The Role of <i>Helicobacter pylori</i> in Patients with Hypothyroidism in Whom Could Not be Achieved Normal Thyrotropin Levels Despite Treatment with High Doses of Thyroxine

Bugdaci, Mehmet Sait; Zuhur, Sayid Shafi; Sokmen, Mehmet; Toksoy, Buket; Bayraktar, Banu

doi:10.1111/j.1523-5378.2011.00830.x

Cited by 32 publications

(33 citation statements)

References 28 publications

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“…In particular, in the study by Centanni et al [7], the daily need for thyroxine was nearly reversed after eradication treatment and was associated with a decrease in thyrotropin levels that was calculated to be near 94% [15]. Similar results were obtained by Bugdaci et al (2011) [12], who noticed a statistically significant improvement in thyroid function tests after H. pylori eradication in all of the enrolled cases. They also noticed the development of a clinical condition related to an excessive absorption of thyroxine (thyrotoxicosis) in 21% of cases after the cure of the infection.…”

Section: H Pylori Eradication and Thyroxinementioning

confidence: 55%

“…A total of seven studies were selected for review of the full paper and data extraction [7][8][9][10][11][12][13]. The high clinical heterogeneity detected in primary studies due to different types of intervention administered, different outcomes described and the low number of identified studies did not allow us to pool data together to produce a summary measure and to perform statistical evaluation.…”

Section: Resultsmentioning

confidence: 99%

“…Previous studies have reported that the intestinal absorption of thyroxine, L-Dopa and iron are pH-dependent [7,18,19]. However, only two studies on thyroxine absorption [7,12] and one study on iron absorption [13] explored the correlation between the grade of H. pylori related gastritis in gastric biopsies, its location in the stomach mucosa (e.g. antrum or corpus), the gastric pH and drug absorption with pre and post eradication changes.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the results of the assessment performed, case series on the relationship between H. pylori eradication and thyroxine absorption [7,12] were considered of medium quality. The two studies performed by Pierantozzi et al [9,10] on L-dopa absorption after H. pylori treated infection were a case series and a randomised trial and were considered of low and high quality, respectively.…”

Section: Quality Assessment Of Included Studiesmentioning

confidence: 99%

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A Systematic Review on Drugs Absorption Modifications after Eradication in Helicobacter pylori Positive Patients undergoing Replacement Therapy

Fiorini

Bland

Hughes

et al. 2015

JGLD

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Background & Aims: Helicobacter pylori (H. pylori) infection has been suggested as a cause of impaired drug absorption. This infection leads to alteration of the gastric acid secretion that may change the conformational characteristics of drugs and their intestinal absorption leading to uncertainties about the dose to administer and the therapeutic results. A systematic review was undertaken to clarify the implications of drug absorption during the administration of replacement therapies.Methods: Electronic databases such as MEDLINE/Pubmed, EMBASE and The Cochrane Library [which includes Cochrane Database of Systematic Review (CDSR), the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstract of Reviews of Effect (DARE)] were searched. Grey literature databases (e.g. the International clinical trials registry platform, Trials Register, Clinical Trials.gov, Controlled Trials and TrialsCentral), Theses database, Government publication and LILACS database were also searched. No language restriction was applied.Results: Infection and altered drug absorption were evaluated in patients under replacement therapies with iron, thyroxin and L-dopa. In all, seven studies included an improvement in drug absorption after eradication and an existing inverse correlation between the grade of gastric inflammation and indices of drug absorption were noticed.Conclusion: This systematic review confirmed the presence of an interaction between infection and drug absorption of orally administered replacement therapies. Gastric acid reduction and subsequent alteration of drug composition seem to lead this mechanism. Clinicians should be aware of this possible interaction when starting a replacement therapy in patients and when evaluating poor clinical response.

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Section: H Pylori Eradication and Thyroxinementioning

confidence: 55%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Quality Assessment Of Included Studiesmentioning

confidence: 99%

See 2 more Smart Citations

A Systematic Review on Drugs Absorption Modifications after Eradication in Helicobacter pylori Positive Patients undergoing Replacement Therapy

Fiorini

Bland

Hughes

et al. 2015

JGLD

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“…Инфекция H. pylori и экстрагастродуоденальные заболевания ция H. pylori приводила к увеличению биодоступности обоих пре-паратов (уровень доказательности 2b) [5,20,21]. Более того, не-давнее проспективное исследование H. Hashim и соавт.…”

Section: терапевтический архив 8 2015unclassified

Helicobacter pylori infection and extragastroduodenal diseases

Маев¹,

Andreev²,

Kucheryavyi³

2015

Ter. arkh.

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АннотацияНа настоящее время достоверно определена клиническая значимость инфекции Helicobacter pylori в рамках развития целого ряда заболеваний гастродуоденальной зоны, включая хронический гастрит, язвенную болезнь желудка и двенад-цатиперстной кишки, MALT-лимфому, а также аденокарциному желудка. В консенсусе Маастрихт IV (2010 г.), определя-ющем международные стандарты диагностики и лечения инфекции H. pylori, экспертный совет постановил, что имеются доказательства возможной ассоциации инфекции H. pylori с развитием ряда экстрагастродуоденальных заболеваний (ЭГДЗ), представленных железодефицитной анемией неуточненной этиологии, идиопатической тромбоцитопенической пурпурой и дефицита витамина В 12 . При этих заболеваниях рекомендовано проведение диагностики инфекции H. pylori и при положительных результатах тестирования -эрадикация микроорганизма. За последнее время проведено большое количество исследований, посвященных изучению связи инфекции H. pylori и с другими ЭГДЗ. В настоящей статье приво-дится обзор теоретических и эпидемиологических данных ассоциации H. pylori с заболеваниями органов сердечно-сосу-дистой системы (атеросклероз, инфаркт миокарда), центральной нервной системы (болезнь Альцгеймера, болезнь Пар-кинсона), поджелудочной железы (аутоиммунный панкреатит, рак поджелудочной железы), онкологическими (аденомы толстой кишки, колоректальный рак, гепатоцеллюлярная карцинома), дерматологическими (хроническая спонтанная кра-пивница, псориаз) а также другими ЭГДЗ. В обзоре освещается потенциальная защитная роль H. pylori при заболеваниях с атопическим элементом генеза и осложненном течении гастроэзофагеальной рефлюксной болезни (пищевод Барретта, аденокарцинома пищевода). At present, the clinical significance of Helicobacter pylori infection has been validly determined within the development of a diversity of gastroduodenal diseases, including chronic gastritis, gastroduodenal ulcer, MALT lymphoma, and gastric adenocarcinoma. The Expert Council's Maastricht IV consensus (2010) determining international standards for the diagnosis and treatment of H. pylori infection is that there is evidence that the latter may be associated with the development of a number of extragastroduodenal diseases (EGDDs) presented by iron-deficiency anemia of unspecified etiology, idiopathic thrombocytopenic purpura, and vitamin B 12 deficiency. In these diseases, it is recommended that infection with H. pylori be diagnosed and, if the test is positive, this microorganism be eradicated. A large number of investigations have been recently conducted to examine the association of H. pylori infection with other EGDDs. This paper reviews theoretical and epidemiological data on the association of H. pylori with diseases of the cardiovascular (atherosclerosis, myocardial infarction) and central nervous (Alzheimer's disease, Parkinson's disease) systems, pancreas (autoimmune pancreatitis, pancreatic cancer), oncological (colonic adenomas, colorectal cancer, hepatocellular carcinoma), dermatological (chronic spontaneous urticaria), and ot...

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Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults

Caron

Grunenwald

Persani

et al. 2021

Rev Endocr Metab Disord

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Levothyroxine (LT4) is a safe, effective means of hormone replacement therapy for hypothyroidism. Here, we review the pharmaceutical, pathophysiological and behavioural factors influencing the absorption, distribution, metabolism and excretion of LT4. Any factor that alters the state of the epithelium in the stomach or small intestine will reduce and/or slow absorption of LT4; these include ulcerative colitis, coeliac disease, bariatric surgery, Helicobacter pylori infection, food intolerance, gastritis, mineral supplements, dietary fibre, resins, and various drugs. Once in the circulation, LT4 is almost fully bound to plasma proteins. Although free T4 (FT4) and liothyronine concentrations are extensively buffered, it is possible that drug- or disorder-induced changes in plasma proteins levels can modify free hormone levels. The data on the clinical significance of genetic variants in deiodinase genes are contradictory, and wide-scale genotyping of hypothyroid patients is not currently justified. We developed a decision tree for the physician faced with an abnormally high thyroid-stimulating hormone (TSH) level in a patient reporting adequate compliance with the recommended LT4 dose. The physician should review medications, the medical history and the serum FT4 level and check for acute adrenal insufficiency, heterophilic anti-TSH antibodies, antibodies against gastric and intestinal components (gastric parietal cells, endomysium, and tissue transglutaminase 2), and Helicobacter pylori infection. The next step is an LT4 pharmacodynamic absorption test; poor LT4 absorption should prompt a consultation with a gastroenterologist and (depending on the findings) an increase in the LT4 dose level. An in-depth etiological investigation can reveal visceral disorders and, especially, digestive tract disorders.

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The Role of Helicobacter pylori in Patients with Hypothyroidism in Whom Could Not be Achieved Normal Thyrotropin Levels Despite Treatment with High Doses of Thyroxine

Abstract: In hypothyroid cases, H. pylori gastritis may be responsible for an inadequate response to the treatment. H. pylori eradication in the cases receiving high doses of thyroxine has a risk for thyrotoxicosis.

Cited by 32 publications

References 28 publications

A Systematic Review on Drugs Absorption Modifications after Eradication in Helicobacter pylori Positive Patients undergoing Replacement Therapy

A Systematic Review on Drugs Absorption Modifications after Eradication in Helicobacter pylori Positive Patients undergoing Replacement Therapy

Helicobacter pylori infection and extragastroduodenal diseases

Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults

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