Effect of bile on thyroxine absorption in the rat

Sinha, K.; Middlesworth, L. Van

doi:10.1152/ajplegacy.1971.220.2.353

Cited by 8 publications

(8 citation statements)

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“…The increased L-T4 requirement associated with liver cirrhosis could be due to defects in bile production and excretion. Indeed, bile is important to maximize the intestinal absorption of L-T4 ( 22 ). However, one additional mechanism for the increased dosage of L-T4 could be the same as that occurring in pregnancy or other conditions of hyperestrogenism ( 28 , 29 , 32 , 33 ), namely, increased binding of L-T4 by the increased estrogen-driven serum levels of TBG, the major thyroid hormone plasma carrier, and failure to compensate for this increased binding.…”

Section: Discussionmentioning

confidence: 99%

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Increased Requirement of Replacement Doses of Levothyroxine Caused by Liver Cirrhosis

et al. 2018

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BackgroundSince hypothyroidism is a fairly common dysfunction, levothyroxine (L-T4) is one of the most prescribed medications. Approximately 70% of the administered L-T4 dose is absorbed. The absorption process takes place in the small intestine. Some disorders of the digestive system and some medicines, supplements, and drinks cause L-T4 malabsorption, resulting in failure of serum TSH to be normal. Only rarely liver cirrhosis is mentioned as causing L-T4 malabsorption.Case reportIn this study, we report increased requirement of daily doses of l-thyroxine in two patients with the atrophic variant of Hashimoto’s thyroiditis and liver cirrhosis. In one patient, this increased requirement could have been contributed by the increased serum levels of the estrogen-dependent thyroxine-binding globulin (TBG), which is the major plasma carrier of thyroid hormones. In the other patient, we switched from tablet L-T4 to liquid L-T4 at the same daily dose. Normalization of TSH levels was achieved, but TSH increased again when she returned to tablet L-T4.ConclusionLiver cirrhosis can cause increased L-T4 requirements. In addition to impaired bile secretion, the mechanism could be increased serum TBG. A similar increased requirement of L-T4 is observed in other situations characterized by elevation of serum TBG. Because of better intestinal absorption, L-T4 oral liquid formulation is able to circumvent the increased need of L-T4 in these patients.

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Section: Discussionmentioning

confidence: 99%

“…Chronic obstructive liver disease and pancreatic insufficiency are mentioned only in less recent reviews ( 20 , 21 ). Textbooks and literature fail to mention that bile is important to maximize the intestinal absorption of L-T4 ( 22 ).…”

Section: Introductionmentioning

confidence: 99%

Increased Requirement of Replacement Doses of Levothyroxine Caused by Liver Cirrhosis

et al. 2018

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“…By contrast, a short exposure to 60 C resulted in the rats receiving the low-bulk diet having a lower clearance rate. Another complicating factor is the presence of substances in the food which inhibit the reabsorption of thyroxine from the intestine, as has been described by Sinha & Van Middlesworth (1971) for plasma proteins. It is also possible that variations in the water content of the faeces, which related to the amount of fibre, alter the rate of passage through the gut, and this, in turn, affects the reabsorption of hormone.…”

Section: Discussionmentioning

confidence: 99%

The influence of food intake and ambient temperature on the rate of thyroxine utilization.

Ingram¹,

Kaciuba-Uściłko²

1977

The Journal of Physiology

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SUMMARYYoung growing pigs of both sexes were subjected to changes in (1) energy intake, (2) ambient temperature, and (3) bulk of food. The rate of disappearance of injected 125I-labelled thyroxine from the plasma (K) was measured. An analysis of variance revealed that the effect attributable to changes in the energy content of the food intake was statistically significant (P < 0.01). A change in ambient temperature had no statistically significant effect on K, nor did a change in the bulk of food when energy intake was constant (P > 0.05).

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“…The pH of naïve cow's milk is around 6.6/6.7 and it contains more than 1 gram of calcium per liter, so that is not surprising that the pH sensitive fraction of T4 absorption might be affected (114). At the same time, naïve milk contains fat, proteins, lactose that may maintain thyroxine in the intestinal lumen preventing its absorption (29,115). The overall mechanism by which intestinal absorption of thyroxine may be impaired in hypo-achlorhydric patients remains, however, unclear.…”

Section: Drugs Interference At Gastric Levelmentioning

confidence: 99%

“…On the same line, a paper by Sinha and Van Middlesworth (115) underlined the role of bile in reducing the binding of thyroxine to intraluminal plasma proteins, thus increasing the absorption of labeled thyroxine in a washed jejunal loop of rats. The authors postulated the presence in the bile of substances competing for T4 binding with plasma proteins (115).…”

Section: Advance Article: Endocrine Reviewsmentioning

confidence: 99%

Gastrointestinal Malabsorption of Thyroxine

et al. 2018

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Effect of bile on thyroxine absorption in the rat

Cited by 8 publications

References 0 publications

Increased Requirement of Replacement Doses of Levothyroxine Caused by Liver Cirrhosis

Increased Requirement of Replacement Doses of Levothyroxine Caused by Liver Cirrhosis

The influence of food intake and ambient temperature on the rate of thyroxine utilization.

Gastrointestinal Malabsorption of Thyroxine

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