Liquid L-thyroxine versus tablet L-thyroxine in patients on L- thyroxine replacement or suppressive therapy: a meta-analysis
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To compare the effectiveness of liquid L-T4 (L-thyroxine) and tablet L-T4 in patients on L-T4 replacement or suppressive therapy.
The Cochrane Library, PubMed, Embase, and Web of Science databases were searched to identify relevant articles. All prospective or randomized controlled studies (RCTs) comparing liquid L-T4 and tablet L-T4 in patients on L-T4 replacement or suppressive therapy were included in the analysis.
Overall, the initial search of the four databases identified 1278 published studies; of these, eight studies were ultimately included in the meta-analysis. TSH (thyroid stimulating hormone) levels were significantly suppressed in patients on liquid L-T4 compared with those on tablet L-T4, in patients on L-T4 suppressive therapy with L-T4 malabsorption (Mean Difference (MD) = −2.26, 95% Confidence Interval (CI): −3.59, −0.93; P = 0.0009)). However, liquid L-T4 and tablet L-T4 did not show a statistically significant difference in patients on L-T4 suppressive therapy without malabsorption (MD = 0.08, 95% CI: −0.31, 0.47; P = 0.69). TSH levels were significantly normalized in patients on liquid L-T4 compared with those on tablet L-T4, in Patients on L-T4 replacement therapy with L-T4 malabsorption (MD = −3.20, 95% CI: −5.08, −1.32; P = 0.0009). However, liquid L-T4 and tablet L-T4 did not show a statistically significant difference in patients on L-T4 replacement therapy without malabsorption (MD = 0.91, 95% CI: −0.03, 1.86; P = 0.06).
Liquid L-T4 is more efficient than tablet L-T4 in patients on L-T4 replacement or suppressive therapy with malabsorption. No significant differences were observed in patients without malabsorption. Further studies should be conducted to verify these findings.
KeywordsLiquid L-thyroxine Tablet L-thyroxine Hypothyroidism Thyroid cancer Meta-analysis
The study was supported by National Natural Science Foundation of China Grants (81370954, 81670785); Fundamental Science and Advanced Technology Research of Chongqing Major Project (cstc2015jcyjBX0096); Chongqing Science and Technology Committee Innovation Project, Technology Development and Application of Precision Medicine (cstc2016shms-ztzx1003).The authors thank Fengfan Zheng, Ting Luo, and John Belly for their advices. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for integrity of the work as whole, and have given approval for the version to be published. All authors approved the final version.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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