Levothyroxine liquid solution versus tablet form for replacement treatment in pregnant women

Objective: To evaluate the need and the magnitude of levothyroxine (LT4) increase in hypothyroid pregnant women on liquid compared to tablet formulations.

Methods: Patients were recruited by searching our “thyroid patients” database. The selection criteria were as follows: a) pregnant women on treatment for hypothyroidism (both liquid and tablet LT4) who gave birth at our hospital between February 2012 and January 2014; b) thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels obtained at least 3 months before missed menstrual cycle, with a TSH value less than 2.5?mIU/L and c) TSH and FT4 obtained within 12 weeks of pregnancy, and each month subsequently.

Results: During pregnancy, 8/31 (25.5%) of the women had to increase the dosage of LT4. Of these, 7/17 (41.2%) were on LT4 replacement therapy with tablets, and 1/14 (7.1%) with liquid formulation (p?=?0.038). Daily LT4 was significantly increased in the liquid group only (52.9?±?19.5 versus 67.5?±?19.2?mcg/day (p?=?0.013). A logistic regression analysis showed that the treatment with LT4 tablets was the only predictor of LT4 increase (OR: 0.44; 95% CI: 0.04–0.83; p?=?0.031).

Conclusion: Pregnant women on optimal replacement therapy before pregnancy require an increase of LT4 dosage more often when on a tablet than liquid formulation.