Thyroxine in Goiter,<i>Helicobacter pylori</i>Infection, and Chronic Gastritis

Introduction: Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women. Objectives: In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience. Materials and methods: The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a scale from A-D was based on the Oxford Centre for Evidence--based Medicine, Levels of Evidence 2009, allowing an unbiased opinion devoid of subjective viewpoints. The areas of interest for the studies comprised diagnosis, screening, treatment and a special section for hypothyroidism in pregnancy. Results: Several questions based on diagnosis, screening, treatment of hypothyroidism in adult population and specifically in pregnant women were posed. Twenty six recommendations were created based on the answers to these questions. Despite the fact that evidence in some areas of hypothyroidism, such as therapy, is lacking, out of 279 references, 73% were Grade A and B, 8% Grade C and 19% Grade D. Conclusions: These evidence-based clinical guidelines on hypothyroidism will provide unified criteria for management of hypothyroidism throughout Latin America. Although most of the studies referred to are from all over the world, the point of view of thyroidologists from Latin America is also given. Arq Bras Endocrinol Metab. 2013;57(4):265-99

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“…Chronic gastritis, Helicobacter pylori and Giardia infections can also decrease L-T4 absorption, and should be considered (204,205) …”

Section: How To Approach Hypothyroid Patients With Persistently High mentioning

confidence: 99%

Clinical practice guidelines for the management of hypothyroidism

Brenta

Vaisman

Sgarbi

et al. 2013

Arq Bras Endocrinol Metab

126

123

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“…64 Although it is clear that excess thyroid hormone can lead to fetal loss, 65 the fetal risk from maternal overtreatment in such patients is generally low. 44 Possible LT 4 interactions with coexisting diseases, such as gastritis, 66 or medications, such as iron supplements, calcium, vitamins, or omeprazole, may reduce LT 4 absorption. 67 In those cases, it is best to advise a 4-hour delay between the medications and LT 4 .…”

Section: Managementmentioning

confidence: 99%

Autoimmune Thyroid Disease in Pregnancy: A Review

Galofré

Davies

2009

Journal of Women's Health

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The maternal physiological changes that occur in normal pregnancy induce complex endocrine and immune responses. During a normal pregnancy, thyroid gland volume may enlarge, and thyroid hormone production increases. Hence, the interpretation of thyroid function during gestation needs to be adjusted according to pregnancy-specific ranges. The elevated prevalence of gestation-related thyroid disorders (10%-15%) and the important repercussions for both mother and fetus reported in multiple studies throughout the world denote, in our opinion, the necessity for routine thyroid function screening both before and during pregnancy. Once thyroid dysfunction is suspected or confirmed, management of the thyroid disorder necessitates regular monitoring in order to ensure a successful outcome. The aim of treating hyperthyroidism in pregnancy with antithyroid drugs is to maintain serum thyroxine (T 4 ) in the upper normal range of the assay used with the lowest possible dose of drug, whereas in hypothyroidism, the goal is to return serum thyroid-stimulating hormone (TSH) to the range between 0.5 and 2.5 mU=L.

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“…One such factor is the amount of LT 4 absorbed in the gastrointestinal tract, which is altered by various medical disorders (10)(11)(12), several medications (13)(14)(15)(16), and food and drink (17)(18)(19). The timing of LT 4 administration also has an impact on its absorption (18,(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

Levothyroxine Replacement Doses Are Affected by Gender and Weight, But Not Age

Devdhar

Drooger

Pehlivanova

et al. 2011

Thyroid

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Background: Body weight (BW) and age have been shown to affect the dose of levothyroxine (LT 4 ) that results in normalization of serum thyroid-stimulating hormone (TSH) in hypothyroid patients. Our objective was to determine whether gender, menstrual status, and ideal BW (IBW) also affect the LT 4 dose required to achieve a serum TSH within the normal range. Methods: We retrospectively reviewed the charts of patients being treated for primary hypothyroidism who had TSH values within a normal range. We selected patients aged 18-85 years who were taking LT 4 without any confounding medications, and who had no serious chronic conditions. Their LT 4 doses, referred to here as LT 4 dose requirements, based on both BW and IBW were documented. The relationship between gender, menstrual status, age, serum TSH concentrations, and the degree of overweight on LT 4 dose requirements were determined using multivariate analyses. Results: Women were significantly more overweight than men (ratio of BW/IBW was 1.35 for women vs. 1.17 for men, p < 0.0001). LT 4 requirements based on BW did not differ by gender when age was included in the model. However, when degree of overweight was also included, men required lower LT 4 doses than both premenopausal women (1.34 mg/kg vs. 1.51 mg/kg, p ¼ 0.038) and menopausal women (1.34 mg/kg vs. 1.49 mg/ kg, p ¼ 0.023). When examining IBW using a model incorporating age, men also required lower LT 4 doses than both premenopausal women (1.64 mg/kg vs. 1.92 mg/kg, p ¼ 0.0033) and menopausal women (1.64 mg/kg vs. 1.90 mg/kg, p ¼ 0.0024). Serum TSH concentrations were not significantly different in any of the gender groups. There was no relationship between serum TSH and either age or BW. The initial serum TSH concentration was by design with the normal range, but the concentration within that range was not a significant predictor of the LT 4 replacement dose in any of the models. Conclusion: In contrast to previous studies suggesting that age affects LT 4 replacement requirements, we found that age-based differences in doses are secondary to differences in BW and gender. In addition, in contrast to prior studies showing that lean body mass, but not gender, affected LT 4 dose, we instead found a significant impact of gender. Gender-based differences in dose requirement only became apparent either when IBW was used to correct for the dose or when degree of overweight was included in the model. Gender differences in LT 4 dose requirement exist, but are masked unless gender-based differences in degree of overweight are also considered.

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Thyroxine in Goiter,Helicobacter pyloriInfection, and Chronic Gastritis

Abstract: Patients with impaired acid secretion require an increased dose of thyroxine, suggesting that normal gastric acid secretion is necessary for effective absorption of oral thyroxine.

Cited by 298 publications

References 33 publications

Clinical practice guidelines for the management of hypothyroidism

Clinical practice guidelines for the management of hypothyroidism

Autoimmune Thyroid Disease in Pregnancy: A Review

Levothyroxine Replacement Doses Are Affected by Gender and Weight, But Not Age

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