Pseudomalabsorption of levothyroxine

Ain, Kenneth B.

doi:10.1001/jama.1991.03470150090036

Cited by 100Thyroid Disorders and TreatmentsPsychosomatic Disorders and Their TreatmentsThyroid and Parathyroid Surgery

Pseudomalabsorption of levothyroxine

Ain, Kenneth B.·1991·JAMA: The Journal of the American Medical Association

DOI 10.1001/jama.1991.03470150090036

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Abstract

OBJECTIVE: --The issue of patient compliance with pharmacological therapy vs malabsorption of medication was explored in the context of persistent hypothyroidism despite the administration of large doses of levothyroxine sodium. DESIGN: --Retrospective case series. SETTING: --Referred care in two large tertiary care centers. PATIENTS: --Four patients, seen within two decades, with clinical and biochemical hypothyroidism while receiving levothyroxine, were evaluated for selective malabsorption of this hormone. INTERVENTIONS: --Studies included serial measurements of thyroid hormone levels after a loading dose of levothyroxine or liothyronine sodium or evaluation with a double-labeled thyroxine tracer technique. Results were compared with studies of levothyroxine malabsorption in the medical literature. RESULTS: --All patients were ultimately found to have normal (82% to 100%) absorption of oral levothyroxine. There was no evidence that malabsorption of levothyroxine can occur as an isolated abnormality. CONCLUSIONS: --Some patients exhibit a factitious disorder suggesting malabsorption of levothyroxine. When treating hypothyroidism, psychiatric issues may result in noncompliance with levothyroxine therapy.

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In 1991, Ain et al. found that patients with persistent hypothyroidism had normal percentage of absorption of LT4 administration.
“However, in 1991, Ain et al. explored the issue of patient compliance vs malabsorption of medication in the context of persistent hypothyroidism, and these patients were found to have normal percentage of absorption of LT4 administration (31).”
From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [31]

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Authors: Ain, K. B.
Affiliations: National Institutes of Health (US)
Corresponding author: Ain, Kenneth B.
ORCID: Ain, Kenneth B.
Venue: JAMA: The Journal of the American Medical Association
Publisher: American Medical Association (AMA)
Published: 1991-10-16
Volume: 266
Issue: 15
Pages: 2118
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.1991.03470150090036
OpenAlex: W2092663272
Cited by: 100
References: 26
Citations by year: 2025: 2 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 3 · 2019: 5 · 2018: 7 · 2017: 4 · 2016: 2 · 2015: 4 · 2014: 7 · 2013: 4 · 2012: 4
FWCI: 0.60
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Diabetes and Digestive and Kidney Diseases (DK 15070)
National Center for Research Resources (RR-00055)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Keywords: levothyroxine, hypothyroidism, medication non-adherence, factitious disorder, thyroid hormone absorption, psychiatric comorbidity
MeSH terms: Adult, Factitious Disorders, Female, Humans, Hypothyroidism, Intestinal Absorption, Middle Aged, Patient Compliance, Retrospective Studies, Thyroxine, Triiodothyronine

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Pseudomalabsorption of levothyroxine

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