Liotrix use while Breastfeeding

Summary of Use during Lactation

Liotrix is a mixture of levothyroxine (T4) and liothyronine (T3), which are normal components of human milk. Limited data on exogenous replacement doses of levothyroxine during breastfeeding indicate no adverse effects in infants. No information is available on the use of exogenous liothyronine during breastfeeding. The American Thyroid Association recommends that subclinical and overt hypothyroidism should be treated with levothyroxine in lactating women seeking to breastfeed.[1] Thyroid dosage requirement may be increased in the postpartum period compared to prepregnancy requirements patients with Hashimoto's thyroiditis.[2]

Drug Levels

Milk levels of thyroid hormones have not been measured after exogenous administration in humans. Levothyroxine is a normal component of human milk. Although somewhat controversial, it appears that levothyroxine passes into milk poorly and that liothyronine might pass into milk in amounts that affect infant thyroid status.[3-7]

Maternal Levels. In a study of 56 mothers with thyroid disorders, 50 had hypothyroidism and were being treated with levothyroxine; 5 mothers had controlled hyperthyroidism with no medications and 1 had hyperthyroidism treated with a medication. Milk levels of thyroid hormones were free T4 4.5 ng/L, total T4 29.6 mcg/L, free T3 2.3 ng/L and total T3 0.35 mcg/L. The average milk to serum level ratios over the period were free T4 0.32 and total T4 0.3. Levels of free and total T3 and total T4 in milk were positively correlated with their respective plasma levels.[8]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Effects of exogenous thyroid hormone administration to mothers on their infant have not been reported. One case of apparent mitigation of cretinism in hypothyroid infants by breastfeeding has been reported, but the amounts of thyroid hormones in milk are not optimal,[9] and this result has been disputed.[10] The thyroid hormone content of human milk from the mothers of very preterm infants appears not to be sufficient to affect the infants' thyroid status.[11] The amounts of thyroid hormones in milk are apparently not sufficient to interfere with diagnosis of hypothyroidism.[12]

In a telephone follow-up study, 5 nursing mothers reported taking levothyroxine (dosage unspecified). The mothers reported no adverse reactions in their infants.[13]

One mother with who had undergone a thyroidectomy was taking levothyroxine 100 mcg daily as well as calcium carbonate and calcitriol. Her breastfed infant was reportedly "thriving" at 3 months of age.[14]

Effects on Lactation and Breastmilk

Adequate thyroid hormone serum levels are required for normal lactation. Replacing deficient thyroid levels should improve milk production caused by hypothyroidism. Supraphysiologic doses would not be expected to further improve lactation.

References

1.

Alexander E, Pearce E, Brent G, et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 2017;27:315-89. [PubMed: 28056690]

2.

Galofré J, Haber R, Mitchell A, et al. Increased postpartum thyroxine replacement in Hashimoto's thyroiditis. Thyroid 2010;20:901-8. [PMC free article: PMC2941405] [PubMed: 20615129]

3.

Sato T, Suzuki Y. Presence of triiodothyronine, no detectable thyroxine and reverse triiodothyronine in human milk. Endocrinol Jpn 1979;26:507-13. [PubMed: 499092]

4.

Varma S, Collins M, Row A, et al. Thyroxine, tri-iodothyronine, and reverse tri-iodothyronine concentrations in human milk. J Pediatr 1978;93:803-6. [PubMed: 712487]

5.

Mallol J, Obregon M, Morreale de Escobar G. Analytical artifacts in radioimmunoassay of L-thyroxin in human milk. Clin Chem 1982;28:1277-82. [PubMed: 7074933]

6.

Oberkotter L, Tenore A. Separation and radioimmunoassay of T3 and T4 in human breast milk. Horm Res 1983;17:11-8. [PubMed: 6551313]

7.

Koldovský O. Hormones in milk. Vitam Horm 1995;50:77-149. [PubMed: 7709605]

8.

Zhang Q, Lian X, Chai X, et al. Relationship between maternal milk and serum thyroid hormones in patients with thyroid related diseases. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2013;35:427-31. [PubMed: 23987491]

9.

Bode H, Vanjonack W, Crawford J. Mitigation of cretinism by breast-feeding. Pediatrics 1978;62:13-6. [PubMed: 683777]

10.

Letarte J, Guyda H, Dussault J, et al. Lack of protective effect of breast-feeding in congenital hypothyroidism: Report of 12 cases. Pediatrics 1980;65:703-5. [PubMed: 7367075]

11.

van Wassenaer A, Stulp M, Valianpour F, et al. The quantity of thyroid hormone in human milk is too low to influence plasma thyroid hormone levels in the very preterm infant. Clin Endocrinol (Oxf) 2002;56:621-7. [PubMed: 12030913]

12.

Abbassi V, Steinour A. Successful diagnosis of congenital hypothroidism in four breast-fed neonates. J Pediatr 1980;97:259-61. [PubMed: 7400893]

13.

Ito S, Blajchman A, Stephenson M, et al. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol 1993;168:1393-9. [PubMed: 8498418]

14.

Caplan R, Wickus G. Reduced calcitriol requirements for treating hypoparathyroidism during lactation. A case report. J Reprod Med 1993;38:914-8. [PubMed: 8277494]

Substance Name

Liotrix

CAS Registry Number

8065-29-0

Drug Class

Breast Feeding

Lactation

Milk, Human

Thyroid Hormones