Treatment of Thyroxine Malabsorption

Jeremiah Kempke, Hammad Hussain, Bhavika Bhan, Leland Graves

Abstract


The aim of the case study was to report the successful use of intramuscular levothyroxine (L-T4) in two patients with profound oral L-T4 malabsorption. We present two cases of patients who remained hypothyroid despite very high oral doses of L-T4. In both cases, poor L-T4 absorption was documented with an absorption study. Intramuscular L-T4 injections were initiated in both cases and doses were titrated to achieve normalization of thyroid stimulating hormone (TSH) and free thyroxine (free T4). Additionally, after achieving euthyroidism for a period of time, each patient was able to successfully transit back to oral administration of L-T4. Synthetic oral L-T4 is the drug of choice for replacement therapy in patients with hypothyroidism. Whenever euthyroidism cannot be achieved despite escalating L-T4 doses, the presence of interfering factors must be considered. These factors include low patient compliance or reduced L-T4 absorption due to other dietary factors, concomitant medication use or gastrointestinal disease. Furthermore, severe hypothyroidism itself may impair absorption, presumably due to edema of the small bowel mucosa. Parenteral L-T4 has been shown to be an effective method of replacing thyroid hormone in those patients with apparent thyroid hormone malabsorption. However, there is no consensus or guidelines available to aid physicians in the use of parenteral L-T4. In patients with hypothyroidism despite large doses of levothyroxine, physicians should consider thyroid malabsorption once compliance and interfering medicines have been ruled out. In these patients, if no correctable interfering factor is identified, intramuscular replacement appears to be an effective alternative.




J Endocrinol Metab. 2015;5(1-2):192-195
doi: http://dx.doi.org/10.14740/jem277w

Keywords


Levothyroxine; Malabsorption; Hypothyroidism

Full Text: HTML PDF
 

Browse  Journals  

 

Journal of Clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics

 

World Journal of Oncology

Gastroenterology Research

Journal of Hematology

 

Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity

 

Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research

 

Journal of Neurology Research

International Journal of Clinical Pediatrics

 

 
       
 

Journal of Endocrinology and Metabolism, bimonthly, ISSN 1923-2861 (print), 1923-287X (online), published by Elmer Press Inc.                     
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.jofem.org   editorial contact: editor@jofem.org    elmer.editorial2@hotmail.com
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.


Disclaimer: The views and opinions expressed in the published articles are those of the authors and do not necessarily reflect the views or opinions of the editors and Elmer Press Inc. This website is provided for medical research and informational purposes only and does not constitute any medical advice or professional services. The information provided in this journal should not be used for diagnosis and treatment, those seeking medical advice should always consult with a licensed physician.