Volume 29, Issue 162, August 2025

The use of liquid levothyroxine in the treatment of patients with hypothyroidism and comorbiditiesa review of the literature

Krzysztof Pawlikowski^1♦, Michał Korpalski², Maria Pawluczyk³, Marek Żygłowicz⁴, Mateusz Marciniak⁵, Adam Torbicki⁶, Piotr Gaworek⁷, Dominik Augustyn⁸, Alicja Trybuła⁹

¹University Clinical Center of the Medical University of Warsaw, Banacha 1A Street, 02-097 Warsaw, Poland
²Dr. Tytus Chałubiński Radom Specialist Hospital, Adolfa Tochtermana 1 Street, 26-610 Radom, Poland
³District Hospital in Sochaczew, Batalionów Chłopskich 3/7 Street, 96-500 Sochaczew, Poland
⁴Ludwik Rydygier Specialist Hospital, Złota Jesień 1 Street, 31-826 Kraków, Poland
⁵Mikołaj Kopernik Provincial Multi-Specialist Center of Oncology and Traumatology Pabianicka 62, 93-513 Łódź, Poland
⁶Nicolaus Copernicus Hospital, COPERNICUS Medical Entity limited liability company under Polish law, Nowe Ogrody 1/6 Street, 80-803 Gdańsk, Poland
⁷Międzyleski Specialist Hospital in Warsaw, Bursztynowa 2 Street, 04-749 Warsaw, Poland
⁸Ludwik Rydygier Specialist Hospital, Złota Jesień 1 Street, 31-826 Kraków, Poland
⁹Kazimierz Pułaski University of Technology and Humanities in Radom: Radom, Mazovia, PL Jacka Malczewskiego 29, 26-600 Radom Poland

^♦Corresponding author
Krzysztof Pawlikowski, University Clinical Center of the Medical University of Warsaw, Banacha 1A Street, 02-097 Warsaw, Poland

ABSTRACT

Objective: The primary drug used to treat hypothyroidism is synthetic levothyroxine. Patients with other diseases besides hypothyroidism often have malabsorption of levothyroxine administered in tablet form. In many cases, resistance to levothyroxine decreases or disappears when the drug is used in liquid form. The purpose of this paper is to systematize current knowledge about the effectiveness of using levothyroxine in liquid form when patients have comorbidities in addition to hypothyroidism. Materials and methods: The literature publicly available in the following databases was reviewed: PubMed and Google Scholar. Articles from january 2015- May 2025 were considered. The following keywords were used: "levothyroxine", "hypothyroidism", "levothyroxine absorption", "levothyroxine pharmacokinetics". Results: Patients are given levothyroxine in various forms. The most popular of these is the tablet, but in many cases, its use does not lead to euthyroidism.The main cause is malabsorption in the gastrointestinal tract associated with Helicobacter pylori infection, celiac disease, autoimmune gastritis, and other conditions. The liquid form has a therapeutic effect due to more favorable pharmacokinetics. Conclusion: The absorption efficiency in the gastrointestinal tract of liquid levothyroxine is higher than that of levothyroxine administered in tablet form. This is especially important in patients with comorbidities, where this absorption is often impaired by pathophysiological mechanisms or medications used. For such patients, the use of liquid levothyroxine appears to be the only option, which should be taken into account when recommending treatment for hypothyroidism.

Keywords: hypothyroidism, absorption, levothyroxine, liquid levothyroxine

Medical Science, 2025, 29, e126ms3632

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DOI: https://doi.org/10.54905/disssi.v29i162.e126ms3632

Published: 07 August 2025