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When it comes to managing hypothyroidism, choosing the right thyroid hormone replacement therapy is essential. Tirosint and Tirosint-SOL are two unique medications that can benefit hypothyroid patients with specific sensitivities or absorption issues. In this article, learn more about Tirosint and Tirosint-SOL.
About hypothyroidism
The thyroid is a small gland at the base of your neck that produces hormones to regulate your body's energy use. Hypothyroidism is a condition when your thyroid gland doesn't produce enough of these thyroid hormones. The lack of hormones causes a slowdown in your body processes. Hypothyroidism is treatable in most people with thyroid hormone replacement medication and lifestyle modifications.
About thyroid hormone replacement medication
The thyroid gland produces two hormones: thyroxine (T4) and triiodothyronine (T3). The job of thyroid hormone replacement medication is to replace these missing hormones. Thyroid replacement medication comes in synthetic T4 and T3 formulations, as well as natural desiccated thyroid (NDT) that combines both hormones.
In a healthy thyroid gland, the inactive T4 hormone is released into circulation and then converted by the body into the active T3 hormone. Often, prescription medicine for thyroid hormone replacement starts with synthetic T4 – known as levothyroxine – assuming that the body can successfully convert T4 into T3 on its own.
Levothyroxine is available commercially in several forms:
- Oral levothyroxine tablets, including manufacturers’ brand names like Synthroid, Levoxyl, and Unithroid, and various generic levothyroxine tablets
- Liquid levothyroxine softgel capsules, including brand name Tirosint
- Liquid levothyroxine oral solution, including brand name Tirosint-SOL
Your Guide To Thyroid Medication
Optimizing your thyroid levels with thyroid hormone replacement medication is usually the first step in minimizing symptoms.
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What is Tirosint?
Tirosint is a brand-name medication, manufactured by IBSA Pharma, that comes as a gel capsule filled with a liquid form of levothyroxine.
In addition to levothyroxine sodium, the active ingredient, Tirosint contains three inactive ingredients: gelatin, glycerin, and water.
Tirosint is sold as individual capsules in a blister pack to protect against moisture and temperature changes, preserve the medication's potency, and ensure that patients don't miss a dose of levothyroxine.
What is Tirosint-SOL?
Tirosint-SOL is a liquid form of levothyroxine, dispensed in individual daily dose ampules.
Tirosint-SOL contains 3 ingredients: levothyroxine sodium (active ingredient), glycerol, and water.
Tirosint-SOL comes in individual dosage ampules.
This liquid levothyroxine is an option for patients who cannot swallow, fed by tube, and for infants and children who require levothyroxine treatment.
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What dosages of Tirosint and Tirosint-SOL are available?
Tirosint and Tirosint-SOL provide the widest range of doses for any levothyroxine therapy available in the U.S.
Tirosint capsules are available in the following dosage sizes: 13 mcg, 25 mcg, 37.5 mcg, 44 mcg, 50 mcg, 62.5 mcg, 75 mcg, 88 mcg, 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, and 200 mcg.
Tirosint-SOL oral solution is available in the following dosage sizes: 13 mcg/mL, 25 mcg/mL, 37.5 mcg/mL, 44 mcg/mL, 50 mcg/mL, 62.5 mcg/mL, 75 mcg/mL, 88 mcg/mL, 100 mcg/mL, 112 mcg/mL, 125 mcg/mL, 137 mcg/mL, 150 mcg/mL, 175 mcg/mL, and 200 mcg/mL.
Who might benefit from Tirosint or Tirosint-SOL?
Tirosint or Tirosint-SOL are often recommended for patients in the following categories:
Patients with allergies or sensitivities
Unlike other levothyroxine medications, Tirosint and Tirosint-SOL don't contain common excipients such as wheat starch (gluten), lactose, sugars, dyes, povidone iodine, acacia (tree bark), or talc125. So people who are allergic to dyes, gluten, or lactose often tolerate Tirosint or Tirosint-SOL better due to their lack of these ingredients.
Patients with absorption issues
Conditions such as celiac disease, irritable bowel syndrome (IBS), or gastric bypass surgery can impair the absorption of traditional levothyroxine tablets. The liquid formulation of Tirosint-SOL helps bypass these challenges, and ensure better absorption of thyroid medication.
Patients who want to eat or drink close to taking their thyroid medication
Both Tirosint and Tirosint-SOL are more resistant to interference from foods and drinks, including:
- foods high in dietary fiber
- coffee
- milk and calcium-fortified juices
Children or elderly patients
Tirosint-SOL allows precise dosing and is easier to administer to those who struggle with swallowing pills.
Patients taking proton pump inhibitors
Proton pump inhibitors (PPIs) are a class of medications that significantly reduce stomach acid production. They are primarily used to treat conditions related to excess stomach acid, such as gastroesophageal reflux disease (GERD), stomach ulcers, and acid reflux. Common generic and brand names of PPIs include:
- Omeprazole (Prilosec, Prilosec OTC)
- Esomeprazole (Nexium)
- Lansoprazole (Prevacid)
- Pantoprazole (Protonix)
Patients needing precise dose adjustments
Because Tirosint and Tirosint-SOL come in the widest number of dosages for levothyroxine, they offer greater flexibility for finding an effective dose for you.
How should Tirosint and Tirosint-SOL be taken and stored?
Here are some things to keep in mind when taking Tirosint or Tirosint-SOL.
- Timing matters: Take either medication on an empty stomach, ideally 30 minutes to an hour before breakfast.
- Consistency is key: Take it at the same time every day to maintain steady thyroid hormone levels.
- Avoid interference: Do not take these medications with iron, antacids, or calcium supplements, as these can interfere with absorption. Wait at least 4 hours after taking Tirosint or Tirosint-SOL before consuming these substances.
- For Tirosint-SOL: Administer the liquid directly into the mouth or mix it with water. Avoid using other liquids like coffee or juice, as they can impact absorption.
Proper storage is essential for maintaining the potency of these medications. They should be kept at room temperature and away from excessive heat, light, or moisture.
Recent research on Tirosint and Tirosint-SOL
Recent research has highlighted several advantages of Tirosint and Tirosint-SOL.
Improved absorption and bioavailability
Tirosint-SOL, the liquid formulation, has demonstrated superior levothyroxine absorption compared to traditional tablet forms. A key study showed that Tirosint-SOL can be taken as early as 15 minutes before breakfast without interfering with absorption or systemic availability. This is a significant improvement over conventional levothyroxine tablets, which typically need to be taken 30 minutes to an hour before eating.
Interaction with proton pump inhibitors
One of the most notable findings is that Tirosint-SOL's absorption is unaffected by (PPIs). A study presented at the American Thyroid Association's Annual Meeting in 2021 demonstrated that the bioavailability of Tirosint-SOL was not impacted by omeprazole, a commonly used PPI. This is particularly important given that over 20 million Americans use PPIs regularly each year.
Effective for challenging patient populations
Research has shown that liquid levothyroxine formulations may be particularly beneficial for patients with persistent hypothyroidism despite adequate doses of levothyroxine tablets. A study found that switching patients from tablets to Tirosint often resulted in normalized TSH levels and improved quality of life, even in patients without known absorption issues.
Comparison to other formulations
Studies have consistently shown that Tirosint-SOL offers the fastest absorption process. This rapid absorption may contribute to more stable thyroid hormone levels throughout the day.
Long-term effectiveness
A long-term study concluded that Tirosint maintains thyroid levels more effectively in hypothyroid patients compared to tablets. This suggests that Tirosint may offer better stability in thyroid function over time.
Implications for patient adherence
The ability to take Tirosint closer to mealtime and its independence from stomach acidity may significantly improve patient adherence to therapy. This is crucial for maintaining consistent thyroid hormone levels and managing hypothyroidism effectively.
Side effects of Tirosint
The most common side effects of Tirosint and Tirosint-SOL are primarily related to overmedication. Taking too much levothyroxine can trigger symptoms of an overactive thyroid -- hyperthyroidism – a situation known as therapeutic overdosage. Symptoms and adverse reactions include the following:
- Fatigue: Feeling unusually tired even though your metabolism is overactive.
- Increased appetite: Feeling hungrier than normal because your body is burning energy faster.
- Weight loss: Loss of body weight without trying, due to a faster metabolism.
- Heat intolerance: Feeling too hot or uncomfortable in warm weather.
- Fever: Running a higher-than-normal body temperature.
- Excessive sweating: Sweating a lot more than usual, even without much activity.
- Headache: Having frequent or severe headaches.
- Hyperactivity: Feeling overly energetic or restless.
- Nervousness, anxiety, or irritability: Feeling on edge, anxious, or easily annoyed.
- Difficulty sleeping: Struggling to fall or stay asleep because you feel too energized.
- Tremors, muscle weakness, or muscle spasms: Shaking hands, weak muscles, or muscle twitches.
- Increased pulse and blood pressure: A faster heartbeat and higher blood pressure than normal.
- Heart irregularities: Palpitations, irregular heartbeat, chest pain, atrial fibrillation
- Shortness of breath: Difficulty catching your breath
- Loose stools, diarrhea, and vomiting: Having an upset stomach, diarrhea, or throwing up.
- Hair loss: Losing more hair than usual, leading to thinning or shedding.
- Skin flushing or rash: Red or irritated skin that may feel warm.
- Menstrual irregularities: Shorter or less frequent periods
If you experience any of these symptoms or adverse effects, talk to your doctor to adjust your medication or dosage.
How much do Tirosint capsules and Tirosint-SOL cost?
The price of Tirosint and Tirosint-SOL without insurance tend to be much higher than levothyroxine tablets. As of 2024, a 30-day supply of either drug can be priced at around $90-$160 per month without insurance. This compares to brand name levothyroxine tablets, which range from $20 to $50 a month without insurance, and generics, which typically cost from $4 to $20 per month.
For those with insurance, keep in mind that some health insurers categorize Tirosint and Tirosint-SOL as specialty drugs for patients with specific medical needs. This means that they are frequently listed at copay tiers 3 or 4, and carry a higher-than-normal copay amount.
The manufacturer, IBSA, has created several ways to save that make Tirosint and Tirosint-SOL more affordable.
Patients with health insurance, using the Tirosint/Tirosint-SOL savings card, can pay as little as $15 for a month’s supply of Tirosint/Tirosint-SOL For a 90 day supply, patients with commercial insurance can pay as little as $40.
The Tirosint Direct program makes Tirosint and Tirosint-SOL available from mail order pharmacies for a cash price of $65 for one month of therapy or $170 for 3 months of therapy, regardless of insurance coverage.
A note from Paloma
Paloma Health specializes in personalized care for people with hypothyroidism, offering expert guidance to determine if Tirosint or Tirosint-SOL is the right thyroid hormone therapy for you. These unique formulations of levothyroxine are designed to be free of allergens and fillers, making them ideal if you have sensitivities or absorption issues. Paloma Health’s dedicated thyroid experts and health care professionals carefully assess your medical history, symptoms, and lab results to craft a tailored treatment plan for your underactive thyroid. Paloma Health will collaborate with you to fine-tune your treatment dosage, ensure that your thyroid levels are optimized, provide personalized medical attention, and manage your hypothyroidism symptoms.
Paloma also offers a convenient way to get thyroid blood tests. The Paloma home test kit is like regular blood tests, except they use painless finger-stick testing that you can perform at home.
Key points
- Tirosint and Tirosint-SOL are thyroid hormone replacement medications, designed for hypothyroid patients with sensitivities or absorption challenges. Tirosint is a liquid gel capsule, while Tirosint-SOL is a liquid solution, both free of allergens like gluten, lactose, and dyes.
- Tirosint and Tirosint-SOL demonstrate superior absorption, and are resistant to the effects of food, coffee, or proton pump inhibitors, making it suitable for patients with digestive issues, those unable to swallow pills, or requiring precise dosing.
- Tirosint and Tirosint-SOL offer the most extensive dosage options for levothyroxine, ensuring flexibility for tailored treatment adjustments.
- Tirosint and Tirosint-SOL benefit people with allergies, absorption issues, or specific needs, such as children, elderly patients, or those using proton pump inhibitors.
- While more expensive than traditional levothyroxine tablets, Tirosint and Tirosint-SOL are made more affordable through savings cards and direct mail programs offered by the manufacturer.
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