Pseudomalabsorption of thyroid hormones: case report and review of the literature

Livadariu, Elena; Valdes-Socin, H.; Burlacu, Maria Cristina; Vulpoi, C; Daly, Adrian; Beckers, Albert

doi:10.1016/j.ando.2007.09.003

Cited by 17 publications

(17 citation statements)

References 14 publications

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“…However, pseudomalabsorption due to intentional non-compliance as part of a psychiatric disorder should be considered, as illustrated in the present and other case reports [1,2,8,10,12,13,[18][19][20][21][22][23] . If a patient has variable levels of fT 4 and TSH including also periods of completely normal levels having been on the same substitution dosage for a long time, this can also suggest pseudomalabsorption.…”

Section: Discussion and Reviewmentioning

confidence: 94%

“…Using the oral levothyroxine absorption test, it is important that the patient is supervised by an experienced nurse or doctor. Side effects of a single high dose of levothyroxine are limited [13] . This can be explained by the fact that T 4 is bound by circulating thyroxine-binding globulin and has to be converted to tri-iodothyronine (T 3 ) to be biologically active.…”

Section: Discussion and Reviewmentioning

confidence: 99%

“…Medical treatment strategies for pseudomalabsorption are parenteral infusion (intravenous every 3-4 days or intramuscular) of levothyroxine or supervised oral ingestion (daily or weekly with supervision by others) [4,12,13,22,26,27,33] . Once weekly administration of levothyroxine is safe and efficient and therefore a possible alternative to customary daily therapy.…”

Section: Discussion and Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Pseudomalabsorption of Levothyroxine: A Challenge for the Endocrinologist in the Treatment of Hypothyroidism

Wilder¹,

Bravenboer²,

Herremans³

et al. 2016

Eur Thyroid J

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Background: Hypothyroidism due to non-compliance with levothyroxine therapy (pseudomalabsorption) is rare. The diagnosis is considered in patients with persistent severe hypothyroidism despite treatment with large doses of levothyroxine. Intestinal malabsorption, drug and dietary interference with levothyroxine absorption and nephrotic syndrome should be excluded. The diagnosis of pseudomalabsorption can be demonstrated by using “an oral 1,000 µg of levothyroxine test” showing a rapid decrease in thyroid-stimulating hormone and increase in thyroxine. There are however few data on the sensitivity and specificity of the test in large cohorts of hypothyroid patients. Treatment of pseudomalabsorption is controversial, with reports using parenteral, intramuscular or single weekly oral dosing of levothyroxine. Cases: We report 3 patients who presented with persistent clinical and biochemical signs of hypothyroidism despite replacement therapy with high doses of levothyroxine. Pseudomalabsorption was diagnosed by a systematic approach, including prior exclusion of digestive, liver and kidney diseases. A peroral challenge test was positive in all cases. Patients denied non-compliance, and a psychiatric approach was elusive. Two of the patients were treated successfully with a single supervised weekly 1,000-µg administration of levothyroxine, while non-supervised weekly administration resulted in hypothyroidism confirming pseudomalabsorption. Conclusions: Non-compliance with medical therapy should be considered in patients with treatment-refractory hypothyroidism. Supervised once weekly levothyroxine treatment is a safe and well-tolerated treatment option, obviating the need for parenteral administration of the drug. Apart from the medical treatment, there is also a need for psychiatric evaluation and care.

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Section: Discussion and Reviewmentioning

confidence: 94%

Section: Discussion and Reviewmentioning

confidence: 99%

Section: Discussion and Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Pseudomalabsorption of Levothyroxine: A Challenge for the Endocrinologist in the Treatment of Hypothyroidism

Wilder¹,

Bravenboer²,

Herremans³

et al. 2016

Eur Thyroid J

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“…Dans un petit nombre de situations, la TSH demeure très élevée malgré la prescription de L-thyroxine à une posologie correcte. Si ces observations peuvent être expliquées par une pathologie organique de l'appareil digestif ou par l'interaction avec d'autres médications [2], elles sont en fait le plus souvent liées à la non observance du patient [3][4][5][6].…”

Section: Introductionunclassified

Prise hebdomadaire de L-thyroxine dans un cas de non-observance du traitement substitutif

Oliver¹,

Grino²,

Vacher-Coponat

et al. 2017

La Revue de Médecine Interne

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“…De nombreux médicaments peuvent également influencer l'absorption. Les mécanismes moléculaires régulant l'absorption intestinale de la L-thyroxine, puis son métabolisme au niveau des tissus périphériques commencent maintenant à être mieux précisés [4]. Plusieurs causes de malabsorption des hormones thyroïdiennes ont été décrites, mais le défaut de compliance du patient, décrit comme pseudomalabsorption, constitue un diagnostic d'élimination, d'affirmation difficile comme l'illustre notre observation [4].…”

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Une hypothyroïdie persistante

et al. 2012

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Pseudomalabsorption of thyroid hormones: case report and review of the literature

Cited by 17 publications

References 14 publications

Pseudomalabsorption of Levothyroxine: A Challenge for the Endocrinologist in the Treatment of Hypothyroidism

Pseudomalabsorption of Levothyroxine: A Challenge for the Endocrinologist in the Treatment of Hypothyroidism

Prise hebdomadaire de L-thyroxine dans un cas de non-observance du traitement substitutif

Une hypothyroïdie persistante

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