Would you recommend changing a patient from the pill form of levothyroxine to Tirosint-SOL if they are started on a proton pump inhibitor?

While it is true that PPI's may lead to a decrease in levothyroxine absorption due to decreased tablet dissolution in the stomach (Guzman-Prado et al., PMID 33469743), and that liquid formulations are not susceptible to this effect (Seng Yue et al., PMID 38554774), the decrease in levothyroxine absorption can often be offset by simply increasing the dose.This is what I routinely do; inevitably, Tirosint-SOL is not covered by insurance, and it is very expensive. Obviously, if the hypothyroidism is still not well-controlled after the levothyroxine dose has been escalated several times, Tirosint-SOL should be considered. It is also important to remember that if the PPI therapy is stopped, the levothyroxine dose will need to be titrated downwar...