Up to one-third of patients treated with levothyroxine for primary hypothyroidism have biochemical evidence of inadequate thyroid hormone replacement. Could treatment effects of levothyoxine be optimized by bedtime administration on an empty stomach? A new study reveals the answer and also sheds light on other possible benefits of this alternative timing.
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References
Vaidya, B. & Pearce, S. H. Management of hypothyroidism in adults. BMJ 337, a801 (2008).
Bolk, N., Visser, T. J., Kalsbeek, A., van Domburg, R. T. & Berghout, A. Effects of evening vs morning thyroxine ingestion on serum thyroid hormone profiles in hypothyroid patients. Clin. Endocrinol. (Oxf.) 66, 43–48 (2007).
Bolk, N. et al. Effects of evening vs morning levothyroxine intake: a randomized double-blind crossover trial Arch. Intern. Med. 170, 1996–2003 (2010).
Parle, J. V., Franklyn, J. A., Cross, K. W., Jones, S. R. & Sheppard, M. C. Thyroxine prescription in the community: serum thyroid stimulating hormone level assays as an indicator of undertreatment or overtreatment. Br. J. Gen. Pract. 43, 107–109 (1993).
Somwaru, L. L., Arnold, A. M., Joshi, N., Fried, L. P. & Cappola, A. R. High frequency of and factors associated with thyroid hormone over-replacement and under-replacement in men and women aged 65 and over. J. Clin. Endocrinol. Metab. 94, 1342–1345 (2009).
Okosieme, O. E., Belludi, G., Spittle, K., Kaiyala, R. & Richards, J. Adequacy of thyroid hormone replacement in a general population. QJM doi:10.1093/qjmed/hcq222.
Bach-Huynh, T. G., Nayak, B., Loh, J., Soldin, S. & Jonklaas, J. Timing of levothyroxine administration affects serum thyrotropin concentration. J. Clin. Endocrinol. Metab. 94, 3905–3912 (2009).
Saranavan, P., Visser, T. J. & Dayan, C. M. Psychological well-being correlates with free thyroxine but not free 3, 5, 3′-triiodothyronine levels in patients on thyroid hormone replacement. J. Clin. Endocrinol. Metab. 91, 3389–3393 (2006).
Walsh, J. P. et al. Small changes in thyroxine dosage do not produce measurable changes in hypothyroid symptoms, well-being, or quality of life: results of a double-blind randomized clinical trial. J. Clin. Endocrinol. Metab. 91, 2624–2630 (2006).
Fish, L. H. et al. Replacement dose, metabolism, and bioavailability of levothyroxine in the treatment of hypothyroidism. Role of triiodothyronine in pituitary feedback in humans. N. Engl. J. Med. 316, 764–770 (1987).
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Vanderpump, M. Hypothyroidism—should levothyroxine be taken at bedtime?. Nat Rev Endocrinol 7, 195–196 (2011). https://doi.org/10.1038/nrendo.2011.29
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DOI: https://doi.org/10.1038/nrendo.2011.29