scholarly journals The Stability of TSH, and Thyroid Hormones, in Patients Treated With Tablet, or Liquid Levo-Thyroxine

2021 ◽  
Vol 12 ◽  
Author(s):  
Alessandro Antonelli ◽  
Giusy Elia ◽  
Francesca Ragusa ◽  
Sabrina Rosaria Paparo ◽  
Gabriella Cavallini ◽  
...  
Keyword(s):  
Liquid Solution ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Pharmacokinetic Studies ◽  
Oral Formulations ◽  
Long Term Follow Up ◽  
Liquid Preparation ◽  
The Stability ◽  
Prospective Longitudinal ◽  
Hypothyroid Patients

Approximately, 5% of the population is affected by hypothyroidism, mainly women and persons aged more than 60 years. After the diagnosis of hypothyroidism the usual therapy is tablet levothyroxine (L-T4), with a monitoring of the thyroid-stimulating hormone (TSH) level in primary hypothyroidism every 6–8 weeks and L-T4 is adjusted as necessary to reach an euthyroid state. Once TSH is stabilized in the normal range, it is recommended to conduct annual testing in the treated subjects to warrant suitable replacement. More recently advances regarding L-T4 treatment are the introduction of new oral formulations: the liquid solution, and soft gel capsule. The soft gel capsule permits a quick dissolution in the acid gastric pH. The liquid preparation does not require an acid gastric environment. Many pharmacokinetic studies demonstrated a more rapid absorption for the liquid L-T4, or capsule, than with tablet. Many studies have shown that the liquid, or capsule, formulations can overcome the interaction with foods, drugs or malabsorptive conditions, that are able to impair the tablet L-T4 absorption. Lately studies have suggested that liquid L-T4 can permit to maintain more efficiently normal TSH levels in hypothyroid patients in the long-term follow-up, than tablet L-T4, both in patients with malabsorptive states, and in those without malabsorption. Further large, prospective, longitudinal studies are needed to evaluate the stability of TSH, in hypothyroid patients treated with different L-T4 formulations.

scholarly journals L-T4 Therapy in Enteric Malabsorptive Disorders

2021 ◽  
Vol 12 ◽  
Author(s):  
Poupak Fallahi ◽  
Silvia Martina Ferrari ◽  
Giusy Elia ◽  
Francesca Ragusa ◽  
Sabrina Rosaria Paparo ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Lactose Intolerance ◽  
Thyroid Stimulating Hormone ◽  
Gastric Ph ◽  
Oral Formulations ◽  
Daily Dose ◽  
Liquid Preparation ◽  
Inflammatory Bowel ◽  
Hypothyroid Patients ◽  
Better Than

Levothyroxine (L-T4) absorption can be impaired by various causes: a) L-T4 ingestion during breakfast, or with food; b) conditions of reduced gastric acidity; c) intestinal procedures and diseases such as bariatric surgery, lactose intolerance (LI), celiac disease (CD), inflammatory bowel disease; d) drugs that alter L-T4 absorption, increasing the gastric pH, or preventing the dissolution of tablets. The development of new oral formulations, i.e. the liquid preparation and the soft gel capsule, represents the most recent advance regarding L-T4 therapy. Treating hypothyroidism with L-T4 tablets can lead to an improper control of thyroid-stimulating hormone (TSH) in ~10%–15% of patients. The improperly elevated TSH is usually managed by increasing the L-T4 daily dose, and revaluating TSH upon 2-6 months. The increase of the L-T4 dosage may cause iatrogenic hyperthyroidism, especially when the underlying disorders are cured. Liquid L-T4 can be administered in patients unable to swallow capsules or tablets, and this is one of its major benefits. Liquid L-T4 can: 1- overcome food and beverages interference; 2- bypass the malabsorption associated with an increased gastric pH; 3- circumvent the issue of malabsorption in patients who underwent bariatric surgery; 4-maintain TSH values under control better than L-T4 tablets in hypothyroid patients with typical or atypical CD, or in patients with LI. Few clinical studies evaluated soft gel L-T4 with encouraging findings in patients with gastric- or coffee-related malabsorption, or hypothyroid patients without malabsorption. Additional research is necessary to investigate liquid L-T4, or soft gel capsule, in other conditions of altered L-T4 absorption.

scholarly journals Stability of Propofol (2,6-Diisopropylphenol) in Thermal Desorption Tubes during Air Transport

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Felix Maurer ◽  
Martin Geiger ◽  
Thomas Volk ◽  
Daniel I. Sessler ◽  
Sascha Kreuer ◽  
...  
Keyword(s):  
Room Temperature ◽  
Pharmacokinetic Studies ◽  
Gas Generator ◽  
Individual Values ◽  
Liquid Injection ◽  
Refrigerated Transport ◽  
Liquid Preparation ◽  
The Stability ◽  
The Individual ◽  
Sample Set

The anesthetic propofol and other exhaled organic compounds can be sampled in Tenax sorbent tubes and analyzed by gas chromatography coupled with mass spectrometry. The aim of this study was to evaluate the stability of propofol in Tenax sorbent tubes during overseas shipping. This is relevant for international pharmacokinetic studies on propofol in exhaled air. Tenax sorbent tube propofol samples with concentrations between 10 and 100 ng were prepared by liquid injection and with a calibration gas generator. For each preparation method, one reference set was analyzed immediately after preparation, a second set was stored at room temperature, and a third one was stored refrigerated. The fourth set was sent from Germany by airmail to USA and back. The shipped set of tubes was analyzed when it returned after 55 days elapsed. Then, the room temperature samples and the refrigerated stored samples were also analyzed. To evaluate the stability of propofol in the stored and shipped tubes, we calculated the recovery rates of each sample set. The mean recovery in the stored samples was 101.2% for the liquid preparation and 134.6% for the gaseous preparation at 4°C. At 22°C, the recovery was 96.1% for liquid preparation and 92.1% for gaseous preparation, whereas the shipped samples had a recovery of 85.3% and 111.3%. Thus, the deviation of the shipped samples is within a range of 15%, which is analytically acceptable. However, the individual values show significantly larger deviations of up to -32.1% (liquid) and 30.9% (gaseous). We conclude that storage of propofol on Tenax tubes at room temperature for 55 days is possible to obtain acceptable results. However, it appears that due to severe temperature and pressure variations air shipment of propofol samples in Tenax tubes without cooling shows severe deviations from the initial concentration. Although it was not tested in this study, we assume that refrigerated transport might be necessary to obtain comparable results as in the stored samples.

The nocturnal thyroid-stimulating hormone surge is absent in overt, present in mild primary and equivocal in central hypothyroidism

1992 ◽  
Vol 126 (3) ◽  
pp. 206-212 ◽  
Author(s):  
Ria Adriaanse ◽  
Johannes A Romijn ◽  
Erik Endert ◽  
Wilmar M Wiersinga
Keyword(s):  
Positive Relationship ◽  
Thyroid Stimulating Hormone ◽  
Relative Increase ◽  
Primary Hypothyroidism ◽  
Overt Hypothyroidism ◽  
Central Hypothyroidism ◽  
Pituitary Disease ◽  
Hypothyroid Patients ◽  
Nocturnal Rise ◽  
Central Lesions

The nocturnal TSH surge was studied in controls, in 34 patients with hypothalamic/pituitary disease and in 21 patients with primary hypothyroidism. It was absent in 5/12 hypothyroid patients and in 5/22 euthyroid patients with hypothalamic/pituitary disease (42% vs 23%. NS). Central hypothyroidism relative to euthyroidism was associated with a lower absolute (0.3±0.4 vs 0.9±1.0 mU/l, p<0.05) and relative (24±31 vs 63±51%, p<0.05) nocturnal rise in TSH. In primary hypothyroidism, the nocturnal TSH surge was absent in eight often patients with overt, in one of five patients with mild and in none of six patients with subclinical hypothyroidism. The relative nocturnal rise in TSH was normal in mild (54±33%) and subclinical (92±69%), but decreased in overt hypothyroidism (2±10%). Plasma T4 was positively and 09.00 plasma TSH negatively related to the relative nocturnal TSH surge in primary hypothyroidism, but not in central lesions. In both conditions, however, a positive relationship was observed between the relative nocturnal TSH surge and the relative increase of TSH to TRH. In conclusion: (a) The nocturnal TSH surge is usually absent in overt hypothyroidism but present in mild primary hypothyroidism and equivocal in central hypothyroidism. This limits its usefulness as an adjunct in the diagnosis of central hypothyroidism. (b) The magnitude of the nocturnal TSH surge in patients with hypothalamic/pituitary disease or primary hypothyroidism is directly related to the TSH response to TRH, and thus appears to be determined by the directly releasable TSH pool of the pituitary.

scholarly journals Recent evidence sets therapeutic targets for levothyroxine-treated patients with primary hypothyroidism based on risk of death

2021 ◽  
Vol 184 (2) ◽  
pp. C1-C3
Author(s):  
Petros Perros ◽  
Krishnarajah Nirantharakumar ◽  
Laszlo Hegedüs
Keyword(s):  
Large Population ◽  
Indirect Evidence ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Normal Serum ◽  
Normal Range ◽  
Ample Evidence ◽  
Risk Of Death ◽  
Hypothyroid Patients ◽  
Serum Tsh

Since the introduction of sensitive assays for serum thyroid-stimulating hormone (TSH) clinicians have advised hypothyroid patients to adjust the dose of levothyroxine (L-T4) in order to achieve a normal serum TSH. A minority of patients are dissatisfied with this treatment strategy and experience symptoms. Some indirect evidence suggests that a normal serum TSH may not necessarily reflect euthyroidism at the tissue level in patients treated with L-T4. Increasingly hypothyroid patients demand higher doses of L-T4 or liothyronine (L-T3) or animal thyroid extract, often purchased online, and titrate the dose against symptoms, although ample evidence suggests that combination treatment (L-T4 with L-T3) is no more effective than L-T4 alone. Community surveys show that up to 53% of treated hypothyroid patients at any time have a serum TSH outside the normal range. The recommendation by guidelines that the upper limit of the normal range for serum TSH should not be exceeded is supported by robust evidence and is generally accepted by clinicians and patients. However, until recently the lower limit of serum TSH for optimal L-T4 replacement has been controversial. New evidence obtained by two independent large population studies over the past two years has shown that mortality of hypothyroid patients treated with levothyroxine is increased when the serum TSH exceeds or is reduced outside the normal reference range. It is estimated that the implementation of a policy of normalising serum TSH in hypothyroid patients will reduce the risk of death of 28.3 million people in the USA and Europe alone.

scholarly journals Improving the Solubilization and Bioavailability of Arbidol Hydrochloride by the Preparation of Binary and Ternary β-Cyclodextrin Complexes with Poloxamer 188

2021 ◽  
Vol 14 (5) ◽  
pp. 411
Author(s):  
Md. Khalid Anwer ◽  
Muzaffar Iqbal ◽  
Mohammad Muqtader Ahmed ◽  
Mohammed F. Aldawsari ◽  
Mohd Nazam Ansari ◽  
...  
Keyword(s):  
Antiviral Agent ◽  
Aqueous Solubility ◽  
Phase Solubility ◽  
Pharmacokinetic Studies ◽  
Solubility Curve ◽  
Cyclodextrin Complexes ◽  
Poloxamer 188 ◽  
The Stability

In the current study, the effect of poloxamer 188 on the complexation efficiency and dissolution of arbidol hydrochloride (ADL), a broad-spectrum antiviral agent, with β-cyclodextrin (β-CD) was investigated. Phase solubility studies confirmed a stoichiometry of a 1:1 ratio for both ADL:β-CD and ADL/β-CD with a 1% poloxamer 188 system with an AL type of phase solubility curve. The stability constants (K1:1) calculated from the AL type diagram were 550 M-1 and 2134 M-1 for AD:β-CD and ADL/β-CD with 1% poloxamer 188, respectively. The binary ADL/β-CD and ternary ADL/β-CD with 1% poloxamer 188 complexes were prepared by kneading and a solvent evaporation method and were characterized by aqueous solubility, FTIR, PXRD, DSC and SEM in vitro studies. The solubility (13.1 fold) and release of ADL were markedly improved in kneaded ternary ADL/β-CD with 1% poloxamer 188 (KDB). The binding affinity of ADL and β-CD was confirmed by 1H NMR and 2D ROSEY studies. The ternary complex (KDB) was further subjected for in vivo pharmacokinetic studies in rats and a significant improvement in the bioavailability (2.17 fold) was observed in comparison with pure ADL. Therefore, it can be concluded that the solubilization and bioavailability of ADL can be remarkably increased by ADL/β-CD complexation in the presence of a third component, poloxamer 188.

scholarly journals LC-MS/MS Method for Simultaneous Quantification of Dexmedetomidine, Dezocine, and Midazolam in Rat Plasma and Its Application to Their Pharmacokinetic Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Wenjuan Cui ◽  
Qin Liu ◽  
Shan Xiong ◽  
Lujun Qiao
Keyword(s):  
Storage Conditions ◽  
Rat Plasma ◽  
Selected Reaction Monitoring ◽  
Pharmacokinetic Studies ◽  
Reaction Monitoring ◽  
Simultaneous Quantification ◽  
Ionization Mode ◽  
The Stability ◽  
Lower Limits ◽  
Interday Precision

A simple, sensitive, and accurate LC-MS/MS method was established and validated for the simultaneous quantification of dexmedetomidine, dezocine, and midazolam in rat plasma. Chromatographic separation was achieved on a C18 column (50 mm × 2.1 mm, 3 µm) using a mobile phase composed of water (containing 0.1% formic acid) and acetonitrile. The lower limits of quantification were 0.1, 0.1, and 0.2 ng/mL for dexmedetomidine, dezocine, and midazolam in rat plasma, respectively. The analytes were determined with selected reaction monitoring under positive ionization mode. The intra- and interday precision and accuracy were all within acceptable limits during the entire validation, and the stability of analytes was acceptable under various storage conditions. The validated method was successfully applied in pharmacokinetic studies of dexmedetomidine, dezocine, and midazolam following intravenous injection.

scholarly journals Non-Alcoholic Fatty Liver Disease in Primary Hypothyroidism

2020 ◽  
Vol 15 (2) ◽  
pp. 206-208
Author(s):  
Nasir Uddin Ahmed ◽  
Md Anwarul Kabir ◽  
Farzana Kalam ◽  
Shaheda Akter
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
World Wide ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Age Group ◽  
Cross Sectional ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver condition world-wide. Hypothyroidism is also a common disorder affecting general population especially in women. Objectives: To determine the association between primary hypothyroidism and NAFLD. Materials and Method: This is a cross-sectional descriptive type of observational study where 100 cases of primary hypothyroidism in age group 15-75 years of both sexes were selected from February 2018 to January 2019 in CMH Momenshahi having higher level of Thyroid stimulating hormone(TSH). In all cases ultra-sonogram of hepatobiliary system was done by efficient sonologist who was blind about clinical scenario of the patients. Results: Mean age of patients 29±SD7.57.Among 100 cases 56(56%) having NAFLD among them 95% were female and 5% were male. Conclusion: NAFLD was significantly correlated with primary hypothyroidism. JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 206-208

scholarly journals Demographic and Clinical Factors Associated With the Appropriate Target Thyroid-Stimulating Hormone Values in Patients With Primary Hypothyroidism Treated With Levothyroxine

2016 ◽  
Vol 6 (4) ◽  
pp. 109-115
Author(s):  
Lara Moreira Baptista de Sousa ◽  
Elisa Baranski Lamback ◽  
Thomaz Schroder Lameirinhas ◽  
Michelle Botelho Caarls ◽  
Leonardo Vieira Neto
Keyword(s):  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Clinical Factors ◽  
Factors Associated ◽  
Stimulating Hormone
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