Skip to main content

Advertisement

SpringerLink
Log in

Prevalence of gastrointestinal disorders having an impact on tablet levothyroxine absorption: should this formulation still be considered as the first-line therapy?

  • Review
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Purpose

In patients with hypothyroidism, levothyroxine (LT4) is the treatment of choice, and tablets are the most commonly prescribed formulation. Despite multiple scenarios being reported in the literature with impaired tablet absorption and likely missed TSH targets, it is yet unclear what the implications are for clinical practice and the role of liquid solution (LS) and soft gel (SG) formulations. We have thus conducted a narrative review evaluating the prevalence within the general population of gastrointestinal disorders impacting tablet LT4 absorption.

Methods

PubMed and Google Scholar were searched until December 2019 for systematic reviews and meta-analyses on the topic. If they could not be retrieved, other types of manuscripts were searched.

Results

Lactose malabsorption and Helicobacter pylori infection represented the most common disorders, with a global prevalence of 68% and 48%, respectively. The prevalence of other conditions, including autoimmune gastritis, bariatric surgery, celiac disease, gastroparesis, giardiasis, liver cirrhosis, or ulcerative colitis, was lower than 20%. Data at regional and country levels were found to be heterogeneous, but at least one in five patients was diagnosed with one disorder.

Conclusions

The worldwide prevalence of gastrointestinal disorders associated with tablet LT4 malabsorption, including lactose malabsorption and Helicobacter pylori infection, is high. Interactions with drugs or food can further increase this risk. Considering that all studies investigating the impact of switching patients from tablet to LS or SG found an improved thyroid balance, the latter formulations should be considered as first-line therapy for managing hypothyroidism.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

References

  1. S.H. Pearce, G. Brabant, L.H. Duntas, F. Monzani, R.P. Peeters, S. Razvi, J.L. Wemeau, 2013 ETA guideline: management of subclinical hypothyroidism. Eur. Thyroid J. 2, 215–228 (2013)

    CAS  PubMed  PubMed Central  Google Scholar 

  2. L. Chaker, A.C. Bianco, J. Jonklaas, R.P. Peeters, Hypothyroidism. Lancet 390, 1550–1562 (2017)

    CAS  PubMed  PubMed Central  Google Scholar 

  3. P.N. Taylor, D. Albrecht, A. Scholz, G. Gutierrez-Buey, J.H. Lazarus, C.M. Dayan, O.E. Okosieme, Global epidemiology of hyperthyroidism and hypothyroidism. Nat. Rev. Endocrinol. 14, 301–316 (2018)

    PubMed  Google Scholar 

  4. B. Biondi, D.S. Cooper, Thyroid hormone therapy for hypothyroidism. Endocrine 66, 18–26 (2019)

    CAS  PubMed  Google Scholar 

  5. N. Rodondi, W.P. den Elzen, D.C. Bauer, A.R. Cappola, S. Razvi, J.P. Walsh, B.O. Asvold, G. Iervasi, M. Imaizumi, T.H. Collet, A. Bremner, P. Maisonneuve, J.A. Sgarbi, K.T. Khaw, M.P. Vanderpump, A.B. Newman, J. Cornuz, J.A. Franklyn, R.G. Westendorp, E. Vittinghoff, J. Gussekloo, Thyroid studies collaboration: subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA 304, 1365–1374 (2010)

    CAS  PubMed  PubMed Central  Google Scholar 

  6. E.K. Alexander, E.N. Pearce, G.A. Brent, R.S. Brown, H. Chen, C. Dosiou, W.A. Grobman, P. Laurberg, J.H. Lazarus, S.J. Mandel, R.P. Peeters, S. Sullivan, 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 27, 315–389 (2017)

    PubMed  Google Scholar 

  7. Z. Shan, W. Teng, Thyroid hormone therapy of hypothyroidism in pregnancy. Endocrine 66, 35–42 (2019)

    CAS  PubMed  Google Scholar 

  8. N.J. McGriff, G. Csako, L. Gourgiotis, C.G. Lori, F. Pucino, N.J. Sarlis, Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer. Ann. Med. 34, 554–564 (2002)

    CAS  PubMed  Google Scholar 

  9. J. Lazarus, R.S. Brown, C. Daumerie, A. Hubalewska-Dydejczyk, R. Negro, B. Vaidya, 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur. Thyroid J. 3, 76–94 (2014)

    CAS  PubMed  PubMed Central  Google Scholar 

  10. J. Jonklaas, A.C. Bianco, A.J. Bauer, K.D. Burman, A.R. Cappola, F.S. Celi, D.S. Cooper, B.W. Kim, R.P. Peeters, M.S. Rosenthal, A.M. Sawka, American Thyroid Association Task Force on thyroid hormone replacement: guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association task force on thyroid hormone replacement. Thyroid 24, 1670–1751 (2014)

    PubMed  PubMed Central  Google Scholar 

  11. B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov, F. Pacini, G.W. Randolph, A.M. Sawka, M. Schlumberger, K.G. Schuff, S.I. Sherman, J.A. Sosa, D.L. Steward, R.M. Tuttle, L. Wartofsky, 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid 26, 1–133 (2016)

    PubMed  PubMed Central  Google Scholar 

  12. G. Grani, V. Ramundo, A. Verrienti, M. Sponziello, C. Durante, Thyroid hormone therapy in differentiated thyroid cancer. Endocrine 66, 43–50 (2019)

    CAS  PubMed  Google Scholar 

  13. C. Virili, P. Trimboli, M. Centanni, Novel thyroxine formulations: a further step toward precision medicine. Endocrine 66, 87–94 (2019)

    CAS  PubMed  Google Scholar 

  14. M. Skelin, T. Lucijanić, D. Amidžić Klarić, A. Rešić, M. Bakula, A.M. Liberati-Čizmek, H. Gharib, D. Rahelić, Factors affecting gastrointestinal absorption of levothyroxine: a review. Clin. Ther. 39, 378–403 (2017)

    CAS  PubMed  Google Scholar 

  15. J.R. Garber, R.H. Cobin, H. Gharib, J.V. Hennessey, I. Klein, J.I. Mechanick, R. Pessah-Pollack, P.A. Singer, K.A. Woeber, American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on hypothyroidism in adults: Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 22, 1200–1235 (2012)

    CAS  PubMed  Google Scholar 

  16. C. Virili, A. Antonelli, M.G. Santaguida, S. Benvenga, M. Centanni, Gastrointestinal malabsorption of thyroxine. Endocr. Rev. 40, 118–136 (2019)

    PubMed  Google Scholar 

  17. S. Benvenga, L. Bartolone, S. Squadrito, F. Lo Giudice, F. Trimarchi, Delayed intestinal absorption of levothyroxine. Thyroid 5, 249–253 (1995)

    CAS  PubMed  Google Scholar 

  18. M. Cellini, M.G. Santaguida, I. Gatto, C. Virili, S.C. Del Duca, N. Brusca, S. Capriello, L. Gargano, M. Centanni, Systematic appraisal of lactose intolerance as cause of increased need for oral thyroxine. J. Clin. Endocrinol. Metab. 99, E1454–E1458 (2014)

    CAS  PubMed  Google Scholar 

  19. M. Centanni, L. Gargano, G. Canettieri, N. Viceconti, A. Franchi, G. Delle Fave, B. Annibale, Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis. N. Engl. J. Med. 354, 1787–1795 (2006)

    CAS  PubMed  Google Scholar 

  20. C. Virili, G. Bassotti, M.G. Santaguida, R. Iuorio, S.C. Del Duca, V. Mercuri, A. Picarelli, P. Gargiulo, L. Gargano, M. Centanni, Atypical celiac disease as cause of increased need for thyroxine: a systematic study. J. Clin. Endocrinol. Metab. 97, E419–E422 (2012)

    CAS  PubMed  Google Scholar 

  21. N. Bolk, T.J. Visser, A. Kalsbeek, R.T. van Domburg, A. Berghout, Effects of evening vs morning thyroxine ingestion on serum thyroid hormone profiles in hypothyroid patients. Clin. Endocrinol. 66, 43–48 (2007)

    CAS  Google Scholar 

  22. G. Fiorini, D. Ribichini, R. Pasquali, D. Vaira, In vivo dissolution of levothyroxine soft gel capsules. Intern. Emerg. Med. 11, 1151–1152 (2016)

    PubMed  Google Scholar 

  23. S. Benvenga, A. Carlé, Levothyroxine formulations: pharmacological and clinical implications of generic substitution. Adv. Ther. 36, 59–71 (2019)

    PubMed  PubMed Central  Google Scholar 

  24. I. Laurent, S. Tang, M. Astère, K.R. Wang, S. Deng, L. Xiao, Q.F. Li, Liquid L-thyroxine versus tablet L-thyroxine in patients on L- thyroxine replacement or suppressive therapy: a meta-analysis. Endocrine 61, 28–35 (2018)

    CAS  PubMed  Google Scholar 

  25. C. Virili, L. Giovanella, P. Fallahi, A. Antonelli, M.G. Santaguida, M. Centanni, P. Trimboli, Levothyroxine therapy: changes of TSH levels by switching patients from tablet to liquid formulation. a systematic review and meta-analysis. Front. Endocrinol. (Lausanne) 9, 10 (2018)

    Google Scholar 

  26. C.L. Storhaug, S.K. Fosse, L.T. Fadnes, Country, regional, and global estimates for lactose malabsorption in adults: a systematic review and meta-analysis. Lancet Gastroenterol. Hepatol. 2, 738–746 (2017)

    PubMed  Google Scholar 

  27. J.K.Y. Hooi, W.Y. Lai, W.K. Ng, M.M.Y. Suen, F.E. Underwood, D. Tanyingoh, P. Malfertheiner, D.Y. Graham, V.W.S. Wong, J.C.Y. Wu, F.K.L. Chan, J.J.Y. Sung, G.G. Kaplan, S.C. Ng, Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology 153, 420–429 (2017)

    PubMed  Google Scholar 

  28. P. Singh, A. Arora, T.A. Strand, D.A. Leffler, C. Catassi, P.H. Green, C.P. Kelly, V. Ahuja, G.K. Makharia, Global prevalence of celiac disease: systematic review and meta-analysis. Clin. Gastroenterol. Hepatol. 16, 823–836 (2018)

    PubMed  Google Scholar 

  29. S.C. Ng, H.Y. Shi, N. Hamidi, F.E. Underwood, W. Tang, E.I. Benchimol, R. Panaccione, S. Ghosh, J.C.Y. Wu, F.K.L. Chan, J.J.Y. Sung, G.G. Kaplan, Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet 390, 2769–2778 (2018)

    Google Scholar 

  30. The International Federation for the Surgery of Obesity and Metabolic Disorders. Fourth IFSO Global Registry Report 2018. https://www.ifso.com/pdf/4th-ifso-global-registry-report-last-2018.pdf. Accessed 10 Oct 2019

  31. World Health Organization. Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed 10 Oct 2019

  32. E.M. Wolf, W. Plieschnegger, M. Geppert, B. Wigginghaus, G.M. Höss, A. Eherer, N.I. Schneider, A. Hauer, P. Rehak, M. Vieth, C. Langner, Changing prevalence patterns in endoscopic and histological diagnosis of gastritis? data from a cross-sectional Central European multicentre study. Dig. Liver Dis. 46, 412–418 (2014)

    PubMed  Google Scholar 

  33. I. Coati, M. Fassan, F. Farinati, D.Y. Graham, R.M. Genta, M. Rugge, Autoimmune gastritis: pathologist’s viewpoint. World J. Gastroenterol. 21, 12179–12189 (2015)

    CAS  PubMed  PubMed Central  Google Scholar 

  34. T. Notsu, K. Adachi, T. Mishiro, H. Fujihara, T. Toda, S. Takaki, Y. Kinoshita, Prevalence of autoimmune gastritis in individuals undergoing medical checkups in Japan. Intern. Med. 58, 1817–1823 (2019)

    PubMed  PubMed Central  Google Scholar 

  35. M. Camilleri, V. Chedid, A.C. Ford, K. Haruma, M. Horowitz, K.L. Jones, P.A. Low, S.Y. Park, H.P. Parkman, V. Stanghellini, Gastroparesis. Nat. Rev. Dis. Prim. 4, 41 (2018)

    PubMed  Google Scholar 

  36. S.M. Cacciò, H. Sprong, in Epidemiology of giardiasis in humans. ed. by H.D. Luján, S. Svärd. Giardia (Springer, Vienna. 2011) https://doi.org/10.1007/978-3-7091-0198-8_2.

    Google Scholar 

  37. H.H. Dib, S.Q. Lu, S.F. Wen, Prevalence of Giardia lamblia with or without diarrhea in South East, South East Asia and the Far East. Parasitol. Res. 103, 239–251 (2008)

    PubMed  Google Scholar 

  38. J. Xiao, F. Wang, N.K. Wong, J. He, R. Zhang, R. Sun, Y. Xu, Y. Liu, W. Li, K. Koike, W. He, H. You, Y. Miao, X. Liu, M. Meng, B. Gao, H. Wang, C. Li, Global liver disease burdens and research trends: analysis from a Chinese perspective. J. Hepatol. 71, 212–221 (2019)

    PubMed  Google Scholar 

  39. Z. Hepp, M.J. Lage, R. Espaillat, V.V. Gossain, The association between adherence to levothyroxine and economic and clinical outcomes in patients with hypothyroidism in the US. J. Med. Econ. 21, 912–919 (2018)

    PubMed  Google Scholar 

  40. B. Misselwitz, M. Butter, K. Verbeke, M.R. Fox, Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut 68, 2080–2091 (2019)

    PubMed  Google Scholar 

  41. D.L. Swagerty Jr, A.D. Walling, R.M. Klein, Lactose intolerance. Am. Fam. Physician 65, 1845–1850 (2002)

    PubMed  Google Scholar 

  42. M. Asik, F. Gunes, E. Binnetoglu, M. Eroglu, N. Bozkurt, H. Sen, E. Akbal, C. Bakar, Y. Beyazit, K. Ukinc, Decrease in TSH levels after lactose restriction in Hashimoto’s thyroiditis patients with lactose intolerance. Endocrine 46, 279–284 (2014)

    CAS  PubMed  Google Scholar 

  43. L. Liwanpo, J.M. Hershman, Conditions and drugs interfering with thyroxine absorption. Best. Pract. Res. Clin. Endocrinol. Metab. 23, 781–792 (2009)

    CAS  PubMed  Google Scholar 

  44. P. Usai-Satta, M. Scarpa, F. Oppia, F. Cabras, Lactose malabsorption and intolerance: what should be the best clinical management? World J. Gastrointest. Pharmacol. Ther. 3, 29–33 (2012)

    PubMed  PubMed Central  Google Scholar 

  45. D. Festi, R. Schiumerini, C. Birtolo, L. Marzi, L. Montrone, E. Scaioli, A.R. Di Biase, A. Colecchia, Gut microbiota and its pathophysiology in disease paradigms. Dig. Dis. 29, 518–524 (2011)

    PubMed  Google Scholar 

  46. G. Certad, E. Viscogliosi, M. Chabé, S.M. Cacciò, Pathogenic mechanisms of cryptosporidium and giardia. Trends Parasitol. 33, 561–576 (2017)

    CAS  PubMed  Google Scholar 

  47. D. Pabla, F. Akhlaghi, H. Zia, A comparative pH-dissolution profile study of selected commercial levothyroxine products using inductively coupled plasma mass spectrometry. Eur. J. Pharm. Biopharm. 72, 105–110 (2009)

    CAS  PubMed  Google Scholar 

  48. E. Lahner, R.M. Zagari, A. Zullo, A. Di Sabatino, A. Meggio, P. Cesaro, M.V. Lenti, B. Annibale, G.R. Corazza, Chronic atrophic gastritis: natural history, diagnosis and therapeutic management. A position paper by the Italian Society of Hospital Gastroenterologists and Digestive Endoscopists [AIGO], the Italian Society of Digestive Endoscopy [SIED], the Italian Society of Gastroenterology [SIGE], and the Italian Society of Internal Medicine [SIMI]. Dig. Liver Dis. 51, 1621–1632 (2019)

    PubMed  Google Scholar 

  49. B. Lebwohl, D.S. Sanders, P.H.R. Green, Coeliac disease. Lancet 391, 70–81 (2018)

    PubMed  Google Scholar 

  50. S. Benvenga, G. Capodicasa, S. Perelli, S.M. Ferrari, P. Fallahi, A. Antonelli, Increased requirement of replacement doses of levothyroxine caused by liver cirrhosis. Front. Endocrinol. 9, 150 (2018)

    Google Scholar 

  51. C. Virili, I. Stramazzo, M.G. Santaguida, G. Bruno, N. Brusca, S. Capriello, M. Cellini, C. Severi, L. Gargano, M. Centanni, Ulcerative colitis as a novel cause of increased need for levothyroxine. Front. Endocrinol. 10, 233 (2019)

    Google Scholar 

  52. P. Fallahi, S.M. Ferrari, I. Ruffilli, F. Ragusa, M. Biricotti, G. Materazzi, P. Miccoli, A. Antonelli, Advancements in the treatment of hypothyroidism with L-T4 liquid formulation or soft gel capsule: an update. Expert Opin. Drug Deliv. 14, 647–655 (2017)

    CAS  PubMed  Google Scholar 

  53. M.G. Santaguida, C. Virili, S.C. Del Duca, M. Cellini, I. Gatto, N. Brusca, C. De Vito, L. Gargano, M. Centanni, Thyroxine softgel capsule in patients with gastric-related T4 malabsorption. Endocrine 49, 51–57 (2015)

    CAS  PubMed  Google Scholar 

  54. C. Virili, P. Trimboli, F. Romanelli, M. Centanni, Liquid and softgel levothyroxine use in clinical practice: state of the art. Endocrine 54, 3–14 (2016)

    CAS  PubMed  Google Scholar 

  55. F. Othman, T.R. Card, C.J. Crooks, Proton pump inhibitor prescribing patterns in the UK: a primary care database study. Pharmacoepidemiol. Drug Saf. 25, 1079–1087 (2016)

    CAS  PubMed  Google Scholar 

  56. A. Pottegård, A. Broe, J. Hallas, O.B. de Muckadell, A.T. Lassen, A.B. Lødrup, Use of proton-pump inhibitors among adults: a Danish nationwide drug utilization study. Ther. Adv. Gastroenterol. 9, 671–678 (2016)

    Google Scholar 

  57. Ó.Ö. Hálfdánarson, A. Pottegård, E.S. Björnsson, S.H. Lund, M.H. Ogmundsdottir, E. Steingrímsson, H.M. Ogmundsdottir, H. Zoega, Proton-pump inhibitors among adults: a nationwide drug-utilization study. Ther. Adv. Gastroenterol. 11, 1756284818777943 (2018)

    Google Scholar 

  58. P. Tuppin, S. Rivière, D. Deutsch, C. Gastaldi-Menager, J.M. Sabaté, Burden of drug use for gastrointestinal symptoms and functional gastrointestinal disorders in France: a national study using reimbursement data for 57 million inhabitants. Ther. Adv. Gastroenterol. 12, 1756284819853790 (2019)

    Google Scholar 

  59. E.D. Kantor, C.D. Rehm, M. Du, E. White, E.L. Giovannucci, Trends in dietary supplement use among US adults from 1999-2012. JAMA 316, 1464–1474 (2016)

    PubMed  PubMed Central  Google Scholar 

  60. World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. 2016. https://apps.who.int/iris/bitstream/handle/10665/250796/9789241549912-eng.pdf;jsessionid=44005E34839EDE838D758B02A4FBD272?sequence=1. Accessed 10 Oct 2019

  61. D. Ribichini, G. Fiorini, A. Repaci, V. Castelli, L. Gatta, D. Vaira, R. Pasquali, Tablet and oral liquid L-thyroxine formulation in the treatment of naïve hypothyroid patients with Helicobacter pylori infection. Endocrine 57, 394–401 (2017)

    CAS  PubMed  Google Scholar 

  62. R. Negro, R. Valcavi, D. Agrimi, K.A. Toulis, Levothyroxine liquid solution versus tablet for replacement treatment in hypothyroid patients. Endocr. Pract. 20, 901–906 (2014)

    PubMed  Google Scholar 

  63. C. Cappelli, I. Pirola, E. Gandossi, C. Casella, D. Lombardi, B. Agosti, F. Marini, A. Delbarba, M. Castellano, TSH variability of patients affected by differentiated thyroid cancer treated with levothyroxine liquid solution or tablet form. Int. J. Endocrinol. 2017, 7053959 (2017)

    PubMed  PubMed Central  Google Scholar 

  64. P. Fallahi, S.M. Ferrari, G. Materazzi, F. Ragusa, I. Ruffilli, A. Patrizio, P. Miccoli, A. Antonelli, Oral L-thyroxine liquid versus tablet in patients submitted to total thyroidectomy for thyroid cancer (without malabsorption): a prospective study. Laryngoscope Investig. Otolaryngol. 3, 405–408 (2018)

    PubMed  PubMed Central  Google Scholar 

  65. R. Ferrara, V. Ientile, V. Arcoraci, C. Ferrajolo, C. Piccinni, A. Fontana, S. Benvenga, G. Trifirò, Treatment pattern and frequency of serum TSH measurement in users of different levothyroxine formulations: a population-based study during the years 2009-2015. Endocrine 58, 143–152 (2017)

    CAS  PubMed  Google Scholar 

  66. D. Gullo, A. Latina, F. Frasca, S. Squatrito, A. Belfiore, R. Vigneri, Seasonal variations in TSH serum levels in athyreotic patients under L-thyroxine replacement monotherapy. Clin. Endocrinol. 87, 207–215 (2017)

    CAS  Google Scholar 

  67. D. Wang, X. Cheng, S. Yu, L. Qiu, X. Lian, X. Guo, Y. Hu, I. Lu, G. Yang, H. Liu, Data mining: seasonal and temperature fluctuations in thyroid-stimulating hormone. Clin. Biochem. 60, 59–63 (2018)

    CAS  PubMed  Google Scholar 

  68. D. Santi, G. Spaggiari, G. Brigante, M. Setti, S. Tagliavini, T. Trenti, M. Simoni, Semi-annual seasonal pattern of serum thyrotropin in adults. Sci. Rep. 9, 10786 (2019)

    PubMed  PubMed Central  Google Scholar 

  69. G. Grani, D. Tumino, V. Ramundo, L. Ciotti, C. Lomonaco, M. Armillotta, R. Falcone, P. Lucia, M. Maranghi, S. Filetti, C. Durante, Changes in TSH levels in athyreotic patients with differentiated thyroid cancer during levothyroxine therapy: influence on dose adjustments. J. Endocrinol. Investig. 42, 1485–1490 (2019)

    CAS  Google Scholar 

Download references

Funding

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Author information

Authors and Affiliations

  1. National Institute of Gastroenterology “S. De Bellis”, Castellana Grotte, Bari, Italy

    Marco Castellana

  2. Margherita di Savoia 93, Putignano, 70017, Bari, Italy

    Carlo Castellana

  3. Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    Luca Giovanella & Pierpaolo Trimboli

  4. Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland

    Pierpaolo Trimboli

Authors
  1. Marco Castellana
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlo Castellana
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luca Giovanella
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pierpaolo Trimboli
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

M.C. and P.T. conceived the review. M.C. and P.T. performed database search and drafted the manuscript. All authors read, provided feedback, and approved the final manuscript.

Corresponding author

Correspondence to Pierpaolo Trimboli.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This narrative review was in accordance with the principles of the Declaration of Helsinki. Analyses were performed on data extracted from published papers.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Castellana, M., Castellana, C., Giovanella, L. et al. Prevalence of gastrointestinal disorders having an impact on tablet levothyroxine absorption: should this formulation still be considered as the first-line therapy?. Endocrine 67, 281–290 (2020). https://doi.org/10.1007/s12020-019-02185-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-019-02185-4

Keywords

Search

Navigation