Thyroid Medication Dosing and Kinetic Service: An Optimal Review (Richard NKWENTI; R.Ph; IMD, Ph.D); Hormone Restoration Expert
Are you tired of struggling with your thyroid medication therapy? Wondering why your treatment outcomes aren't optimal? Well, here's a secret: precise dosing and kinetic service hold the key to unlocking the full potential of your thyroid medication.
One size does not fit all. That's where Kinetic Service steps in, offering personalized dosing strategies tailored to your unique needs. By understanding the factors influencing thyroid medication dosing, we can optimize your therapy for maximum results.
But why settle for mediocrity when you can aim for greatness? With our comprehensive approach, we'll delve into the intricacies of thyroid medication kinetics, ensuring you receive the right dose at the right time. Say goodbye to guesswork and hello to a brighter future with improved treatment outcomes.
Don't let imprecise dosing hold you back any longer! It's time to take control of your thyroid health and explore the world of personalized medication strategies. Get ready for a transformative journey towards optimal well-being. Let's dive in together!
Understanding Levothyroxine's Pharmacokinetics
Levothyroxine, a commonly prescribed medication for thyroid disorders, follows a complex journey within the body as it is absorbed, distributed, metabolized, and eliminated. This article will delve into the intricate details of levothyroxine's pharmacokinetics and highlight factors that can influence its effectiveness.
Absorption, Distribution, Metabolism, and Elimination
Upon oral ingestion, levothyroxine is primarily absorbed in the upper part of the small intestine. From there, it enters the bloodstream and binds to plasma proteins such as thyroxine-binding globulin (TBG), transthyretin (TTR), and albumin for distribution throughout the body. The binding to these proteins ensures stability and availability when needed.
The metabolism of levothyroxine occurs mainly in the liver through enzymatic processes involving deiodination. Here, some of the active hormone is converted into inactive forms like reverse T3 (rT3) or undergoes further metabolism to produce triiodothyronine (T3). Eventually, both metabolites are eliminated from the body through urine and feces.
Factors Affecting Absorption and Bioavailability
The body's ability to absorb levothyroxine depends on a number of factors. One crucial factor is food intake. Certain foods or medications may interfere with absorption due to their impact on gastric pH levels or interactions with binding proteins. For optimal absorption, it is generally recommended to take levothyroxine on an empty stomach at least 30 minutes before breakfast.
Another significant consideration is drug-drug interactions. Medications such as calcium supplements, iron supplements, antacids containing aluminum or magnesium hydroxide, cholestyramine resin, sevelamer carbonate, sucralfate, and certain anti-seizure drugs can impede levothyroxine absorption. It is important to inform healthcare providers about all medications being taken to ensure appropriate dosing adjustments.
Importance of Consistent Timing and Administration Guidelines
Consistency in timing and administration is vital for achieving optimal results with levothyroxine therapy. Deviating from prescribed guidelines can lead to fluctuations in hormone levels, potentially affecting the patient's well-being. It is generally advised to take levothyroxine at the same time each day, preferably in the morning, to establish a routine.
Additionally, it's crucial to follow a doctor's instructions and not skip or double doses. Missing doses can disrupt hormonal balance, while doubling up on medication may result in excessive thyroid hormone levels, leading to symptoms such as palpitations, anxiety, or weight loss.
Different Formulations and Their Impact on Pharmacokinetics
Levothyroxine is available in various formulations that may have different pharmacokinetic properties. While the active ingredient remains the same, excipients and manufacturing processes can influence how the drug behaves within the body.
For instance, generic formulations of levothyroxine may have slight variations in bioavailability compared to brand-name versions due to differences in inactive ingredients. However, regulatory authorities ensure that generic versions are therapeutically equivalent and meet strict quality standards.
Some patients may require alternative formulations, such as liquid preparations or chewable tablets, due to difficulties swallowing traditional tablets. These alternative options offer convenience without compromising therapeutic effectiveness.
Optimizing Therapy: Adjusting Levothyroxine Dose
Indications for adjusting levothyroxine dosage in patients with thyroid disorders
Adjusting the dosage of levothyroxine, a common thyroid medication, is essential for optimizing therapy in patients with thyroid disorders. The need to adjust the dose may arise due to various factors, such as changes in the patient's health status, alterations in body weight, or other medications that could interact with levothyroxine. It is crucial to monitor the patient closely and make necessary adjustments to ensure they receive the appropriate amount of medication.
Monitoring TSH levels to guide dose adjustments
One of the primary indicators used to guide dose adjustments is monitoring Thyroid-Stimulating Hormone (TSH) levels. The pituitary gland produces TSH, which stimulates the thyroid gland to produce hormones. Elevated TSH levels suggest an underactive thyroid (hypothyroidism), indicating a need for an increase in levothyroxine dosage. Conversely, low TSH levels indicate an overactive thyroid (hyperthyroidism) and might require a decrease in levothyroxine dosage.
Considerations when titrating levothyroxine dose based on clinical response and laboratory results
When adjusting levothyroxine dosage, it is important to consider both clinical response and laboratory results. Clinical response refers to how well the patient feels and functions while taking the medication. Some individuals may experience symptomatic improvement at lower doses, while others may require higher doses for optimal functioning. Laboratory results, including TSH levels, provide objective data that can help determine if further dose adjustments are necessary.
To optimize therapy effectively:
- Start with a conservative initial dosage and gradually increase as needed.
- Regularly monitor symptoms such as fatigue, weight gain or loss, sensitivity to cold or heat, mood changes, and any other signs of hypothyroidism or hyperthyroidism.
- Track TSH levels through blood tests to ensure they are within the desired range.
- Adjust the levothyroxine dosage based on both clinical response and laboratory results, aiming for a TSH level within the target range.
Potential challenges in achieving optimal dosing and strategies to overcome them
Achieving optimal dosing of levothyroxine can be challenging due to various factors. One common challenge is individual variability in how patients metabolize and respond to the medication. Some individuals may require higher doses than others due to differences in their bodies ability to absorb and utilize levothyroxine.
To overcome these challenges, healthcare providers can:
- Regularly assess patient symptoms and adjust dosage accordingly.
- Educate patients about the importance of consistent medication adherence, as fluctuations in intake can affect therapeutic outcomes.
- Consider potential drug interactions that could interfere with levothyroxine absorption or metabolism.
- Collaborate with patients to establish an open line of communication regarding any changes in health status or concurrent medications.
Exploring Conventional Drug Delivery Methods
Conventional drug delivery methods play a crucial role in the administration of thyroid medication dosing and kinetic service. Let's delve into the common methods used to deliver levothyroxine, their advantages and limitations, factors influencing drug absorption, and the challenges associated with patient adherence.
Common methods of delivering levothyroxine
The most prevalent conventional method for administering levothyroxine is through oral tablets or capsules. Patients ingest these formulations, which contain the active ingredient in a solid form. Some patients may receive injectable forms of levothyroxine under specific circumstances, although this method is less common.
Advantages and limitations of conventional drug delivery systems
Conventional drug delivery systems offer several advantages in the context of thyroid medication dosing. They are widely available, cost-effective, and easy to manufacture on a large scale. Furthermore, oral tablets and capsules provide a convenient way for patients to take their prescribed doses at home without requiring medical assistance.
However, these methods also have their limitations. One significant drawback is that they rely on the patient's ability to swallow pills effectively. Some individuals may struggle with this due to physical or psychological reasons such as dysphagia or pill aversion. Moreover, conventional formulations may not be suitable for patients who have difficulty absorbing medications orally or those with gastrointestinal disorders that affect absorption.
Factors influencing drug absorption from conventional formulations
Several factors influence the absorption of levothyroxine in conventional formulations. The first critical factor is food intake; certain foods can interfere with levothyroxine absorption when taken simultaneously. For optimal results, it is recommended to take levothyroxine on an empty stomach at least 30 minutes before consuming any food or beverages other than water.
Another factor affecting absorption is concurrent medication use. Certain drugs like antacids, calcium supplements, iron supplements, and cholesterol-lowering medications can interact with levothyroxine and reduce its absorption. It is crucial for healthcare providers to consider potential drug interactions when prescribing levothyroxine to ensure optimal absorption and effectiveness.
Challenges associated with patient adherence to prescribed regimens
Patient adherence to prescribed thyroid medication regimens poses a significant challenge in achieving optimal treatment outcomes. Many patients find it challenging to adhere consistently due to various reasons, such as forgetfulness, complex dosing schedules, or simply feeling better and assuming they no longer need the medication.
To address these challenges, healthcare providers play a pivotal role in educating patients about the importance of adhering to their prescribed regimen. Simplifying dosing schedules, providing reminders through mobile applications or pill organizers, and scheduling regular follow-up appointments can enhance patient adherence. Involving patients in shared decision-making processes and addressing any concerns they may have can foster a sense of ownership over their treatment plan.
Novel Drug Delivery Methods for Levothyroxine
Levothyroxine is a commonly prescribed medication for individuals with thyroid disorders. Traditionally, it has been administered orally in the form of tablets or capsules. However, innovative approaches such as transdermal patches or sublingual formulations are emerging as potential alternatives for levothyroxine delivery.
Overview of innovative approaches like transdermal patches or sublingual formulations for levothyroxine delivery
Transdermal patches offer a convenient and non-invasive method of delivering levothyroxine through the skin. These patches contain microscopic needles that penetrate the outer layer of the skin to deliver the medication directly into the bloodstream. This bypasses the gastrointestinal system, avoiding issues related to variable absorption due to factors like food intake or other medications.
Sublingual formulations involve placing a tablet or liquid formulation under the tongue, where it dissolves and gets absorbed through the rich network of blood vessels present in this area. By bypassing digestion in the stomach and intestines, sublingual administration can lead to faster onset of action and potentially more consistent absorption compared to traditional oral methods.
Benefits offered by novel drug delivery methods in terms of improved bioavailability or ease of use
One significant benefit of these novel drug delivery methods is their potential to improve bioavailability, which refers to how much of a medication actually reaches its target site within the body. With traditional oral administration, levothyroxine may encounter various barriers before being absorbed into systemic circulation. Transdermal patches and sublingual formulations allow direct entry into the bloodstream, resulting in higher bioavailability and potentially more predictable therapeutic effects.
Moreover, these alternative delivery methods offer increased ease of use. Transdermal patches can be applied once daily and require minimal effort on part of patients. They eliminate concerns about proper timing with meals or interactions with other medications that may affect absorption. Similarly, sublingual administration is simple and convenient, making it an attractive option for individuals who may have difficulty swallowing tablets or capsules.
Current research advancements in alternative routes of administration
Researchers are actively exploring other innovative routes for levothyroxine delivery to further enhance patient outcomes. Some ongoing studies focus on nasal sprays, inhalation devices, and even intranasal powders as potential methods of administration. These approaches aim to exploit the rich blood supply in the nasal cavity for efficient absorption.
There is growing interest in developing sustained-release formulations that can provide a controlled release of levothyroxine over an extended period. This could potentially reduce the frequency of dosing and improve medication adherence, especially for patients who struggle with multiple daily doses.
Potential future implications for thyroid medication therapy
The development and adoption of novel drug delivery methods have the potential to revolutionize thyroid medication therapy. By improving bioavailability and ease of use, these approaches offer the promise of enhanced treatment outcomes and improved quality of life for individuals with thyroid disorders.
Combining Levothyroxine and Liothyronine in various ratios to optimize TSH AND free T3 levels
The use of synthetic forms of both T4 (levothyroxine) and T3 (liothyronine) in combination therapy has gained attention as a potential strategy to optimize thyroid hormone levels. By combining these medications in different ratios, healthcare providers aim to achieve the desired balance of TSH and free T3 levels in patients with thyroid disorders.
Rationale behind combining synthetic forms of both T4 (levothyroxine) and T3 (liothyronine)
The rationale for combining levothyroxine and liothyronine lies in their distinct mechanisms of action. Levothyroxine is a prohormone that gets converted into the active form of thyroid hormone, T3, within the body. On the other hand, liothyronine is a direct source of T3. By combining these two medications, healthcare providers can provide patients with both precursor hormone (T4) and active hormone (T3), potentially addressing any conversion issues that may exist within the patient's body.
Different ratios used in combination therapy to achieve desired thyroid hormone levels
When prescribing combined levothyroxine and liothyronine therapy, healthcare providers consider various ratios based on individual patient needs. One commonly used ratio is 10:1, where levothyroxine is prescribed at ten times the dose of liothyronine. This ratio aims to maintain an adequate supply of precursor hormone while supplementing with a smaller amount of active hormone.
Another approach involves using a 1:1 ratio, where equal amounts of levothyroxine and liothyronine are administered. This ratio provides a more balanced supply of both precursor and active hormones.
Clinical considerations when prescribing combined levothyroxine and liothyronine therapy
Prescribing combined levothyroxine and liothyronine therapy requires careful consideration of individual patient factors. Factors such as the severity of thyroid dysfunction, patient symptoms, and response to previous treatments play a crucial role in determining the appropriateness of combination therapy.
Furthermore, healthcare providers must monitor patients closely for any signs of over- or undermedication. Regular assessment of TSH and free T3 levels is essential to ensure that the prescribed ratio is effectively optimizing thyroid hormone levels without causing adverse effects.
Monitoring parameters to assess the effectiveness of combination therapy
To evaluate the effectiveness of combined levothyroxine and liothyronine therapy, healthcare providers rely on several monitoring parameters. These include regular measurements of TSH and free T3 levels to assess whether the desired balance has been achieved.
Patient-reported symptoms such as fatigue, weight changes, mood disturbances, and cognitive function are considered when evaluating treatment efficacy. Adjustments to medication dosing may be necessary based on these clinical indicators.
Monitoring Effectiveness of Thyroid Medication
Regular monitoring is crucial in assessing the effectiveness of thyroid medication therapy. By closely tracking the patient's progress, healthcare professionals can ensure that the prescribed dosage is appropriate and adjust it if necessary. This article will discuss the importance of regular monitoring, key laboratory tests for evaluating thyroid function, interpreting lab results, and long-term monitoring strategies to ensure optimal treatment outcomes.
Importance of Regular Monitoring
Regular monitoring allows healthcare providers to evaluate how well a patient's thyroid medication is working. Since every individual responds differently to treatment, it is essential to assess their progress over time. Through periodic check-ups and laboratory tests, any deviations from the desired therapeutic range can be identified promptly.
Key Laboratory Tests for Evaluating Thyroid Function
Several laboratory tests are commonly used to assess thyroid function. These include measuring levels of thyroid-stimulating hormone (TSH), free thyroxine (free T4), and free triiodothyronine (free T3). TSH is often considered the primary indicator as it reflects the body's feedback loop regulating thyroid hormone production. Free T4 and free T3 levels provide additional insights into hormone availability and metabolism.
Interpreting Lab Results and Adjusting Medication Dosages Accordingly
Interpreting lab results requires a comprehensive understanding of reference ranges and target values for each test. If TSH levels are outside the normal range, it may indicate inadequate or excessive dosing. Elevated TSH suggests undertreatment, while suppressed levels may signal overtreatment. Similarly, abnormal free T4 or free T3 values can guide adjustments in medication dosages.
Adjusting medication dosages should be done cautiously based on clinical judgment rather than solely relying on lab results. Factors such as symptoms experienced by patients alongside their lab values should also be taken into account. Collaborative decision-making between healthcare professionals and patients plays a vital role in optimizing treatment outcomes.
Long-Term Monitoring Strategies
Once a patient's thyroid medication dosage has been stabilized, long-term monitoring is necessary to ensure continued efficacy. Regular follow-up appointments and periodic laboratory tests help track the stability of hormone levels and detect any changes that may require dose adjustments.
In addition to TSH, free T4, and free T3 measurements, other factors should be considered during long-term monitoring. These include the patient's overall well-being, symptomatology, weight changes, heart rate, and blood pressure. By taking a holistic approach to monitoring thyroid function, healthcare providers can better assess treatment effectiveness.
To summarize, regular monitoring is vital in evaluating the effectiveness of thyroid medication therapy. Key laboratory tests such as TSH, free T4, and free T3 levels provide valuable information for adjusting medication dosages when needed. Long-term monitoring strategies encompass not only lab results but also various patient-specific factors. By closely tracking progress over time and making appropriate adjustments, healthcare professionals can optimize treatment outcomes for individuals receiving thyroid medication therapy.
Key Takeaways on Dosing and Delivery
Personalized Approaches for Optimal Treatment
It is crucial to understand that each individual has unique needs. There is no one-size-fits-all approach. As discussed in the previous sections, several factors come into play while determining the appropriate dosage and delivery method for a patient.
The first step towards personalized treatment is a comprehensive evaluation of the patient's medical history, including any underlying health conditions, allergies, or sensitivities. This information helps healthcare providers tailor the medication regimen to suit the individual's specific requirements.
Healthcare professionals also consider the patient's age, weight, and overall health status when determining the optimal dosage. For instance, older individuals may require lower doses due to changes in metabolism and potential interactions with other medications they may be taking.
Consistent Adherence for Effective Management
Consistency is key. Adhering to prescribed regimens ensures that patients receive consistent levels of hormones necessary for proper functioning of their thyroid gland. Inconsistent use can lead to fluctuations in hormone levels, resulting in inadequate symptom control or even exacerbation of symptoms.
To promote adherence, healthcare providers often recommend establishing a routine around medication administration. Taking medications at the same time every day can help patients remember their doses and make it easier to incorporate them into their daily lives. Using pill organizers or setting reminders on smartphones can serve as helpful tools for maintaining consistency.
It is important for patients not to alter their prescribed dosage without consulting their healthcare provider first. Adjustments should only be made under professional guidance based on regular monitoring of hormone levels through blood tests.
Open Communication with Healthcare Providers
Maintaining open communication with healthcare providers plays a vital role in optimizing thyroid medication dosing and delivery methods. Patients should feel comfortable discussing any concerns or questions they have regarding their treatment plan.
Regular follow-up appointments allow healthcare providers to assess the effectiveness of the current regimen and make any necessary adjustments. It is essential for patients to communicate any changes in symptoms or side effects they may experience, as this information helps guide treatment decisions.
Patients should also inform their healthcare providers about any other medications, supplements, or herbal remedies they are taking, as these can potentially interact with thyroid medications and affect dosing requirements.
By actively engaging in conversations with their healthcare providers, patients can ensure that their medication regimen remains tailored to their specific needs and circumstances.
Adding chromium, selenium, low dose naltrexone and others into thyroid medicine
Supplementing thyroid medication with additional nutrients or medications has become a topic of interest in recent years. Many individuals are exploring the potential benefits of incorporating substances like chromium, selenium, and low-dose naltrexone into their thyroid treatment regimen. While these additives may offer some advantages, it is important to understand their role and consider certain factors when combining them with standard thyroid medication.
Exploring the potential benefits of supplementing thyroid medication with additional nutrients or medications
Finding the optimal treatment approach is crucial for patients' overall well-being. While standard thyroid medication can effectively address hormonal imbalances, some individuals may seek complementary options to enhance their treatment outcomes. This has led to an exploration of various additives that could potentially support thyroid function.
Role of chromium and selenium in supporting thyroid function
Chromium and selenium are two essential minerals that have been studied for their potential role in maintaining healthy thyroid function. Chromium plays a vital role in glucose metabolism and insulin regulation, which indirectly affects the production and conversion of thyroid hormones. Selenium, on the other hand, is involved in the synthesis and metabolism of these hormones directly.
Including these minerals as part of a comprehensive treatment plan may help optimize thyroid function by supporting hormone production and metabolism. However, it is important to consult with a healthcare professional before introducing any new supplements into your routine.
Low-dose naltrexone as an adjunctive therapy for autoimmune thyroid conditions
Autoimmune thyroid conditions such as Hashimoto's disease or Graves' disease can significantly impact a person's quality of life. In recent years, low-dose naltrexone (LDN) has gained attention as a potential adjunctive therapy for these conditions.
LDN works by modulating the immune system response through its interaction with opioid receptors. By doing so, it aims to reduce inflammation and the autoimmune response that may contribute to thyroid dysfunction. While research on LDN's effectiveness in treating autoimmune thyroid conditions is ongoing, some individuals have reported positive outcomes when using it alongside standard thyroid medication.
Considerations when combining these additives with standard thyroid medication
When considering the addition of chromium, selenium, low-dose naltrexone, or any other substances to your thyroid medication regimen, several factors should be taken into account:
- Consultation with a healthcare professional: It is crucial to consult with a knowledgeable healthcare professional who can assess your specific condition and provide guidance on appropriate dosages and potential interactions.
- Potential interactions: Some additives may interact with standard thyroid medication or other medications you are taking. Understanding these potential interactions is essential to avoid adverse effects or reduced efficacy.
- Individual variability: Every person's body chemistry is unique, and what works for one individual may not work for another. It is important to monitor your response closely and make adjustments as necessary under medical supervision.
- Quality and reliability of supplements: If you decide to incorporate additional nutrients into your treatment plan, ensure that you choose reputable brands that adhere to quality standards and undergo third-party testing.
- Regular monitoring: Regular follow-up appointments with your healthcare provider will help monitor the effectiveness of the combined treatment approach and make any necessary adjustments.
Conclusion
In conclusion, compounding T3 and T4 during thyroid medication dosing offers several benefits compared to using Armour Thyroid. By understanding levothyroxine's pharmacokinetics, we can optimize therapy by adjusting the dose accordingly. Exploring both conventional and novel drug delivery methods allows for more efficient absorption and utilization of the medication.
Combining levothyroxine and liothyronine in various ratios can help optimize TSH and free T3 levels, leading to improved patient outcomes. Monitoring the effectiveness of thyroid medication is crucial in ensuring proper dosing and adjustment as needed.
Key takeaways from this discussion include the importance of considering compounding options for thyroid medication dosing, as well as exploring alternative drug delivery methods. Adding chromium, selenium, low-dose naltrexone, or other supplements to thyroid medicine may provide additional benefits.
To make informed decisions about your thyroid medication dosing and kinetic service, it is essential to consult with a healthcare professional who specializes in endocrinology or personalized medicine. They can guide you through the process and tailor your treatment plan based on your individual needs.
Remember that everyone's journey with thyroid health is unique, so what works for one person may not work for another. It's important to stay proactive in managing your condition and regularly communicate with your healthcare provider.
Take charge of your health today by exploring different options for compounding thyroid medications and discussing them with your doctor. Together, you can find the best approach to optimize your therapy and improve your quality of life.
FAQs
Can I switch from Armour Thyroid to compounded T3 and T4?
Yes, it is possible to switch from Armour Thyroid to compounded T3 (liothyronine) and T4 (levothyroxine). However, it is crucial to consult with a healthcare professional who can guide you through the transition process safely.
How long does it take to adjust the levothyroxine dose?
The time required to adjust the levothyroxine dose varies from person to person. It may take several weeks or even months to find the optimal dosage that balances TSH and free T3 levels effectively.
Are there any side effects associated with compounded thyroid medications?
As with any medication, there is a potential for side effects when using compounded thyroid medications. However, these risks can be minimized by working closely with a knowledgeable healthcare professional who can monitor your progress and make necessary adjustments.
Can adding supplements like chromium and selenium improve thyroid medication effectiveness?
While some studies suggest that supplements like chromium and selenium may have positive effects on thyroid function, it is important to consult with your healthcare provider before incorporating them into your thyroid medication regimen. They can assess whether these supplements are suitable for you based on your individual needs.
How often should I monitor my thyroid medication's effectiveness?
Regular monitoring of thyroid medication effectiveness is essential for maintaining optimal dosing. Your healthcare provider will determine how frequently you should have blood tests to evaluate your hormone levels and make any necessary adjustments.
Please note that this information is not intended as medical advice, and consulting with a qualified healthcare professional is crucial for personalized guidance in managing your specific health condition.
References
1. Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012;22(12):1200-1235. doi:10.1089/thy.2012.0205
2. Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014;24(12):1670-1751. doi:10.1089/thy.2014.0028
3. Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017;27(3):315-389. doi:10.1089/thy.2016.0457
4. Wiersinga WM. Paradigm shifts in thyroid hormone replacement therapies for hypothyroidism. Nature Reviews Endocrinology. 2014;10(3):164-174. doi:10.1038/nrendo.2013.258
5. Peterson SJ, Cappola AR, Castro MR, Dayan CM, Farwell AP, Hennessey JV, Kopp PA, Ross DS, Samuels MH, Sawka AM, Schneider DF, Singh Ospina N, Bernet VJ. An online survey of hypothyroid patients demonstrates prominent dissatisfaction. Thyroid. 2018 Jul;28(7):707-721. doi: 10.1089/thy.2018.0105.
6. Hoermann R, Midgley JE, Larisch R, Dietrich JW. Relational Stability in the Expression of Normality, Variance, and Control of Thyroid Function. Front Endocrinol (Lausanne). 2016;7:142. Published 2016 Oct 25. doi:10.3389/fendo.2016.00142
7. Wiersinga WM, Duntas L, Fadeyev V, Nygaard B, Vanderpump MP. 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism. Eur Thyroid J. 2012;1(2):55-71. doi:10.1159/000339444
8. Peterson SJ, Cappola AR, Castro MR, Dayan CM, Farwell AP, Hennessey JV, Kopp PA, Ross DS, Samuels MH, Sawka AM, Schneider DF, Singh Ospina N, Bernet VJ. An online survey of hypothyroid patients demonstrates prominent dissatisfaction. Thyroid. 2018 Jul;28(7):707-721. doi: 10.1089/thy.2018.0105.
9. Jonklaas J, Tefera E, Shara N. Clinical progress in thyroidology: greater understanding of levothyroxine absorption and of the effects of gastrointestinal disease and medications on levothyroxine absorption. Nature Reviews Endocrinology. 2022;18(1):11-24. doi:10.1038/s41574-021-00535-x
10. Santini F, Pinchera A, Marsili A, et al. Lean body mass is a major determinant of levothyroxine dosage in the treatment of thyroid diseases. J Clin Endocrinol Metab. 2005 Jan;90(1):124-7. doi: 10.1210/jc.2004-1580.
