 so I don't have much in the way of a stomach and have a considerably shorter intestine. I can't help but wonder if I might benefit from a liquid formula. That said, I hope to god they've improved it since I had to take liquid meds post surgery 🤢. I recall it having a taste I alikened to severely gone off chicken soup, I struggled so hard to take it and I'm not particularly fussy when it comes to yucky meds usually. My GP, however, is so fixed on a diagnosis of PMDD and that it is all just me being sensitive to normal hormonal fluctuations, she has referred me to gynae and isn't prepared to consider that it could be as a result of thyroid or adrenal issues. I'm on levothyroxine so that's my thyroid sorted right? 😉

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