Levothyroxine Replacement With Liquid Gel Capsules vs Tablets Post-thyroidectomy
Levothyroxine Replacement With Liquid Gel Capsules vs Tablets Post-thyroidectomy
In some patients, levothyroxine liquid gel capsules may demonstrate superior absorption than
 the tablet option. Impaired absorption of thyroid hormone directly correlates to higher and
 more unpredictable TSH (thyroid stimulating hormone) levels.

 The investigators therefore hypothesize that following thyroidectomy for Stage I/II
 differentiated thyroid cancer the gel capsule levothyroxine formulation will provide more
 predictable TSH results and in turn require fewer dose adjustments to achieve optimal hormone
 levels in the postoperative period.

 The aim of this investigation is to compare the use of levothyroxine in liquid gel capsules
 to tablet form for TSH suppression following thyroidectomy for presumed stage I/II
 differentiated thyroid cancer.
Ten patients will be randomized prior to surgery to receive levothyroxine in tablet form and
 ten patients will be randomized to receive in gel capsule form. Both forms will be
 encapsulated in order to allow double-blinding of the study.

 The postoperative goal TSH will be between 0.1 and 0.5 mU/L (milli units per litre) in both
 arms.

 Patients will be seen at weeks 6, 12 and 18 postoperatively and have TSH and Free T4
 measured. The primary outcome is the number of patients at each visit that are at goal range
 TSH.

 A secondary analysis will compare the dose changes required between the two groups in order
 to achieve goal TSH.

 Another secondary analysis will investigate the patients' quality of life. Two different
 surveys (see secondary outcomes below) will be performed at both study entry and completion
 to compare the two groups.
Inclusion Criteria:

 -  Age > 18 years

 -  Presumed AJCC (American Joint Committee on Cancer) tumor Stage I or II

 -  Planned total or near-total thyroidectomy

 -  Planned goal TSH suppression 0.1-0.5 mU/L for at least 18 weeks postoperatively

 -  Normal serum TSH within 12 months preceding surgery

 Exclusion Criteria:

 -  AJCC Stage III or greater

 -  Undifferentiated, Anaplastic or Medullary Thyroid Cancer

 -  Planned postoperative TSH goal other than 0.1-0.5 mU/L

 -  History of gastrointestinal malabsorption or gastric bypass surgery

 -  Pregnancy

 -  Use of medications that alter the absorption or metabolism of levothyroxine

 -  Prior use of levothyroxine