 Hi, this is Dr. Ruscio and good news if you're someone out there who is hypothyroid and on thyroid medication yet has been unable to find a stable dose or to stabilize your TSH and T4 levels. I'll put this study up here on the screen, but a study recently found that for those who are struggling to stabilize their dose, switching to a liquid form of thyroid hormone may be very effective and let me quote the findings from this study. The change from tablets to liquid oral formulation normalized serum TSH while switching back to the tablets cause thyroid stimulating hormone levels to worsen. These results suggest that liquid T4 formulations are more effective than tablets than a tablet one in controlling TSH levels in hypothyroid patients. So I give you the science just so you know that this is not some speculative conjecture but this is legitimate information that can help people with hypothyroid on medication and struggling to find a dose that works well for them. It may be that you're not able to adequately absorb the tablet form and therefore it's very difficult to find a stable dose of your thyroid hormone that works well for you. Now I won't put all the links in here but there have been other studies that have shown that liquid thyroid hormone and it's not technically liquid, it's actually liquid in a gel capsule so you still swallow a pill but the actual thyroid hormone is a liquid encapsulated in a gel tab. When patients take the gel tabs they don't have to fast so they can have breakfast and still take their thyroid hormone and still have adequate absorption. This may be one of the key reasons why. Some people may not always fast or they may have kind of slow digestion where they fast for let's say 30 minutes but because their digestion is slow they may actually need to fast for an hour in order for the food not to interfere with the tablet form. So this may be part of the reason why the liquid formulations seem to be better in allowing those who are on a tablet form which are most forms of thyroid hormones to enable them to find a stable dose and stabilize their thyroid hormone levels. So one may be because we don't have to worry about fast and you can take liquid thyroid hormone with food and still see benefit. Now there's some other interesting information starting to surface that suggests that part of the another reason why people may do better on liquid or gel tab thyroid hormone is because those who have gastrointestinal damage or inflammation or just any kind of general digestive problem and don't absorb things well may actually be better able to absorb the liquid forms. And it makes sense if you think about how easy it is to absorb a liquid compared to a tablet if someone has something like IBS, SIBO, H. pylori, gastritis, ulcers these people may not have adequate absorption or the adequate ability to break down and absorb a tablet. So this may be another reason why those taking the liquid form actually seem to do better find a stable dose and stable levels of their thyroid hormone when on the liquid gel tabs. So what should you do? The first thing you should do is start with your gut. If you haven't taken steps to improve the health of your gut this is a very important aspect of overall health including of course thyroid health. Some evidence shows that both improving gut health can help with thyroid autoimmunity which is a chief cause of hypothyroidism and also can help with absorption of thyroid hormone and potentially allow people to decrease or minimize the amount of medication they need because they've enhanced their absorption. So first start with your gut. If that doesn't work then speak with your doctor about a trial of a liquid thyroid hormone. One of the more common formulations is known as tyrosine and see if that is able to help you stabilize your levels and stabilize your dose. So in recap liquid thyroid hormone may be easier to absorb and may be better for people who have digestive problems and or cannot find a stable dose of medication that works well for them. So this is Dr. Ruscio, I hope this information helps you get healthy and get back to your life. Thanks.