Dr. Danielle Weiss is the founder of the Center for Hormonal Health and Well-Being, a personalized, proactive, patient-centered medical practice with a unique focus on integrative endocrinology. She enjoys giving lectures and writing articles for both the lay public and medical audiences.

Tirosint is the brand name for a form of levothyroxine designed for people with allergies to fillers and dyes found in standard formulations. It is available in soft gel capsules, as well as a liquid formulation, that do not contain dyes, gluten, alcohol, lactose, or sugar. Besides T4, Tirosint contains only three inactive ingredients: gelatin, glycerin, and water.

In addition to those with allergies, Tirosint has been found effective in treating people with hypothyroidism who have certain digestive conditions, such as celiac disease, Crohn's disease, or atrophic gastritis. These conditions interfere with the absorption of traditional levothyroxine tablets, making them less effective; Tirosint seems to bypass the malabsorption problems.

Along the same line, Tirosint offers benefits to people for whom food or drink interfere with the absorption of their levothyroxine tablets. In fact, Tirosint appears to be "coffee-resistant" and, according to researchers, may be used to achieve a target thyroid-stimulating hormone (TSH) level in people who are unwilling or unable to change the way they take their levothyroxine.

Even for people who do not drink coffee within an hour of taking their medication, TSH testing suggests that people may achieve better absorption using Tirosint, as compared to levothyroxine in tablet form.

If your practitioner prescribes Tirosint, be sure to review all possible side effects.

According to the Food and Drug Administration prescribing information for the drug, Tirosint may cause heart problems, including an increased heart rate, chest pain, an irregular heartbeat, and weak or brittle bones.  Your risk of developing these issues may be higher if you are elderly or take too much of the medication.

If you have diabetes, Tirosint may make it harder to control your blood sugar levels. In this case, your healthcare provider may have to adjust your diabetes treatment regimen and monitor you more closely.

Make sure to give your healthcare provider a list of all your current medications, vitamins, and supplements before you start taking Tirosint.

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Tirosint capsules cannot be crushed, chewed, or cut.

The liquid formulation is taken once daily on an empty stomach, one-half to one hour before breakfast, and dosing is based on specific patient needs.

Tirosint is manufactured by IBSA Institute Biochimique, a privately-owned, global pharmaceutical company headquartered in Lugano, Switzerland. Tirosint is distributed by IBSA USA, headquartered in Parsippany, New Jersey. The company provides two options to help defray the cost of Tirosint.

Through Tirosint Direct, you can get the lowest cash price available, even without health insurance. Prescriptions are delivered by mail at a significantly reduced price through a network of mail-order pharmacies.

If your Tirosint copay is high, you may be able to cut the cost to no more than $25 with Tirosint's copay card.

You also can receive your medication by standard USPS delivery for free (it usually takes five days) or by Federal Express overnight or second-day delivery at additional cost.

If you are having problems with your thyroid replacement medication due to allergies or absorption problems, Tirosint may be a sensible alternative for you. If you are switching to Tirosint, be sure to follow up with your healthcare provider—you will need to have blood tests after six weeks to ensure you are on the proper dose. and to monitor potential adverse effects of the drug.

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Fallahi P et al. Advancements in the treatment of hypothyroidism With L-T4 liquid formulation or soft gel capsule: An update. Expert Opin Drug Deliv. 2017;14(5):647-55. doi:10.1080/17425247.2016.1227782

Vita R, Saraceno G, Trimarchi F, Benvenga S. A novel formulation of L-thyroxine (L-T4) reduces the problem of L-T4 malabsorption by coffee observed with traditional tablet formulations. Endocrine. 2013;43(1):154-60. doi:10.1007/s12020-012-9772-2

Food and Drug Administration. Tirosint (levothyroxine sodium).

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