In thyroxine-replaced hypothyroid postmenopausal women under simultaneous calcium supplementation, switch to oral liquid or softgel capsule l-thyroxine ensures lower serum TSH levels and favorable effects on blood pressure, total cholesterolemia and glycemia
- 64 Downloads
In postmenopausal women under L-T4 therapy, which was subsequently accompanied by calcium carbonate (CC) supplementation taken 6–8 h after tablet L-T4, TSH levels were greater than prior to adding CC. Total cholesterolemia [CHOL], fasting glycemia [FG], systolic and diastolic blood pressure [SBP, DBP] were also greater than baseline. Our aim was to explore the effects of either liquid or softgel capsule L-T4, while maintaining CC ingestion 6–8 h, later on TSH levels, CHOL, FG, SBP, and DBP.
We proposed to 50 hypothyroid postmenopausal women under tablet L-T4 therapy, to switch to either liquid or softgel capsule L-T4 at the same daily dose while maintaining CC ingestion 6–8 h later. Sixteen women accepted [group I; liquid (n = 9), capsule (n = 7)], while 34 continued tablet L-T4 [group II, (n = 34)].
After 3 months, in group I, TSH decreased significantly (1.23 ± 0.49 vs. 1.80 ± 0.37 mU/L, P < 0.01), as did FG (80.7 ± 7.9 vs. 83.4 ± 6.3 mg/dL, P < 0.05); CHOL, SBP, and DBP decreased, though insignificantly. In contrast, in group II, TSH, FG, CHOL, SBP increased insignificantly, and DBP increased borderline significantly (69.7 ± 9 vs. 66.3 ± 6.5, P < 0.10). Compared to baseline (before adding CC), in group I, TSH was significantly lower (P < 0.01) and the other indices similar; in group II, TSH, FG, and SBP were significantly higher (P < 0.05), DBP borderline significantly higher (P < 0.10) and CHOL insignificantly higher. Performance of liquid L-T4 and capsule L-T4 was similar.
Delaying CC ingestion even by 6–8 h after taking tablet L-T4 is not entirely satisfactory, unlike liquid or softgel L-T4.
KeywordsHypothyroidism Liquid l-thyroxine Calcium carbonate Serum cholesterol Blood glucose Blood pressure
Compliance with ethical standards
Conflict of interest
S.B. received novel formulations of LT4 from IBSA Institute Biochimique (Lugano, Switzerland) and IBSA s.r.l. (Lodi, Italy) to be given to patients for conducting clinical studies. In addition, S.B. was an invited speaker at symposia organized by IBSA. However, IBSA had no role in any phase of the writing of this manuscript. The remaining authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of our institutional research committee at University Hospital of Messina and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 7.E. Morini, A. Catalano, A. Lasco, N. Morabito, S. Benvenga, l-thyroxine malabsorption due to calcium carbonate impairs blood pressure, total cholesterolemia, and fasting glycemia. Endocrine (2018). https://doi.org/10.1007/s12020-018-1798-7
- 9.I.L. Klein, S. Danzi, in Werner and Ingbar’s the Thyroid: a Fundamental and Clinical Text, ed. by L.E Bravermann, D.S Cooper (Wolters Kluver, Lippincott, Willimas & Wilkins, Philadelphia, 2013), p. 575–582Google Scholar
- 12.B. Xu, H. Yang, Z. Wang, T. Yang, H. Guo, P. Cheng, W. He, M. Sun, H. Chen, Y. Duan, Elevated thyroid stimulating hormone levels are associated with metabolic syndrome in a Chinese community-based population of euthyroid people aged 40 years and older. J. Biomed. Res. 30, 476–482 (2016)Google Scholar
- 13.I.M. Benseñor, A.C. Goulart, C. Molina Mdel, É.J. de Miranda, I.S. Santos, P.A. Lotufo, Thyrotropin levels, insulin resistance, and metabolic syndrome: a cross-sectional analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Metab. Syndr. Relat. Disord. 13, 362–369 (2015)CrossRefGoogle Scholar
- 17.A. Giandalia, G.T. Russo, E.L. Romeo, A. Alibrandi, P. Villari, A.A. Mirto, G. Armentano, S. Benvenga, D. Cucinotta, Influence of high-normal serum TSH levels on major cardiovascular risk factors and Visceral Adiposity Index in euthyroid type 2 diabetic subjects. Endocrine 47, 152–160 (2014)CrossRefGoogle Scholar
- 19.V. Velkoska Nakova, B. Krstevska, M. Bosevski, Ch Dimitrovski, V. Serafimoski, Dyslipidaemia and hypertension in patients with subclinical hypothyroidism. Prilozi 30, 93–102 (2009)Google Scholar
- 22.T. Ittermann, D. Tiller, C. Meisinger, C. Agger, M. Nauck, R. Rettig, A. Hofman, T. Jørgensen, A. Linneberg, J.C. Witteman, O.H. Franco, K.H. Greiser, K. Werdan, A. Döring, A. Kluttig, B.H. Stricker, H. Völzke, High serum thyrotropin levels are associated with current but not with incident hypertension. Thyroid 23, 955–963 (2013)CrossRefGoogle Scholar
- 25.D. Liu, F. Jiang, Z. Shan, B. Wang, J. Wang, Y. Lai, Y. Chen, M. Li, H. Liu, C. Li, H. Xue, N. Li, J. Yu, L. Shi, X. Bai, X. Hou, L. Zhu, L. Lu, S. Wang, Q. Xing, W. Teng, A cross-sectional survey of relationship between serum TSH level and blood pressure. J. Hum. Hypertens. 24, 134–138 (2010)CrossRefGoogle Scholar
- 27.L. Petrosyan, Relationship between high normal TSH levels and metabolic syndrome components in type 2 diabetic subjects with euthyroidism. J. Clin. Transl. Endocrinol. 2, 110–113 (2015)Google Scholar
- 33.M. Laclaustra, Y. Hurtado-Roca, M. Sendin, M. Leon, M. Ledesma, E. Andres, A. Fernandez-Ortiz, E. Guallar, J.M. Ordovas, J.A. Casasnovas, Lower-normal TSH is associated with better metabolic risk factors: a cross-sectional study on Spanish men. Nutr. Metab. Cardiovasc. Dis. 25, 1095–1103 (2015)CrossRefGoogle Scholar
- 35.P.M. Mannucci, A. Nobili, L. Pasina, REPOSI Collaborators (REPOSI is the acronym of REgistro POliterapie SIMI, Società Italiana di Medicina Interna). Polypharmacy in older people: lessons from 10 years of experience with the REPOSI register. Intern. Emerg. Med. 13(8), 1191–1200 (2018)CrossRefGoogle Scholar
- 37.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. 9, 10 (2018). https://doi.org/10.3389/fendo.2018.00010 CrossRefGoogle Scholar