Cappelli Carlo, Pirola Ilenia, Castellano Maurizio
Department of Clinical and Experimental Sciences, SSD Medicina Ad Indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia 25123, Italy.
Case Rep Endocrinol. 2020 Sep 5;2020:8858887. doi: 10.1155/2020/8858887. eCollection 2020.
Levothyroxine (L-T4) is among the most widely prescribed medications in the world, and it is considered by the World Health Organization an essential medicine for basic health care. Replacement therapy has always been considered straightforward although different factors may interfere with intestinal absorption of L-T4, including food, dietary fibre, coffee, drugs, and gastrointestinal diseases. For these reasons, current guidelines recommend that L-T4 should be taken in a fasting state because its absorption is maximised when it is taken on an empty stomach, reflecting the importance of gastric acidity in the absorption process. In addition to sodium L-T4 in tablet form, various formulations (soft-gel capsules and liquid solutions) have become available for clinical use in the last years promising improved absorption. We described a 31-year-old Italian man who took liquid levothyroxine formulation during lunch. He was under replacement therapy with liquid levothyroxine 75 mcg daily for hypothyroidism due to Hashimoto thyroiditis for three years. During confirmation of the L-T4 replacement therapy, the patient stated that he was going to continue to "take liquid levothyroxine during (his) lunch every day." We recommended taking the medication correctly in the morning at least thirty minutes before breakfast and repeating TSH, fT4, and fT3 after three months. The thyroid hormonal profiles taken after 3 and 6 months were comparable to those when the patient was taking the medication during lunch. In conclusion, liquid levothyroxine formulation should be preferred in case of malabsorption or potential malabsorption. Liquid formulation should be preferred due to the possibility of taking it during breakfast, which significantly improves the compliance of patients. Further studies are needed to evaluate the possibility of taking liquid L-T4 during lunch.
左甲状腺素（L-T4）是世界上处方量最广泛的药物之一，世界卫生组织将其视为基本医疗保健的 essential medicine。尽管不同因素可能会干扰L-T4的肠道吸收，包括食物、膳食纤维、咖啡、药物和胃肠道疾病，但替代疗法一直被认为很简单。由于这些原因，目前的指南建议L-T4应在空腹状态下服用，因为空腹服用时其吸收最大化，这反映了胃酸在吸收过程中的重要性。除了片剂形式的左甲状腺素钠，近年来各种制剂（软胶囊和液体溶液）已可供临床使用，有望提高吸收率。我们描述了一名31岁的意大利男子，他在午餐时服用液体左甲状腺素制剂。他因桥本甲状腺炎导致甲状腺功能减退，接受每日75微克液体左甲状腺素替代治疗三年。在确认L-T4替代治疗期间，患者表示他将继续“每天午餐时服用液体左甲状腺素”。我们建议在早餐前至少三十分钟的早晨正确服用该药物，并在三个月后复查促甲状腺激素（TSH）、游离甲状腺素（fT4）和游离三碘甲状腺原氨酸（fT3）。3个月和6个月后采集的甲状腺激素谱与患者午餐时服用该药物时的谱相当。总之，在吸收不良或潜在吸收不良的情况下，应首选液体左甲状腺素制剂。由于可以在早餐时服用，液体制剂应更受青睐，这显著提高了患者的依从性。需要进一步研究来评估午餐时服用液体L-T4的可能性。
