Levothyroxine sodium oral solution to control thyroid function in a patient with hypothyroidism and celiac disease

Asamoah, Ernest

doi:10.1002/ccr3.4170

Cited by 7 publications

(8 citation statements)

References 12 publications

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“…Liquid LT4 has previously ameliorated impaired absorption issues, including in 8 patients with lactose intolerance whose TSH levels normalized when switched from LT4 tablets to LT4 liquid formulation [ 17 ]. Further, a case study reported that symptoms resolved and TSH levels stabilized in a patient with Hashimoto's thyroiditis and celiac disease following the switch from LT4 tablets to LT4 liquid formulation and a gluten-free diet [ 31 ]. Another case study found that switching a patient with Hashimoto's disease, gastroparesis, and small intestinal bacterial overgrowth to LT4 liquid formulation from compounded T4/T3 achieved TSH levels within the optimal range with resolution of symptoms [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Switching from Natural Desiccated Thyroid to a Liquid Formulation of Levothyroxine for Hypothyroidism

Khoshaba,

Patarkatsi

2023

Case Reports in Endocrinology

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Natural desiccated thyroid (NDT) is a treatment option for many patients with hypothyroidism, but some still exhibit symptoms despite achievement of normal levels of thyroid stimulating hormone (TSH). In this retrospective case series, 13 patients with hypothyroid symptoms were switched from NDT to a liquid formulation of levothyroxine (LT4; Tirosint®-SOL). Laboratory values ≥4 weeks following the switch showed a decrease in TSH levels, maintenance of free triiodothyronine (fT3) levels, and significant increases in free thyroxine (fT4) levels. Patients reported good tolerability, and case summaries are presented for four patients. In summary, this small retrospective case series showed that patients who still had hypothyroid symptoms despite use of NDT can respond well to oral LT4 liquid formulation, including patients who are intolerant of gluten and/or lactose or on hormone replacement therapy or iron supplementation.

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Section: Discussionmentioning

confidence: 99%

Switching from Natural Desiccated Thyroid to a Liquid Formulation of Levothyroxine for Hypothyroidism

Khoshaba,

Patarkatsi

2023

Case Reports in Endocrinology

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“…Although liquid LT4 formulation safety and efficacy has been investigated in numerous studies and clinical scenarios, this is one of the first reports on the new, alcohol-free liquid LT4 composition, containing only L-thyroxine, glycerol, and water. To date, outcomes of therapy with alcohol-free liquid LT4 have been described in a single-centre study in patients with primary and central hypothyroidism [14] and case studies concerning a newborn with congenital hypothyroidism and 21 trisomy [37], a patient with celiac and Addison's disease [38], patients with celiac disease, a pregnant pa-tient with post-operative hypothyroidism, a patient with post-operative hypothyroidism due to Graves' disease [39], and in a patient with malabsorption due to multiple gastrointestinal disorders [40]. Our results seem to be in line with the previous reports, suggesting potential benefits of treatment with novel LT4 formulation.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Liquid levothyroxine improves thyroid control in patients with different hypothyroidism aetiology and variable adherence — case series and review

Ruchała

Bossowski²,

Brzózka³

et al. 2022

Endokrynol Pol

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suboptimal or excessive in about 32-45% of cases [3]. Further, more than three-quarters of patients on tablet LT4 therapy complain about poor quality of life (QoL) and low treatment satisfaction [4][5][6].There are numerous possible causes of poor control of hypothyroidism. LT4 has a narrow therapeutic index, i.e. the difference between the minimum effective concentration and the minimum toxic concentration

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“…Malabsorption in addition to celiac disease (CD) has been reported in AD patients; CD is an immune-mediated small intestinal disease affecting both children and adults, with a general prevalence in the general population of 0.5–1%; the diagnosis is based on clinical, serological assessments and small intestinal biopsies [ 146 , 147 , 148 ]. CD is associated with other autoimmune diseases: most often type 1 DM in children and teenagers and autoimmune thyroid disorders (mostly hypothyroidism) in adults, but also autoimmune types of AD, hepatitis, hypoparathyroidism, hypopituitarism, premature ovarian failure, etc.…”

Section: Methodsmentioning

confidence: 99%

New Approach to Addison Disease: Oral Manifestations Due to Endocrine Dysfunction and Comorbidity Burden

et al. 2022

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This review highlights oral anomalies with major clinical impact in Addison disease (AD), including dental health and dermatologic features, through a dual perspective: pigmentation issues and AD comorbidities with oral manifestations. Affecting 92% of AD patients, cutaneomucosal hyperpigmentation is synchronous with or precedes general manifestations by up to a decade, underlying melanocytic infiltration of the basal epidermal layer; melanophages in the superficial dermis; and, rarely, acanthosis, perivascular lymphocytic infiltrate, and hyperkeratosis. Intraoral pigmentation might be the only sign of AD; thus, early recognition is mandatory, and biopsy is helpful in selected cases. The buccal area is the most affected location; other sites are palatine arches, lips, gums, and tongue. Pigmented oral lesions are patchy or diffuse; mostly asymptomatic; and occasionally accompanied by pain, itchiness, and burn-like lesions. Pigmented lingual patches are isolated or multiple, located on dorsal and lateral areas; fungiform pigmented papillae are also reported in AD individuals. Dermoscopy examination is particularly indicated for fungal etiology; yet, it is not routinely performed. AD’s comorbidity burden includes the cluster of autoimmune polyglandular syndrome (APS) type 1 underlying AIRE gene malfunction. Chronic cutaneomucosal candidiasis (CMC), including oral CMC, represents the first sign of APS1 in 70–80% of cases, displaying autoantibodies against interleukin (IL)-17A, IL-17F ± IL-22, and probably a high mucosal concentration of interferon (IFN)-γ. CMC is prone to systemic candidiasis, representing a procarcinogenic status due to Th17 cell anomalies. In APS1, the first cause of mortality is infections (24%), followed by oral and esophageal cancers (15%). Autoimmune hypoparathyroidism (HyP) is the earliest endocrine element in APS1; a combination of CMC by the age of 5 years and dental enamel hypoplasia (the most frequent dental complication of pediatric HyP) by the age of 15 is an indication for HyP assessment. Children with HyP might experience short dental roots, enamel opacities, hypodontia, and eruption dysfunctions. Copresence of APS-related type 1 diabetes mellitus (DM) enhances the risk of CMC, as well as periodontal disease (PD). Anemia-related mucosal pallor is related to DM, hypothyroidism, hypogonadism, corresponding gastroenterological diseases (Crohn’s disease also presents oral ulceration (OU), mucogingivitis, and a 2-3 times higher risk of PD; Biermer anemia might cause hyperpigmentation by itself), and rheumatologic diseases (lupus induces OU, honeycomb plaques, keratotic plaques, angular cheilitis, buccal petechial lesions, and PD). In more than half of the patients, associated vitiligo involves depigmentation of oral mucosa at different levels (palatal, gingival, alveolar, buccal mucosa, and lips). Celiac disease may manifest xerostomia, dry lips, OU, sialadenitis, recurrent aphthous stomatitis and dental enamel defects in children, a higher prevalence of caries and dentin sensitivity, and gingival bleeding. Oral pigmented lesions might provide a useful index of suspicion for AD in apparently healthy individuals, and thus an adrenocorticotropic hormone (ACTH) stimulation is useful. The spectrum of autoimmune AD comorbidities massively complicates the overall picture of oral manifestations.

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Levothyroxine sodium oral solution to control thyroid function in a patient with hypothyroidism and celiac disease

Abstract: Implementing a gluten-free diet and switching to the levothyroxine oral solution significantly improved malabsorptive and hypothyroid symptoms in a patient with hypothyroidism, Addison's disease, and celiac disease without the need to increase levothyroxine dosage.

Cited by 7 publications

References 12 publications

Switching from Natural Desiccated Thyroid to a Liquid Formulation of Levothyroxine for Hypothyroidism

Switching from Natural Desiccated Thyroid to a Liquid Formulation of Levothyroxine for Hypothyroidism

Liquid levothyroxine improves thyroid control in patients with different hypothyroidism aetiology and variable adherence — case series and review

New Approach to Addison Disease: Oral Manifestations Due to Endocrine Dysfunction and Comorbidity Burden

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