David Caldwell Biol.

1615 W 4:00

Administration of Levothyroxyin
Levothyroxine is a drug used to treat diseases or conditions related to the thyroid gland, the most common of which is hypothyroidism. In medical terms, hypothyroidism occurs when the thyroid gland does not produce sufficient amounts of the thyroid hormone. Clinically, normal levels of the thyroid hormones are determined by measuring an associated hormone produced in the pituitary gland, the thyroid stimulating hormone (TSH), Thyrotropin, which has an inverse relationship to the thyroid hormone, such that low TSH levels indicate an excess of the thyroid hormone, and high TSH levels indicate an insufficiency of the thyroid hormone (Arem, 1999). When a person has been diagnosed with hypothyroidism and is taking a thyroid supplement, such as levothyroxine, the aim is to raise the level of thyroid hormone. This should, in turn, lower the TSH to back within a more normal range.

It can be difficult to determine the appropriate dose for an underactive thyroid though, and there are many variables that can affect the consideration of what a correct dose should be. The article that I chose to review examines one such variable. It has to do with the efficiency and reliability of a certain dose reaching the bloodstream from the intestine after being taken orally as a tablet with water. The article refers to this efficiency as the bioavailability of levothyroxine and notes that such a bioavailability is not only dependent upon the compliant intake of levothyroxine tablets but also on other factors which affect bioavailability including concomitant ingestion of food and other oral medications and intestinal malabsorption. (Seechurn, Sharma, & Oyibo, 2012)

The experiment conducted in the article sought to establish greater control of this bioavailability, or efficiency of absorption, by separating the ingestion of the medication from the ingestion of food. The experiment asked people on the medication who typically took the dose at breakfast to begin taking the dose 45 to 60 minutes before breakfast. The study found that the switch

resulted in reduced TSH levels without increasing the dosage, indicating that the medication was reaching the target of the bloodstream more efficiently when it was taken long enough before breakfast, due to increased absorption of the tablet.

I share some similarities with the subjects of the experiment. I was diagnosed with hypothyroidism in my early twenties after experiencing a multitude of symptoms that are associated with an underactive thyroid, such as feeling cold, fatigued, and excessively sleepy; noticing changes in hair, skin, eyes and muscles; as well as experiencing a cognitive spacey feeling or brain fog (Rosenthal, 2000). I subsequently spent considerable effort trying to stabilize the symptoms and find a regimen that would maintain the hormone levels at normal amounts. Also, like the subjects in the experiment, I have typically taken the levothyroxine medication at breakfast.

The article demonstrates that changing the routine from taking the medication at breakfast to taking the medication a sufficient amount of time before breakfast is beneficial from a strict biological perspective, by increasing the absorption rate of the medication; but one aspect that the experiment did not address was the practicality of such an approach from a real-life perspective. Outside of the lab, the vast majority of people who are taking the medications do not view themselves as specimens, but rather real people with jobs, school, families, and in short, daily stresses and lifestyles that typically cant afford to revolve around a pill. Many people find it difficult amid daily routines just to find the time to eat breakfast, much less plan on 45 minutes to an hour before breakfast just to take a pill. The question becomes whether the benefits are great enough to offset such an inconvenience.

The article suggests a further study needed to justify whether taking levothyroxine at bedtime is biochemically better than taking it first thing in the morning... (Seechurn et al., 2012). It seems to me that taking it at bedtime would be preferable from a lifestyle perspective, and that the question should be whether an approach is even biochemically comparable and not necessarily better.

References

Arem, Ridha (1999). The Thyroid Solution. New York, NY: Random House. Rosenthal, Sara (2000). The Thyroid Sourcebook (4th ed.). Lincolnwood, IL: Lowell House.

Seechurn, Shivshanker, Sanjeev Sharma, & Samson Oyibo. Administration of Thyroxin 45 60 Minutes Before Breakfast Improves Biochemical Availability as Evidenced by Reduced Thyrotropin Levels. Open Journal of Endocrine and Metabolic Diseases, 2012, 2, 36-39. Published Online August 2012 http://www.SciRP.org/journal/ojemd