Switch from tablet levothyroxine to oral solution resolved reduced absorption by intestinal parasitosis
| Autor: | Mario Vitale, Domenico La Sala, Anna Tortora |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Thyroiditis
Weight loss Malabsorption endocrine system diseases Endocrinology Diabetes and Metabolism Levothyroxine White Gastroenterology Ultrasound scan lcsh:Diseases of the endocrine glands. Clinical endocrinology Intestinal absorption 0302 clinical medicine Antibiotics Medicine FT3 Flatulence Euthyroid FT4 Thyroid Hypoalbuminaemia TSH Nausea Short bowel syndrome Diarrhoea Diarrhea Italy Thyroid antibodies 030220 oncology & carcinogenesis Female Appetite reduction/loss medicine.symptom Thyroid function Abdominal cramp medicine.drug Adult medicine.medical_specialty endocrine system Thyroxine (T4) 030209 endocrinology & metabolism 03 medical and health sciences BMI Hypothyroidism Internal medicine Internal Medicine Novel treatment Lactose intolerance lcsh:RC648-665 March business.industry Triiodothyronine (T3) medicine.disease Weight Thyroid ultrasonography business |
| Zdroj: | Endocrinology, Diabetes & Metabolism Case Reports, Vol 1, Iss 1, Pp 1-4 (2019) Endocrinology, Diabetes & Metabolism Case Reports |
| ISSN: | 2052-0573 |
| Popis: | Summary Reduced intestinal absorption of levothyroxine (LT4) is the most common cause of failure to achieve an adequate therapeutic target in hypothyroid patients under replacement therapy. We present the case of a 63-year-old woman with autoimmune hypothyroidism previously well-replaced with tablet LT4 who became unexpectedly no more euthyroid. At presentation, the patient reported the onset of acute gastrointestinal symptoms characterized by nausea, loss of appetite, flatulence, abdominal cramps and diarrhea, associated with increase of thyrotropin levels (TSH: 11 mIU/mL). Suspecting a malabsorption disease, a thyroxine solid-to-liquid formulation switch, at the same daily dose, was adopted to reach an optimal therapeutic target despite the gastrointestinal symptoms persistence. Oral LT4 solution normalized thyroid hormones. Further investigations diagnosed giardiasis, and antibiotic therapy was prescribed. This case report is compatible with a malabsorption syndrome caused by an intestinal parasite (Giardia lamblia). The reduced absorption of levothyroxine was resolved by LT4 oral solution. Learning points: The failure to adequately control hypothyroidism with oral levothyroxine is a common clinical problem. Before increasing levothyroxine dose in a patient with hypothyroidism previously well-controlled with LT4 tablets but no more in appropriate therapeutic target, we suggest to investigate non adhesion to LT4 therapy, drug or food interference with levothyroxine absorption, intestinal infection, inflammatory intestinal disease, celiac disease, lactose intolerance, short bowel syndrome after intestinal or bariatric surgery, hepatic cirrhosis and congestive heart failure. LT4 oral solution has a better absorptive profile than the tablet. In hypothyroid patients affected by malabsorption syndrome, switch of replacement therapy from tablet to liquid LT4 should be tested before increasing the dose of LT4. |
| Databáze: | OpenAIRE |
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