Liquid Levothyroxine: Efficacy and Application in the Treatment of Myxoedema Coma - A Narrative Review
DOI:
https://doi.org/10.12775/QS.2024.19.53789Keywords
myxoedema coma, hypothyroidism, liquid levothyroxine, thyroid hormone replacement, endocrine emergencyAbstract
Introduction: Myxoedema coma is a severe and rare manifestation of hypothyroidism that requires immediate and effective intervention. Traditional treatment involves the use of levothyroxine, a synthetic thyroid hormone. Liquid levothyroxine presents an alternative formulation that may offer advantages in the critical care setting, particularly when gastrointestinal absorption is impaired.
Aim of the Study: This narrative review aims to evaluate the efficacy and application of liquid levothyroxine in the treatment of myxoedema coma, comparing it to other available forms and providing insights into its clinical use.
Materials and Methods: A comprehensive literature search was conducted using databases such as PubMed, Medline, and Cochrane Library. Studies, clinical trials, case reports, and reviews were included if they addressed the use of liquid levothyroxine in myxoedema coma. Data were extracted and analyzed to assess the pharmacokinetics, administration protocols, outcomes, and comparative efficacy of liquid levothyroxine.
Results: The review identified several key studies and case reports indicating that liquid levothyroxine offers superior bioavailability and faster onset of action compared to oral tablets, particularly in patients with compromised gastrointestinal function. Case studies demonstrated improved clinical outcomes and recovery times with liquid levothyroxine, highlighting its potential benefits in the acute management of myxoedema coma.
Conclusion: Liquid levothyroxine appears to be a promising alternative for the treatment of myxoedema coma, offering enhanced absorption and rapid therapeutic effects. While preliminary data are encouraging, further research and clinical trials are necessary to establish standardized treatment protocols and confirm its efficacy. Understanding the role of liquid levothyroxine in this critical condition can enhance treatment strategies and improve patient outcomes.
References
Benvenga, S., & Vita, R. (2017). Thyroid hormone replacement therapy: three “simple” questions, complex answers. European Thyroid Journal, 6(2), 46-53. https://doi.org/10.1159/000457967
Baduni, N., Sinha, S. K., & Sanwal, M. K. (2012). Perioperative management of a patient with myxedema coma and septicemic shock. Indian Journal of Critical Care Medicine, 16(4), 228–230. https://doi.org/10.4103/0972-5229.106510
Benvenga, S., & Vita, R. (2017). Thyroid hormone replacement therapy: three “simple” questions, complex answers. European Thyroid Journal, 6(2), 46-53. https://doi.org/10.1159/000457967
Bernareggi, A., & Pinorini, M. T. (2012). Liquid formulation of levothyroxine is stable in breakfast beverages and may improve thyroid patient compliance. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 32(3), 251-253. https://doi.org/10.1002/j.1875-9114.2012.01021.x
Bornikowska, K., Gietka-Czernel, M., Raczkiewicz, D., Glinicki, P., & Zgliczyński, W. (2021). Improvements in Quality of Life and Thyroid Parameters in Hypothyroid Patients on Ethanol-Free Formula of Liquid Levothyroxine Therapy in Comparison to Tablet LT4 Form: An Observational Study. Journal of Clinical Medicine, 10(22), 5233. https://doi.org/10.3390/jcm10225233
Centanni, M., Gargano, L., Canettieri, G., et al. (2006). Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis. New England Journal of Medicine, 354(17), 1787-1795. https://doi.org/10.1056/NEJMoa043903
Charoensri, S., Sriphrapradang, C., & Nimitphong, H. (2017). Split high‐dose oral levothyroxine treatment as a successful therapy option in myxedema coma. Clinical Case Reports, 5(10), 1706–1711. https://doi.org/10.1002/ccr3.1131
Chasińska-Mrowiec, D., Zajac, K., Gałuszka-Bednarczyk, A., et al. (2014). Myxoedema coma: a life-threatening complication of hypothyroidism. Endokrynologia Polska, 65(5), 396-401. https://doi.org/10.5603/EP.2014.0060
Colucci, P., D’Angelo, P., Messa, P., et al. (2013). A new oral liquid levothyroxine preparation ensures more uniform serum TSH levels compared to tablet formulation in patients with hypothyroidism. Journal of Clinical Endocrinology & Metabolism, 98(5), 1982-1988. https://doi.org/10.1210/jc.2012-4077
Dolkar, T., Zouetr, M., Shankar, M., Rayapureddy, A. K., & Shiferaw-Deribe, Z. (2022). Subclinical Hypothyroidism Presenting as Myxedema Coma: Case Report and Literature Review. Cureus. https://doi.org/10.7759/cureus.25588
Elghawy, O., Hafey, A. C., McCartney, C. R., & Steinman, J. R. (2021). Successful treatment of myxedema coma using levothyroxine and liothyronine in the setting of adrenal crisis and severe cardiogenic shock in a patient with apparent primary empty sella. Journal of Clinical and Translational Endocrinology: Case Reports, 22, 100095. https://doi.org/10.1016/j.jecr.2021.100095
Esfahanian, F., & Afshar, H. (2011). Myxedema coma: a report of three cases. Journal of Research in Medical Sciences, 16(1), 118-123.
Fallahi, P., Ferrari, S. M., Camastra, S., et al. (2017). TSH normalization in hypothyroid patients treated with liquid levothyroxine as compared to tablet levothyroxine. Endocrine Journal, 64(6), 555-560. https://doi.org/10.1507/endocrj.EJ17-0012
Hennessey, J. V., & Espaillat, R. (2015). Diagnosis and management of myxedema coma. Journal of Intensive Care Medicine, 30(6), 339-348. https://doi.org/10.1177/0885066613508847
Holvey, D. N., Goodner, C. J., Nicoloff, J. T., & Dowling, J. T. (1964). Treatment of myxedema coma with intravenous thyroxine. Archives of Internal Medicine, 113(1), 89-96. https://doi.org/10.1001/archinte.1964.03860010091008
James, R., James, J., Vij, A. S., & Vij, K. K. (2014). Postoperative myxoedema coma. BMJ Case Reports, bcr2013010066. https://doi.org/10.1136/bcr-2013-010066
Jonklaas, J., Bianco, A. C., Bauer, A. J., et al. (2014). Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid, 24(12), 1670-1751. https://doi.org/10.1089/thy.2014.0028
Klubo-Gwiezdzinska, J., & Wartofsky, L. (2012). Thyroid Emergencies. Medical Clinics of North America, 96(2), 385–403. https://doi.org/10.1016/j.mcna.2012.01.015
Kwaku, M. P., & Burman, K. D. (2007). Myxedema coma. Journal of Intensive Care Medicine, 22(4), 224-231. https://doi.org/10.1177/0885066607301360
Mathew, V., Misgar, R. A., Ghosh, S., Mukhopadhyay, P., Roychowdhury, P., Pandit, K., Mukhopadhyay, S., & Chowdhury, S. (2011). Myxedema Coma: A New Look into an Old Crisis. Journal of Thyroid Research, 2011, 1–7. https://doi.org/10.4061/2011/493462
McDermott, M. T. (2020). Hypothyroidism. Annals of Internal Medicine, 173(1), ITC1–ITC16. https://doi.org/10.7326/AITC202007070
Ono, Y., Ono, S., Yasunaga, H., Matsui, H., Fushimi, K., & Tanaka, Y. (2017). Clinical characteristics and outcomes of myxedema coma: Analysis of a national inpatient database in Japan. Journal of Epidemiology, 27(3), 117–122. https://doi.org/10.1016/j.je.2016.04.002
Pingitore, A., Landi, P., Taddei, M. C., et al. (2019). Triiodothyronine levels for risk stratification of patients with chronic heart failure. American Journal of Medicine, 119(1), 76.e7–76.e11. https://doi.org/10.1016/j.amjmed.2019.01.021
Rajendran, A., Bhavani, N., Nair, V., Pavithran, P. V., Menon, V. U., & Kumar, H. (2020). Oral Levothyroxine is an Effective Option for Myxedema Coma: A Single-Centre Experience. European Thyroid Journal, 1–7. https://doi.org/10.1159/000507855
Sokołowski, G., Motyka, M., Gillis-Januszewska, A., Stefańska, A., & Hubalewska-Dydejczyk, A. (2023). Liquid levothyroxine in the treatment of myxoedema coma. Endokrynologia Polska, 74(2), 215–216. https://doi.org/10.5603/EP.a2023.0017
Vita, R., Di Bari, F., & Benvenga, S. (2018). Oral liquid levothyroxine treatment at breakfast: a mistake? Endocrine, 60(2), 280-284. https://doi.org/10.1007/s12020-018-1554-0
Vita, R., Saraceno, G., Trimarchi, F., & Benvenga, S. (2014). A novel formulation of L-thyroxine (L-thyroxine oral solution) for the therapy of hypothyroid patients. Endocrine, 47(3), 798-804. https://doi.org/10.1007/s12020-014-0284-1
Vita, R., & Benvenga, S. (2020). The management of hypothyroidism in the elderly. Frontiers in Endocrinology, 11, 566. https://doi.org/10.3389/fendo.2020.00566
Wartofsky, L., & Dickey, R. A. (2005). The evidence for a narrower thyrotropin reference range is compelling. Journal of Clinical Endocrinology & Metabolism, 90(9), 5483-5488. https://doi.org/10.1210/jc.2005-0455
Yue, C. S., Scarsi, C., Ducharme, M., et al. (2015). Pharmacokinetics and potential advantages of a new oral solution of levothyroxine vs. other available dosage forms. Expert Opinion on Drug Delivery, 12(1), 179-186. https://doi.org/10.1517/17425247.2015.961420
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Patrycja Nowoświat, Maria Maślankiewicz, Magdalena Muzyk, Patrycja Mrowczyk, Michał Bado, Paulina Bednarczyk, Ewa Katarzyna Malaka, Weronika Duda, Sandra Agnieszka Pilawska, Michał Goncerz, Krzysztof Bilecki
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 67
Number of citations: 0
