Clinically, we often find that: some patients have taken sufficient amount of Eugenol, but TSH is still not suppressed. Then, the following points need to be asked to confirm. 1, the source of eugenol: some patients’ eugenol is bought from pharmacies, but we can’t rule out the possibility that pharmacies will have fake drugs. 2.If we can be sure that the eugenol is from the regular hospital, we need to further ask the patient whether the time of taking the medicine is correct; whether the compliance of taking the medicine is very good; whether they drink milk, soy milk, etc. immediately after taking the medicine, and whether they take calcium tablets, etc., because these can affect the absorption of eugenol. 3. Ask whether there are any gastrointestinal diseases, whether you are taking proton pump inhibitors, etc.; whether there are signs of lactose intolerance, such as intolerance to drinking milk. 4. If all of the above are ruled out, then consider other factors: such as thyroid hormone resistance syndrome, more rarely with deiodinase abnormalities; more rarely with a pituitary gland that simply responds poorly to T3 as the cause. A summary on medication taking for your study and correction. 1. Identify the authenticity of Eugenol. To buy in the regular hospital, do not lose a lot because of small. 2, correct storage. A patient with hypothyroidism used to take Eugenol for a long time, and his condition was well controlled, but in the summer his thyroid function indicators fluctuated greatly. After repeated inquiries, he found that he did not put the drug in the refrigerator, but in the bedroom, due to the high temperature led to drug failure and deterioration. Therefore, it is important to store the medication according to the instructions: refrigerated below 25°C. 3. Time of taking medication and compliance. Because of its long half-life (about 7 days), you only need to take it once a day to obtain a stable blood concentration. Because taking Eugenol with food may affect its absorption, the recommended time to take Eugenol, if possible, is early in the morning on an empty stomach, with breakfast 30 minutes after taking the medication, and some studies have reported that eating 60 minutes after taking it is optimal. This is because taking it with food may interfere with the absorption of Eugenol. If the dose of the drug is slightly larger, it can also be taken in two doses, early in the morning on an empty stomach before bedtime (3 hours after dinner). Some people may ask: Why is it not routinely recommended to take the medication before bedtime? Because taking the medication early in the morning is more in line with the circadian rhythmical changes of thyroid hormones. Generally speaking, it peaks 5-6 hours after taking Eugenol, so if you take it at night and it peaks around 3:00 am, your heart will be so excited that it will make your heart skip a beat, so do you want to sleep happily? But in everyday life, compliance with the medication is also an issue that needs to be considered. Nowadays, many young people wake up very late, but need to solve breakfast before going to work, in this case, taking the medication before bedtime may be the best choice. Many studies have found that some diets may affect the absorption of Eugenol, such as grapefruit, soy, strong coffee, milk and high-fiber diets, so avoid taking it with such foods. After informing him about the effect of soy milk on the drug, he never drank it in the morning again and his thyroid function indicators were normalized. This is also why Professor Guan prompted to ask the patient if he drank soy milk and milk after taking Eugenol.Tips: Eugenol should be taken with plain water and do not eat any food within half an hour. 5. Drugs that affect the absorption of Eugenol. Eugenol should be taken 4-5h before taking Eugenol and Clofibrate. Drugs containing aluminum, iron and calcium: such as gastric mucosal protector aluminum thioglycollate, antacid aluminum hydroxide and calcium tablets can complex with L-T4 in the intestine and prevent its absorption.Tips: Eugenol should be taken at least 2h before taking the above drugs. Drugs affecting the PH of gastric juice: H2 receptor blockers and proton pump inhibitors affect the PH by inhibiting gastric acid secretion, hindering its absorption. Tips: Eugenol should be taken at least 4h before taking the above drugs. 6, diseases affecting the absorption of Eugenol such as celiac disease, liver cirrhosis, gastric acid deficiency and other absorption disorder syndromes. In addition, some people have lactose intolerance, such as milk drinking intolerance, etc.: because Eugenol contains lactose in it, this part of patients may be intolerant to Eugenol. 7. drugs affecting the clearance of eugenol Since L-T4 is mainly metabolized in the liver, any drugs with liver enzyme-inducing effects, such as barbiturates, phenytoin sodium, carbamazepine, rifampin, etc., will accelerate the metabolism of L-T4 and increase the hepatic clearance, resulting in a shorter duration of action in the body and a decrease in blood concentration. tips: patients taking these drugs at the same time need to increase the dosage of eugenol. Replenishing thyroid hormones and re-establishing the balance of the hypothalamic-pituitary-thyroid axis generally takes 4-6 weeks. Therefore, at the beginning of treatment, the relevant hormone indicators are measured every 4-6 weeks, and then the dosage of Eugenol is adjusted according to the test results until the treatment goal is reached. After the treatment target is reached, the relevant hormone indexes need to be rechecked every 6-12 months. If the treatment does not reach the target, the reasons should be carefully searched, such as whether the patient is informed of the correct time and precautions to take the medication, and whether there are any conditions that affect the absorption of the medication, one by one.