The effect of proton pump inhibitors (PPI) seems to be related to their role in increasing gastric juice pH that might impact on disintegration and dissolution phases of tablet thyroxine (see for rev ref
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However, a small percentage of patients discontinue treatment specifically due to persistent or severe gastrointestinal side effects
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That same rigidity affects chromatographic behavior, so laboratories verifying identity by HPLC should expect retention characteristics distinct from comparable-length linear peptides