A Case of Refractory Hypothyroidism Requiring Daily Intravenous Thyroxine

Nagaoka, Toshinori; Miyakoshi, Hisatsugu; Takamura, Toshinari; Nagai, Yukihiro; Matsushita, Shoichiro; Kaneko, Shuichi; Kobayashi, Kenichi

doi:10.1177/147323000203000418

Cited by 5 publications

(6 citation statements)

References 9 publications

(10 reference statements)

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“…Conversely, there have been previously described ultimately unresolved cases of hypothyroidism refractory to oral therapy where no interfering factors could be found [21][22][23][24]. Almost all have been described in women, mostly aged 40 -50 and with history of papillary thyroid cancer and surgical hypothyroidism [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of Thyroxine Malabsorption

et al. 2015

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The aim of the case study was to report the successful use of intramuscular levothyroxine (L-T 4 ) in two patients with profound oral L-T 4 malabsorption. We present two cases of patients who remained hypothyroid despite very high oral doses of L-T 4 . In both cases, poor L-T 4 absorption was documented with an absorption study. Intramuscular L-T 4 injections were initiated in both cases and doses were titrated to achieve normalization of thyroid stimulating hormone (TSH) and free thyroxine (free T 4 ). Additionally, after achieving euthyroidism for a period of time, each patient was able to successfully transit back to oral administration of L-T 4 . Synthetic oral L-T 4 is the drug of choice for replacement therapy in patients with hypothyroidism. Whenever euthyroidism cannot be achieved despite escalating L-T 4 doses, the presence of interfering factors must be considered. These factors include low patient compliance or reduced L-T 4 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-T 4 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-T 4 . 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.

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Section: Discussionmentioning

confidence: 99%

“…Almost all have been described in women, mostly aged 40 -50 and with history of papillary thyroid cancer and surgical hypothyroidism [21][22][23]. It is also noteworthy that in a majority of these cases, absorption capacity improved once stable euthyroidism had been achieved by intermittent parenteral levothyroxine administration.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Thyroxine Malabsorption

et al. 2015

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“…A malabsorção da tiroxina pode ocorrer devido a situações clínicas ou ao uso de medicamentos. Pode ser observada nos procedimentos de bypass jejunoileal, na síndrome do intestino curto, nos casos de cirrose hepática grave e na insuficiência cardíaca congestiva (5,6,8). Os medicamentos, também envolvidos com a má absorção da levotiroxina, são o hidróxido de alumínio, o sucralfato, o sulfato ferroso, a colestiramina, o carbonato de cálcio e a lovastatina (5,6,8).…”

Section: Discussionunclassified

“…Apesar de não tecerem maiores considerações sobre a possível causa da má absorção, essa paciente foi tratada com regime intravenoso de tiroxina. Não ficou claro, ao contrário dos outros artigos mencionados acima, se a paciente foi acompanhada adequadamente para assegurar a ingestão da levotiroxina ou o seu uso através de supositório (8).…”

Section: Discussionunclassified

Pseudomalabsorção de levotiroxina: relato de um caso

Pedrosa¹,

Santana²

2005

Arq Bras Endocrinol Metab

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A 49-year-old woman who had been treated with sodium levothyroxine because of hypothyroidism after diagnosis of Hashimoto thyroiditis and total thyroidectomy for multinodular atoxic goiter was evaluated for persistent hypothyroidism despite the use of large doses of levothyroxine (600 microg/day). The patient showed signs and symptoms of hypothyroidism and her laboratory tests were: TSH of 351 microUI/mL, free thyroxine of 0.20 ng/dL, and total triiodothyronine of 27 ng/dL. She was submitted, under medical supervision, to a levothyroxine overload test with no evidence of malabsorption of the thyroid hormone. Diagnosis of factitious disorder and Munchausen syndrome leading to the pseudomalabsorption of levothyroxine was considered.

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“…High doses of levothyroxine may be needed in some patients, and hypoacidic conditions in the gastric environment could influence the drug's absorption, leading to unresponsiveness to the medication. The impact could be to the extent that, in some case reports, parenteral levothyroxine was administered without a clear reason for the underlying pathophysiological malabsorption mechanism 75–77 . The study by Antúnez et al 78 investigated the effect of vitamin C administration in 28 hypothyroid patients requiring >1.70 μg/kg of levothyroxine but with normal TSH levels.…”

Section: Role Of Vitamin C In Levothyroxine Absorptionmentioning

confidence: 99%

The interplay between vitamin C and thyroid

Farasati Far,

Behnoush,

Ghondaghsaz

et al. 2023

Endocrino Diabet & Metabol

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Vitamin C is involved in the maintenance of several body functions, and its role has been shown in several organs and systems. 1 Although its main form in the body is ascorbate, it acts as a co-substrate for several enzymes and antioxidants. 2,3 Its role as an antioxidant is well known and it is well known as reactive oxygen species (ROS) scavenger in neurons. 4,5 Its concentration in body fluids and tissues depends on intestinal absorption, cellular transport and excretion. 6 The thyroid gland, as one of the main sources of controlling

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A Case of Refractory Hypothyroidism Requiring Daily Intravenous Thyroxine

Cited by 5 publications

References 9 publications

Treatment of Thyroxine Malabsorption

Treatment of Thyroxine Malabsorption

Pseudomalabsorção de levotiroxina: relato de um caso

The interplay between vitamin C and thyroid

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