Skip to main content
SpringerLink
Log in

Comparison between liquid and tablet levothyroxine formulations in patients treated through enteral feeding tube

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Background

The majority of clinicians suggest that enteral feedings should be held 1–2 h prior to and after L-T4 administration despite lack of data for continuous enteral nutrition.

Aim

The aim of this study was to: (1) compare the thyroid hormonal profile in patients submitted to L-T4 treatment in tablets or liquid formulation with an enteral feeding tube; (2) evaluate the nursing compliance with the two different formulations.

Subjects and methods

20 euthyroid patients submitted to total laryngectomy and thyroidectomy consecutively started L-T4 treatment in tablets (Group T) or in liquid formulation (Group L) with enteral feeding tube the day after surgery. Tablets were crushed before administration and enteral feeding was stopped for 30 min before and after L-T4 treatment, whereas liquid formulation was placed into the nasoenteric tube immediately. A questionnaire about the preparation and administration of thyroxine replacement therapy was given to the nurses.

Results

No difference of TSH, fT4 and fT3 before and after L-T4 treatment was observed among patients of Group L. A slightly serum TSH increase was observed in Group T, but not reaching statistical significance (2.50 ± 1.18 vs 2.94 ± 1.22 mUI/L), whereas no difference in fT4 and fT3 levels was found. Preparation and administration of liquid L-T4 was considered excellent by 12/13 nurses, whereas tablet formulation was considered poor by 10/13.

Conclusions

Our data showed that liquid L-T4 formulation can be administered directly through feeding tube with no need for an empty stomach, with a significant improvement in therapy preparation and administration by nurses.

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

Abbreviations

L-T4:

Levothyroxine

TSH:

Thyroid stimulating hormone

fT4:

Free thyroxine

fT3:

Free triiodothyronine

TL:

Total laryngectomy

Reference

  1. Mendelson AA, Al-Khatib TA, Julien M et al (2009) Thyroid gland management in total laryngectomy: meta-analysis and surgical recommendations. Otolaryngol Head Neck Surg 140:298–305

    Article  PubMed  Google Scholar 

  2. Ho AC, Ho WK, Lam PK et al (2008) Thyroid dysfunction in laryngectomees—10 years after treatment. Head Neck 30:336–340

    Article  PubMed  Google Scholar 

  3. Martín Villares C, Fernández Pello ME, San Román Carbajo J et al (2003) Postoperative nutrition in patients with head and neck cancer. Nutr Hosp 18:243–247

    PubMed  Google Scholar 

  4. Pacini F, Castagna MG (2012) Approach to and treatment of differentiated thyroid carcinoma. Med Clin N Am 96:369–383

    Article  CAS  PubMed  Google Scholar 

  5. Almandoz JP, Gharib H (2012) Hypothyroidism: etiology, diagnosis, and management. Med Clin N Am 96:203–221

    Article  CAS  PubMed  Google Scholar 

  6. Wenzel KW, Kirschsieper HE (1977) Aspects of the absorption of oral L-thyroxine in normal man. Metabolism 26:1–8

    Article  CAS  PubMed  Google Scholar 

  7. Centanni M, Gargano L, Canettieri G et al (2006) Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis. N Engl J Med 354:1787–1795

    Article  CAS  PubMed  Google Scholar 

  8. Checchi S, Montanaro A, Pasqui L et al (2008) l-thyroxine requirement in patients with autoimmune hypothyroidism and parietal cell antibodies. J Clin Endocrinol Metab 93:465–469

    Article  CAS  PubMed  Google Scholar 

  9. Centanni M. Malabsorption of T4: new insights on oral thyroxine treatment. Hot Thyrology http://www.hotthyroidology.com/editorial_169.html

  10. Sherman SI, Malecha SE (1995) Absorption and malabsorption of levothyroxine sodium. Am J Ther 2:814–818

    Article  PubMed  Google Scholar 

  11. Mechanick JI, Brett EM (2002) Nutrition Support of the chronically critically ill patient. Crit Care Clin 18:597–618

    Article  CAS  PubMed  Google Scholar 

  12. Yue CS, Scarsi C, Ducharme MP (2012) Pharmacokinetics and potential advantages of a new oral solution of levothyroxine vs. other available dosage forms. Arzneimittelforschung 62:631–636

    Article  CAS  PubMed  Google Scholar 

  13. Cappelli C, Pirola I, Gandossi E, Formenti A, Castellano M (2013) Oral liquid levothyroxine treatment at breakfast: a mistake? Eur J Endocrinol 170:95–99

    Article  PubMed  Google Scholar 

  14. Santini F, Pinchera A, Marsili A et al (2005) Lean body mass is a major determinant of levothyroxine dosage in the treatment of thyroid diseases. J Clin Endocrinol Metab 90:124

    Article  CAS  PubMed  Google Scholar 

  15. Naber TH, Schermer T, de Bree A et al (1997) Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications. Am J Clin Nutr 66:1232

    CAS  PubMed  Google Scholar 

  16. Martyn CN, Winter PD, Coles SJ et al (1998) Effect of nutritional status on use of health care resources by patients with chronic disease living in the community. Clin Nutr 17:119

    Article  CAS  PubMed  Google Scholar 

  17. Chima CS, Barco K, Dewitt ML et al (1997) Relationship of nutritional status to length of stay, hospital costs, and discharge status of patients hospitalized in the medicine service. J Am Diet Assoc 97:975

    Article  CAS  PubMed  Google Scholar 

  18. Rollins CJ (1995) Adult enteral nutrition. In: Koda-Kimble MA et al, eds. Applied therapeutics: the clinical use of drugs. 6th ed, Chap 34. Applied Therapeutics, Vancouver, pp 1–28

  19. Beckwith MC, Feddema SS, Barton RG et al (2004) A Guide to drug therapy in patients with enteral feeding tubes: dosage form selection and administration methods. J Hosp Pharm 39:225–237

    Google Scholar 

  20. Lamson MJ, Pamplin CL, Rolleri RL et al (2004) Quantitation of a substantial reduction in levothyroxine (T4) absorption by food. Thyroid 14:876

    Google Scholar 

  21. Dickerson RN, Maish GO, Minard G et al (2010) Clinical relevancy of the levothyroxine-continuous enteral nutrition interaction. Nutr Clin Pract 25:646–652

    Article  PubMed  Google Scholar 

  22. Phillips NM, Nay R (2007) Nursing administration of medication via enteral tubes in adults: a systematic review. Int J Evid Based Healthc 5:324–353

    PubMed  Google Scholar 

  23. Seifert CF, Frye JL, Belknap DC et al (1995) A nursing survey to determine the characteristics of medication administration through enteral feeding catheters. Clin Nurs Res 4:290–305

    Article  CAS  PubMed  Google Scholar 

  24. Mota ML, Barbosa IV, Studart RM et al (2010) Evaluation of intensivist-nurses’ knowledge concerning medication administration through nasogastric and enteral tubes. Rev Lat Am Enfermagem 18:888–894

    PubMed  Google Scholar 

  25. Mitchell JF, Pawlicki KS (1996) Oral solid dosage forms that should not be crushed: 1994 revision. Hosp Pharm 29(666–8):670–675

    Google Scholar 

  26. Manessis A, Lascher S, Bukberg P et al (2008) Quantifying amount of adsorption of levothyroxine by percutaneous endoscopic gastrostomy tubes. JPEN J Parenter Enteral Nutr 32:197–200

    Article  CAS  PubMed  Google Scholar 

  27. Vita R, Saraceno G, Trimarchi F, Benvenga S (2013) A novel formulation of L-thyroxine (L-T4) reduces the problem of L-T4 malabsorption by coffee observed with traditional tablet formulations. Endocrine 43:154–160

    Article  CAS  PubMed  Google Scholar 

  28. Peroni E, Vigone MC, Mora S et al (2013) Congenital hypothyroidism treatment in infants: a comparative study between liquid and tablet formulations of levothyroxine. Horm Res Paediatr (in press)

  29. Bernareggi A, Grata E, Pinorini MT, Conti A (2013) Oral liquid formulation of levothyroxine is stable in breakfast beverages and may improve thyroid patient compliance. Pharmaceutics 5:621–633

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Garber JR, Cobin RH, Gharib H et al (2012) Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract 18:988–1028

    Article  PubMed  Google Scholar 

  31. Golger A, Fridman TR, Eski S et al (2003) Three-week thyroxine withdrawal thyroglobulin stimulation screening test to detect low-risk residual/recurrent well-differentiated thyroid carcinoma. J Endocrinol Invest 26:1023–1031

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, Clinica Medica, University of Brescia, c/o 1^ Medicina Spedali Civili di Brescia, Piazzale Spedali Civili n°1, Brescia, 25100, Italy

    I. Pirola, L. Daffini, E. Gandossi, A. Formenti, M. Castellano & C. Cappelli

  2. Department of Otorhinolaryngology, Head and Neck Surgery, University of Brescia, Brescia, Italy

    D. Lombardi

Authors
  1. I. Pirola
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Daffini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Gandossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Lombardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Formenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Castellano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Cappelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Cappelli.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pirola, I., Daffini, L., Gandossi, E. et al. Comparison between liquid and tablet levothyroxine formulations in patients treated through enteral feeding tube. J Endocrinol Invest 37, 583–587 (2014). https://doi.org/10.1007/s40618-014-0082-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-014-0082-9

Keywords

Search

Navigation