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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.

Intestinal resections are most commonly performed in dogs and currently it is involved with extensive use of different antibiotics before surgical intervention. Metronidazole and cephalosporins are considered as best choice for prophylactic use in gastrointestinal operations. Therefore, the study is established to reveal the comparative effect of metronidazole, ceftriaxoine sodium and their combination on the tensile strength of jejunual anastomotic site. A total of twenty healthy stray dogs were included in this study. These dogs were randomly divided into four groups, which underwent end to end jejunal ansastmosis. The dogs in Group I (control) were operated for jejunal anstomosis without any antibiotic prophylaxis. The metronidazole alone was administered intravenously to dogs in Group II at the dose rate of 50mg/kg while the dogs in Group III were administered with intravenous ceftriaxone sodium at the dose rate of 30mg/Kg body weight two hours prior to surgery. The dogs in Group IV were given metronidazole in combination with ceftriaxone sodium by intravenous route at the dose rate of 50mg/Kg and 30mg/kg respectively two hours before surgical intervention. A significant difference was noted in the tensile strength between the four studied groups (P < 0.05). The study concluded that the combination of ceftriaxone sodium with metronidazole was found to enhance the gain in tensile strength significantly i.e. 47.50 %.

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