Effect of phosphate binders upon TSH and l-thyroxine dose in patients on thyroid replacement
@article{Diskin2007EffectOP, title={Effect of phosphate binders upon TSH and l-thyroxine dose in patients on thyroid replacement}, author={Charles J Diskin and Thomas J. Stokes and Linda M. Dansby and Lautrec Radcliff and Thomas B. Carter}, journal={International Urology and Nephrology}, year={2007}, volume={39}, pages={599-602} }
BackgroundWhile calcium carbonate is known to interfere with the gastrointestinal absorption of levothyroxine, we hypothesized that other phosphate binders would also bind to levothyroxine and decrease bioavailability of levothyroxine in dialysis patients.MethodsThe records of 1,566 patients on hemodialysis who were being treated by the Hypertension, Nephrology, Dialysis, and Transplantation Center (the regional renal referral center for Eastern Alabama, USA) were evaluated. The type of…
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Liquid levothyroxine is resistant to the sequestration by calcium or iron, and the high rate of thyroid-stimulating hormone normalization already at the first check (6–8 weeks) should avoid frequent adjustments in lev Timothyroxine doses and assays of Thyroid- Stimulating hormone, with consequent financial savings.
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- 2011
Hypothyroid patients should be cautioned to take their levothyroxine well-separated from all of these calcium formulations, as the effect of calcium is modest compared with some other medications previously studied.
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- 2013
Levothyroxine administration with breakfast could be an alternative regimen for patients who have adherence difficulties due to the need for delaying intake, and is more likely to cause variability in the TSH level, meaning the patient should be followed more closely.
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- 2010
Differences between those who developed subclinical or overt hypothyroidism versus those who remained euthyrotic could not be explained by age, weight, levothyroxine dose, type of EN formula, or amount of EN received.
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The available data showed that novel levothyroxine formulations circumvent gastric pH impairment due to multiple interfering drugs such as proton pump inhibitors, calcium or iron supplements, sevelamer, aluminum/magnesium hydroxide and sodium alginate.
Concurrent Milk Ingestion Decreases Absorption of Levothyroxine.
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This is the first study to demonstrate that concurrent cow's milk ingestion reduces oral levothyroxine absorption, supporting previous literature showing the interference of elemental calcium and food with thyroid hormone absorption.
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Clinicians should carefully consider adjusting levothyroxine therapy in presence of concomitant drugs, such as proton-pump inhibitors, which may reduce lev Timothyroxine bioavailability.
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