A Rare Case of Escitalopram-Induced Acute Dystonia in an Adolescent.

Levothyroxine (L-T4) replacement therapy remains the standard care of treatment for primary, central, and postsurgical hypothyroidism (). Initially, the therapeutic goal seems well-defined: restore thyroid hormone availability and achieve normalization of serum thyroid-stimulating hormone (TSH) levels. However, conventional weight-based dosing frequently fails to consistently achieve optimal targets, a considerable proportion of patients who are biochemically “euthyroid” continue to experience persistent symptoms, and the long-term effects on cardiovascular outcomes and bone mineral density (BMD) demand careful clinical management. Emerging evidence from studies published between 2024 and 2026 are driving a paradigm shift in endocrinology, moving the field beyond empirical, “one-size-fits-all” treatment strategies toward a more personalized approach to thyroid hormone replacement. The efficacy of oral L-T4 therapy depends on its bioavailability (60–80% in healthy adults) (). Absorption occurs primarily in the jejunum and upper ileum and requires an acidic gastric environment for optimal tablet dissolution (, ). A key advance in overcoming L-T4 absorption limitations has been the introduction of liquid formulations (). A retrospective observational study by evaluated long-term TSH stability in hypothyroid patients with gastric disorders, including chronic gastritis, gastric cancer-related gastrectomy, and gastroplasty, comparing liquid L-T4 (n=84) with conventional tablet formulations (T-LT4; n=120). Proton pump inhibitors (PPIs) were commonly prescribed in both groups (66% in the tablet group and 51% in the liquid group), potentially affecting gastric pH and impairing tablet dissolution.