December 10, 2015
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Levothyroxine ingested at breakfast may improve adherence

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Therapeutic compliance may be improved in patients with hypothyroidism with ingestion of a liquid levothyroxine formulation at breakfast, according to results of the TICO study.

According to the researchers, current guidelines recommend levothyroxine treatment after a fasting period, which may negatively affect medication adherence.

Carlo Cappelli, MD, of the endocrine and metabolic unit at the University of Brescia in Italy, and colleagues evaluated 77 adults (median age, 45.4 years) with hypothyroidism who were previously untreated to determine the effect of levothyroxine consumption at breakfast or 30 minutes before breakfast on serum thyroid-stimulating hormone levels.

All participants completed two 6-week treatment periods: placebo before breakfast and active levothyroxine at breakfast or levothyroxine 30 minutes before breakfast. TSH, free thyroxine and free triiodothyronine were measured at the end of each period.

After the first period treatment, similar numbers of participants achieved euthyroidism. Participants whose TSH levels were more than 4.2 mIU/L had their levothyroxine dose adjusted, continued treatment and, eventually, achieved euthyroidism.

No differences were found between the treatment types for serum TSH, free T4 or free T3 levels. Similarly, the treatment types did not affect levothyroxine dose or posttreatment TSH values.

“The present study suggests that a liquid [levothyroxine] formulation can be ingested directly at breakfast, thus potentially improving therapeutic compliance,” the researchers wrote. “This observation is of considerable clinical relevance, given that subjects who do not comply with [levothyroxine] therapy requirements are more likely to show variability in TSH concentrations and consequent unwanted effects.” – by Amber Cox

Disclosure: The researchers report no relevant financial disclosures.