{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:48:08Z","timestamp":1791254888741,"version":"4.1.0"},"reference-count":19,"publisher":"The Endocrine Society","issue":"4","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Levothyroxine (LT4) is recommended for intake in a fasting state to optimize absorption. However, fasting intake is often burdensome and may reduce adherence. In a previous questionnaire study, we observed a strong patient preference for taking LT4 with breakfast. Therefore, we conducted a randomized controlled trial to evaluate whether nonfasting LT4 intake\u2014accompanied by a 15% dose increase\u2014could maintain TSH stability compared to fasting LT4 intake.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adults with well-controlled hypothyroidism were randomized to fasting or dose-adjusted, breakfast LT4 intake. TSH, free T4, and total T3 were measured every 6 weeks, followed by LT4 dose adjustment if needed. The primary outcome was TSH stability, defined as 2 consecutive values within the reference range and a maximum \u00b11\u2005mIU\/L change from baseline. Patients were followed until TSH stability was reached, with a maximum of 24 weeks. After the initial study period, patients in the fasting group were invited to cross over to nonfasting intake, with similar follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty-eight patients (80.7% female, median age 62y [interquartile range: 49-69]) were randomized to fasting (n = 43) or breakfast intake (n = 45). TSH stability was comparable between groups: 74.4% [95% confidence interval (CI): 61.0-88.0%] in the fasting vs 73.3% (95%CI: 60.0-87.0%) in the breakfast group (P = not significant). Similar findings were observed in the crossover group. The breakfast group reported greater improvement in self-reported well-being (33.3% vs 16.3%, P = .07) and a stronger preference for nonfasting intake (76.2% vs 44.2%, P &amp;lt; .001). By the end of the study, 88.9% chose to continue nonfasting intake.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LT4 ingestion with breakfast with a 15% dose increase maintained TSH stability and improved patient well-being. Given the strong patient preference, this patient-centered approach may offer a viable alternative to fasting administration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgaf686","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T12:36:51Z","timestamp":1766407011000},"page":"938-944","source":"Crossref","is-referenced-by-count":4,"title":["Fasting vs Nonfasting, Dose-adjusted Levothyroxine Ingestion in Hypothyroidism: A Randomized Clinical Trial"],"prefix":"10.1210","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8478-3177","authenticated-orcid":false,"given":"Jeresa I A","family":"Willems","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Zuyd Thyroid Center, Zuyderland Medical Center , 6162 BG Sittard-Geleen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8433-8030","authenticated-orcid":false,"given":"Daan J L","family":"van Twist","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Zuyd Thyroid Center, Zuyderland Medical Center , 6162 BG Sittard-Geleen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floris","family":"Helmich","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry and Hematology, Zuyderland Medical Center , 6162 BG Sittard-Geleen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thijs","family":"Sluiter","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Zuyd Thyroid Center, Zuyderland Medical Center , 6162 BG Sittard-Geleen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7271-7858","authenticated-orcid":false,"given":"Marco","family":"Medici","sequence":"additional","affiliation":[{"name":"Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center , 3015 GD Rotterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7732-9371","authenticated-orcid":false,"given":"Robin P","family":"Peeters","sequence":"additional","affiliation":[{"name":"Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center , 3015 GD Rotterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roderick F A","family":"Tummers-de Lind van Wijngaarden","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Zuyd Thyroid Center, Zuyderland Medical Center , 6162 BG 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