The Effect of Coffee on the Absorption of Thyroid Hormone in Patients With Thyroid Carcinoma

• Change in TSH (thyrotropin-stimulating-hormone) with each beverage type [ Time Frame: 6 hours ] [ Designated as safety issue: No ]
  1. change in TSH over 6 hours
  2. peak change in TSH over 6 hours
  
  

• Change in TSH with various beverages [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]
  To determine if taking Synthroid for 6 weeks with each of the prescribed study beverages results in a different baseline TSH, reflecting altered absorption of levothyroxine with each particular beverage.
  
  
• Change in total T4 with each beverage type [ Time Frame: 6 hours ] [ Designated as safety issue: No ]
  1. Change in total T4 over 6 hours
  2. Peak change in total T4 over 6 hours
  3. area under the curve (AUC) for total T4
  
  
• Change in free T4 with each beverage type [ Time Frame: 6 hours ] [ Designated as safety issue: No ]
  1. Change in free T4 over 6 hours
  2. Peak change in free T4 over 6 hours
  3. area under the curve (AUC) for free T4
  
  
• Change in total T3 with each beverage type [ Time Frame: 6 hours ] [ Designated as safety issue: No ]
  1. Change in total T3 over 6 hours
  2. Peak change in total T3 over 6 hours
  3. area under the curve (AUC) for total T3
  
  

Previous studies have suggested that taking thyroid replacement therapy with coffee potentially hinders its absorption. We already know that food especially a fiber-rich diet, cholestyramine resin, aluminum containing antacids, activated charcoal, and certain herbal remedies among others interfere with the ability to absorb thyroid medicine. These findings have prompted providers to advise patients to take their levothyroxine on an empty stomach in the morning. However, many patients take their thyroid medicine with their morning cup of coffee prior to eating breakfast. A small study has shown that Italian espresso coffee can decrease the absorption of levothyroxine, but the effect of American style coffee is not known. Given that the intestinal absorption of levothyroxine can be hindered by multiple substances and coffee is the most commonly consumed beverage worldwide, it is important to investigate what effect coffee may have on thyroid hormone absorption and thyroid function tests.

Using methods similar to those used in previous studies, this study will measure thyroid function tests in approximately 10-20 subjects (18-60 years of age) over a 6 hour period of time after taking their thyroid medication with the specified study beverage for a 6 week period. Subjects will be randomized to water, black coffee, coffee with milk, and black tea as four specified study beverages, with water serving as the control beverage. Each subject will be recruited to participate with each study beverage for a 6 week period of time in a total of four consecutive 6 week periods. Blood draws will occur at the end of each 6 week period on test days 1, 2, 3, and 4. The coffee will represent the most common household coffee brand, Folgers. Thyroid function tests with each beverage will be compared to thyroid function tests with water to determine if thyroid medication absorption is impaired by coffee, coffee with milk, or tea.

This study will help determine the safest and most efficacious way for adults to take their thyroid medication and will guide medical practitioners in how to counsel their patients when they prescribe thyroid replacement therapy.