Rectal Levothyroxine for the Treatment of Hypothyroidism: A Case Study

Ybarra, Marina; Santos, Tiago Jeronimo Dos; Pinheiro, Claudia; Dichtchekenian, Vaê; Damiani, Durval

doi:10.1542/peds.2017-3317

Cited by 8 publications

(5 citation statements)

References 25 publications

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“…Children with short bowel syndrome will also have reduced absorption (118). Recently, rectal administration of LT4 was been shown to be effective in a child with this condition (119). Increased type 3 deiodinase activity in large hemangiomas can cause increased metabolic clearance of administered LT4 and, with that, necessitate a higher LT4 dose (120)(121)(122).…”

Section: Evidencementioning

confidence: 99%

Congenital Hypothyroidism: A 2020–2021 Consensus Guidelines Update—An ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology

Trotsenburg

Stoupa

Léger

et al. 2021

Thyroid

288

254

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Background: An ENDO-European Reference Network (ERN) initiative was launched that was endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology with 22 participants from the ENDO-ERN and the two societies. The aim was to update the practice guidelines for the diagnosis and management of congenital hypothyroidism (CH). A systematic literature search was conducted to identify key articles on neonatal screening, diagnosis, and management of primary and central CH. The evidence-based guidelines were graded with the Grading of Recommendations, Assessment, Development and Evaluation system, describing both the strength of recommendations and the quality of evidence. In the absence of sufficient evidence, conclusions were based on expert opinion. Summary: The recommendations include the various neonatal screening approaches for CH as well as the etiology (also genetics), diagnostics, treatment, and prognosis of both primary and central CH. When CH is diagnosed, the expert panel recommends the immediate start of correctly dosed levothyroxine treatment and frequent follow-up including laboratory testing to keep thyroid hormone levels in their target ranges, timely assessment of the need to continue treatment, attention for neurodevelopment and neurosensory functions, and, if necessary, consulting other health professionals, and education of the child and family about CH. Harmonization of diagnostics, treatment, and follow-up will optimize patient outcomes. Lastly, all individuals with CH are entitled to a well-planned transition of care from pediatrics to adult medicine. Conclusions: This consensus guidelines update should be used to further optimize detection, diagnosis, treatment, and follow-up of children with all forms of CH in the light of the most recent evidence. It should be helpful in convincing health authorities of the benefits of neonatal screening for CH. Further epidemiological and experimental studies are needed to understand the increased incidence of this condition.

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Section: Evidencementioning

confidence: 99%

Congenital Hypothyroidism: A 2020–2021 Consensus Guidelines Update—An ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology

Trotsenburg

Stoupa

Léger

et al. 2021

Thyroid

288

254

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“…Before each administration the drug was prepared freshly. Clinical and laboratory recovery was achieved at the end of four weeks of rectal treatment ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

An Alternative Route of Treatment in Transient Hypothyroxinemia of Prematurity: Rectal Administration of Levothyroxine

Tunçel¹,

İnce²,

Aygün³

et al. 2023

Jcrpe

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Transient hypothyroxinaemia of prematurity (THOP) is a disorder encountered particularly in extremely low birth weight and preterm newborns. In recent years, the survival rates of these babies have increased, owing to the advances in neonatal care, thereby increasing the incidence of THOP. Controversies about the management of this disorder still continues while accompanying morbidites may create difficulties in the treatment of these patients. A preterm baby boy, born at 25 6/7 gestational weeks with a birthweight of 665 g who developed short bowel syndrome after necrotizing enterocolitis surgery and who was treated with rectal levothyroxine, is presented.

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“…The rectal route seemed appealing, but LT4 suppositories were also not available. Rectal enemas were administered instead, as the effectiveness and safety of this preparation has been reported in an infant with short bowel syndrome [ 7 ]. Furthermore, the comparability of the therapeutic effectiveness of antithyroid drugs as enemas to suppositories, with a higher bioavailability in favor of enemas, was encouraging [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Management of Hypothyroidism in Gastric Outlet Obstruction Using Levothyroxine Rectal Enemas: A Case Report

et al. 2018

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Patient: Male, 53Final Diagnosis: Gastric cancerSymptoms: Abdominal and/or epigastric pain • vomiting • weigh lossMedication: —Clinical Procedure: GastrectomySpecialty: SurgeryObjective:Unusual setting of medical careBackground:Hypothyroidism is the second most common endocrine disorder following diabetes. Appropriate hormone replacement therapy is the cornerstone of its management and is typically in the form of oral preparations of levothyroxine. Intravenous replacement is a well-known alternative in patients who are unable to take medication orally for long periods. However, effective and safe alternatives to oral preparations of levothyroxine should be sought in the absence of the parenteral alternative. The aim of this report is to describe an alternative route for levothyroxine supplementation when the oral and parenteral routes are not available.Case Report:This study reports a hypothyroid patient with symptomatic malignant gastric outlet obstruction requiring surgery. However, the patient’s surgical condition precluded oral administration of levothyroxine and the parenteral alternative was unavailable. Hormone replacement therapy was administered rectally in the form of enemas in preparing the patient for surgery.Conclusions:Rectal administration of levothyroxine using enemas can be a safe and effective alternative for patients in whom administration via the oral route is not feasible, especially when parenteral formulas are unavailable.

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Rectal Levothyroxine for the Treatment of Hypothyroidism: A Case Study

Cited by 8 publications

References 25 publications

Congenital Hypothyroidism: A 2020–2021 Consensus Guidelines Update—An ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology

Congenital Hypothyroidism: A 2020–2021 Consensus Guidelines Update—An ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology

An Alternative Route of Treatment in Transient Hypothyroxinemia of Prematurity: Rectal Administration of Levothyroxine

Successful Management of Hypothyroidism in Gastric Outlet Obstruction Using Levothyroxine Rectal Enemas: A Case Report

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