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Levothyroxine , -  Common brand names include Levothroid , Thyrax, Unithroid  , Euthyrox, Levaxin, L-thyroxine, Eltroxin and Thyrax Duotab in Europe; Thyrox in South Asia; Eutirox, Tirosint, Levoxyl , and Synthroid  in North America. There are also numerous generic versions.

Levothyroxine is a synthetic form of thyroxine (thyroid hormone), used as a hormone replacement for patients with thyroid problems. The natural hormone is chemically in the chiral L-form, as is the pharmaceutical agent. Dextrothyroxine (D-thyroxine) briefly saw research as an anticholesterol agent but was pulled due to cardiac side-effects.

Levothyroxine is typically used to treat hypothyroidism.  It may also be used to treat goiter via its ability to lower thyroid-stimulating hormone (TSH), a hormone that is considered goiter-inducing.

There are foods and other substances that can interfere with absorption of thyroxine replacement. People ought to avoid taking calcium and iron supplements within 4 hours, as well as soy products within 3 hours of the medication, as these can reduce absorption of the drug. Grapefruit juice may delay the absorption of levothyroxine, but it is not believed to have a significant effect on bioavailability. Other substances that reduce absorption are aluminium and magnesium containing antacids, simethicone or sucralfate, cholestyramine, colestipol, Kayexalate. A study of eight women suggested that coffee may interfere with the intestinal absorption of levothyroxine, though at a level less than eating bran. Different substances cause other adverse effects that may be severe. Ketamine may cause hypertension and tachycardia and tricyclic and tetracyclic antidepressants increase its toxicity.

Adverse effects

Dosing must be carefully controlled to achieve TSH levels within the normal reference range. Long-term suppression of TSH values below normal values will frequently cause

• Heart problems -  cardiac side-effects
  
  
• Osteoporosis – this drug can contribute to decreases in bone mineral density (high TSH levels are also well known to contribute to osteoporosis).
  
  
• Hyperthyroidism - Patients prescribed too high a dose of levothyroxine may experience hyperthyroidism. Overdose can result in heart palpitations, abdominal pain, nausea, anxiousness, confusion, agitation, insomnia, weight loss, and increased appetite.
  
  
• Allergic reactions -  ‘Allergic reactions’ to the drug are characterized by symptoms such as difficulty breathing, shortness of breath, or swelling of the face and tongue.

Acute overdose may cause fever, hypoglycemia, heart failure, coma and unrecognized adrenal insufficiency.

On Sep, 3, 2015: 67,670 people reported to have side effects when taking Levothyroxine sodium. Among them, 353 people (0.52%) have Hallucination.

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 On Sep, 10, 2015: 5,198 people reported to have side effects when taking Levothroid. Among them, 29 people (0.56%) have Hallucination.

 On Sep, 10, 2015: 14,861 people reported to have side effects when taking Levoxyl. Among them, 89 people (0.60%) have Hallucination.

 On Aug, 27, 2015: 89,069 people reported to have side effects when taking Synthroid. Among them, 649 people (0.73%) have Hallucination.

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