{"id":128338,"date":"2026-07-30T07:06:00","date_gmt":"2026-07-30T10:06:00","guid":{"rendered":"https:\/\/www.ufrgs.br\/jornal\/?p=128338"},"modified":"2026-08-05T09:42:56","modified_gmt":"2026-08-05T12:42:56","slug":"study-investigates-the-efficiency-of-different-kinds-of-levothyroxine-use-in-hypothyroidism-treatment","status":"publish","type":"post","link":"https:\/\/www.ufrgs.br\/jornal\/study-investigates-the-efficiency-of-different-kinds-of-levothyroxine-use-in-hypothyroidism-treatment\/","title":{"rendered":"Study investigates the efficiency of different kinds of levothyroxine use in hypothyroidism treatment"},"content":{"rendered":"\n

Health | A doctoral dissertation of the Graduate Program in Epidemiology indicates that the most effective intakes are in the morning, upon waking, and at night, before bed. The evidence for other administration regimens was inconclusive<\/strong>
<\/h4>\n\n\n\n

*First published in February 27, 2025
<\/em>*Photo: In Brazil, levothyroxine has been used to treat hypothyroidism since 1960. In pharmacies, it is sold under the names Synthroid, Euthyrox, Levoid, Puran T4, Levotroid, or Tiroidin (Photo: Fl\u00e1vio Dutra\/JU)<\/em><\/p>\n\n\n\n

<\/div>\n\n\n\n

Currently, it is estimated that hypothyroidism affects 8 to 12% of the Brazilian population.  The disease causes alterations in thyroid-stimulating hormone (TSH) and thyroxine (T4) levels. The most common treatment is the use of levothyroxine, which can be administered orally or intravenously. <\/p>\n\n\n\n

Patients are typically advised to take the medication daily, in the morning, on an empty stomach, but some studies have also investigated and tested other recommendations, such as taking the medication once a week or during a meal, for example.  <\/p>\n\n\n\n

Therefore, one of the objectives of a doctoral dissertation in the Graduate Program in Epidemiology at UFRGS was to evaluate studies on the topic to identify the most effective administration regimen of the medication, considering absorption, TSH levels, and the results reported by patients.<\/p>\n\n\n\n

\u201cWhat we realized was that using it at night, from 2 to 3 hours after dinner, could be as effective as before breakfast,\u201d explains Bianca Bianchini, author of the study.<\/p>\n\n\n\n

\"Pesquisadora
Bianca Bianchini analyzed the effect of levothyroxine on patients based on formerly published research. To achieve this, the research group used studies published in seven databases, including PubMed and Scielo. (Photo: Pietro Scopel\/JU)<\/figcaption><\/figure>\n\n\n\n

In her work, Bianca analyzed 14 studies (available in databases such as PubMed and Scielo) that investigated different recommendations of medication regimen and its effects. The instructions ranged from taking the medication before breakfast, during breakfast, or before bed; regarding frequency, from daily to once, or twice a week.<\/p>\n\n\n\n

The doctor of epidemiology explains that levothyroxine is better absorbed when taken on an empty stomach; therefore, the most effective intake times are in the morning (upon waking) and at night (before bed). The analysis found inconclusive results regarding other administration regimens because studies about them have a high risk of bias.<\/p>\n\n\n\n

Bianca points out that this was a common flaw in the studies analyzed. Overall, what indicates the success of levothyroxine is the drop in TSH levels in most treated patients. However, in some cases, the patient sample used in the studies was too small, not random, or did not have enough information: \u201cAt times, it revealed the final TSH result, but didn’t show me the initial amount of it.\u201d <\/p>\n\n\n\n

Only three articles addressed patient-reported outcomes (PROs), self-assessment questionnaires which contain a qualitative analysis of well-being of people undergoing treatment. Among these, two confirmed that the timing of use (before bed, before or during breakfast) did not make a difference in quality of life. The third one showed that the weekly dose improved wellness aspects, such as body aches, vitality, socializing, and mental health.  <\/p>\n\n\n\n

Due to the few studies on the subject, also lacking standardization, Bianca believes them to be insufficient to decide whether to recommend or advise against other administration regimens. For her, the databases showed how contemporary conventions about the use of levothyroxine are grounded in low-quality evidence. Since the most common regimen (taking the medication before breakfast) reaches the goal of lowering TSH, the other ones remain mostly unexplored to date.<\/p>\n\n\n\n

Levothyroxine treatment and the risk of Cardiac Arrhythmia<\/strong><\/h5>\n\n\n\n

The study also used data from more than 111,000 patients with one type of hypothyroidism \u2013 the subclinical \u2013 to investigate whether the use of levothyroxine was associated with a higher risk of arrhythmia in such cases. <\/p>\n\n\n\n

The patients were divided into two groups. The first one included users who had been monitored from the moment they began treatment until one of two events occurred: sudden death or the occurrence of one of the three most significant arrhythmias (atrial fibrillation, atrial flutter, or ventricular tachycardia). <\/p>\n\n\n\n

The second group was designated as \u201cthe control group\u201d, which comprised patients not using levothyroxine. These individuals were kept under observation for a certain number of days after their subclinical hypothyroidism diagnosis. As long as the user and non-user remained arrhythmia-free, the research would continue. <\/p>\n\n\n\n

\u201cIf no cardiac event occurs, the research continues until death or until the person no longer wants to provide any further information to the database. Also, we have included the first intake date of some medications [as an event] or other diseases that can influence the TSH levels,\u201d explains Bianca. After about 3 years, there had been 5,254 Cardiac Arrhythmias recorded. Only 3.6% of levothyroxine users and 5.7% of untreated individuals had this cardiovascular outcome.<\/p>\n\n\n

\n
\"\"<\/figure>\n<\/div>\n\n\n

The researcher explains that this difference in numbers does not indicate enhanced risk: \u201cWe could not interpret these results and say \u2018that those who do not choose treatment will have a worse outcome\u2019. It was not statistically significant.\u201d Therefore, the study concluded that the use of the medication does not have an influence on this outcome. <\/p>\n\n\n\n

The article on the administration of levothyroxine has already been published on the Expert Review of Clinical Pharmacology<\/a>. The full doctoral dissertation will soon be available on Lume \u2013 Digital Repository<\/a>.<\/p>\n\n\n\n

\n\n\n\n

Doctoral Dissertation: The efficiency and safety of the treatment with levothyroxine: administration regimens and incidence rate of cardiac arrhythmia

Author: Bianca Vendruscolo Bianchin<\/a>
Supervisor: Tatiane da Silva Dal Pizzol<\/a>
Program: Graduate Program in Epidemiology \u2013 Medical School (FAMED – UFRGS)<\/p>\n\n\n\n

\n\n\n\n

Translated into English by Mariana Carletti Rodrigues<\/strong>, undergraduate student enrolled in the course \u201cSupervised Translation Training II (English)\u201d of the Undergraduate Program in Language and Literature, under the supervision and translation revision of Professor Elizamari R. Becker (P.h.D.) \u2013 IL\/UFRGS.<\/p>\n\n\n\n

\n\n\n\n

:: Read in Portuguese<\/strong>
Estudo investiga efic\u00e1cia de diferentes modos de uso da levotiroxina para tratamento do hipotireoidismo<\/a><\/p>\n\n\n\n

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Explore the full section In English<\/strong> <\/a><\/div>\n<\/div>\n\n\n\n
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<\/p>\n<\/div><\/div>\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

Health | A doctoral dissertation of the Graduate Program in Epidemiology indicates that the most effective intakes are in the morning, upon waking, and at night, before bed. The evidence for other administration regimens was inconclusive
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