Diagnosis and Treatment of Hypothyroidism

Ashraff, Suhel; Razvi, Salman

doi:10.1007/978-3-319-45013-1_14

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“…1 Biochemically, the diagnosis of overt primary hypothyroidism is established in the presence of an elevated thyroid-stimulating hormone (TSH) concentration and a low free thyroxine (FT4) level. 2 Oral levothyroxine (LT4) in solid tablet form represents the conventional treatment for hypothyroidism. Most patients require approximately 1.6-1.8 µg/kg/day.…”

Section: Introductionmentioning

confidence: 99%

Levothyroxine liquid oral substitution as an alternative treatment for refractory hypothyroidism due to gastrointestinal malabsorption: A case report

Cherchir,

Oueslati,

Mouelhi

et al. 2023

SAGE Open Medical Case Reports

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Tablets of levothyroxine (LT4) are the most used form for the treatment of hypothyroidism. Some patients may present with refractory hypothyroidism despite a high daily LT4 dose. We report the case of a 49-year-old woman who was admitted to our department for refractory hypothyroidism. She was treated with 300 μg oral LT4 tablets daily (3.9 μg/kg/day). Despite good compliance and regular intake of high doses of LT4, she had persistent symptoms of hypothyroidism and a thyroid-stimulating hormone level of 92.4 mIU/L. LT4 absorption test was consistent with the diagnosis of malabsorption. Etiological investigations revealed Helicobacter pylori gastritis. Helicobacter infection was adequately treated, but symptoms of hypothyroidism and elevated thyroid-stimulating hormone persisted. Increased LT4 doses (400 μg) failed to normalize thyroid-stimulating hormone levels. Thus, she was put on LT4 liquid form at a dose of 80 drops/day per day (400 µg). Two weeks later, she presented with clinical and biological improvement with a normal free thyroxine level of 1.14 ng/dL. Patients with gastrointestinal disorders may present with refractory hypothyroidism despite increasing doses of LT4. Switching to liquid formulation may resolve this problem.

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Section: Introductionmentioning

confidence: 99%