title: Advancements in the treatment of hypothyroidism with L-T4 liquid formulation or soft gel capsule: an update.
abstract: The most recent advance concerning levothyroxine (L-T4) therapy is the development of novel oral formulations: the liquid preparation, and the soft gel capsule. Areas covered: This review evaluates the most recent clinical studies about these new formulations. The liquid formulation has been shown to overcome: the food and beverages intereference with L-T4 tablets absorption, caused by food or coffee at breakfast; malabsorption induced by the increased gastric pH, resulting from atrophic gastritis, or due to proton-pump inhibitors; and malabsorption after bariatric surgery. The use of liquid L-T4 has been studied also in pregnancy, newborns and infants, suggesting a better bioequivalence than tablets. Finally, liquid L-T4 is more active than tablets in the control of thyroid-stimulating hormone (TSH) in hypothyroid patients without malabsorption, drug interference, or gastric disorders, leading to a hypothesized higher absorption of liquid L-T4 also in these patients. Few studies have evaluated soft gel L-T4 with promising results in patients with malabsorption related to coffee or gastritis. Expert opinion: Liquid L-T4 (and soft gel capsules) are more active than the tablet L-T4 in the control of TSH in hypothyroid patients with gastric disorders, malabsorption, or drug interference, but also in patients without absorption disorders.
authors.affiliation: a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy.
authors.forename: Poupak
authors.initials: P
authors.lastname: Fallahi
authors.affiliation: a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy.
authors.forename: Silvia Martina
authors.initials: SM
authors.lastname: Ferrari
authors.affiliation: a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Ruffilli
authors.affiliation: a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ragusa
authors.affiliation: b Department of Surgical, Medical, Molecular Pathology and Critical Area , University of Pisa , Pisa , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Biricotti
authors.affiliation: b Department of Surgical, Medical, Molecular Pathology and Critical Area , University of Pisa , Pisa , Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Materazzi
authors.affiliation: b Department of Surgical, Medical, Molecular Pathology and Critical Area , University of Pisa , Pisa , Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Miccoli
authors.affiliation: a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonelli
mesh_terms: D002214:Capsules; D002626:Chemistry, Pharmaceutical; D003069:Coffee / Q000009:adverse effects; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy*; D013607:Tablets; D013810:Therapeutic Equivalency; D013972:Thyrotropin / Q000378:metabolism*; D013974:Thyroxine / Q000008:administration & dosage*
chemical_list: D002214:Capsules; D003069:Coffee; D013607:Tablets; D013972:Thyrotropin; D013974:Thyroxine
keywords: Bariatric surgery; L-T4; PPI; drug interference; gastritis; liquid L-T4; malabsorption; soft gel L-T4; tablet L-T4