Abstract

Patients with hypothyroidism are routinely advised to take levothyroxine without food or beverages on the assumption that food substances reduce its availability1. However, the pharmacokinetic effect of many common foods are unknown. We describe a patient with high levothyroxine requirements who only achieved adequate replacement by taking grapes along with levothyroxine. Through a cycle of challenge, withdrawal, and-re-challenge, we were able to demonstrate that levothyroxine availability was enhanced by grapes in this case.

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