Severe hypothyroidism in patients dependent on prolonged thyroxine infusion through a jejunostomy
Abstract
Background and aims Enteral absorption of thyroxine (T4) is variable; the duodenum and jejunum appear to be the most important sites of absorption. Our objective is to demonstrate that T4 infused via a standard jejunostomy may occasionally be poorly absorbed.Methods Two patients underwent esophagolaryngeal resection for carcinoma of the cervical esophagus. The procedure was accompanied by complete removal of the thyroid and parathyroid glands. A neck fistula at the gastropharyngeal anastomosis led to a restriction of oral intake; daily requirements of T4 and nutrients were given via the jejunostomy. T4 plasma levels deteriorated and thyroid-stimulating hormone (TSH) levels increased and in the third postoperative week, T4 (300 microg) was administered via a nasogastric tube.Results Although given a high dose (300 microg) of T4, both patients developed severe hypothyroidism. Infusion of T4 through the nasogastric tube precipitated the normalization of T4 and TSH plasma levels. Both patients (cases 1 and 2) resumed oral intake during the fifth and sixth postoperative weeks respectively.Conclusion T4 malabsorption may occur in patients dependent on prolonged T4 infusion via a standard jejunostomy.
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Since ∼70% of oral LT4 is absorbed in the duodenum, jejunum, and ileum, jejunostomy and bowel resection lead to a substantial decrease in drug absorption.
“Since ∼70% of oral LT4 is absorbed in the duodenum, jejunum, and ileum, jejunostomy and bowel resection lead to a substantial decrease in drug absorption (52).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [52]
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“Moreover, classical pharmacokinetic data indicate that levothyroxine absorption occurs predominantly in the duodenum and proximal jejunum, allowing adequate uptake when intestinal perfusion and motility are preserved [15].”
- Authors
- Smyrniotis, V., Vaos, N., Arkadopoulos, N., Kostopanagiotou, G., Theodoraki, K., & Lambrou, A.
- Affiliations
- National and Kapodistrian University of Athens (GR)
- ORCID
- Theodoraki, K.
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2000-02
- Volume
- 19
- Issue
- 1
- Pages
- 65-67
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W2142401188
- Cited by
- 13
- References
- 14
- Citations by year
- 2025: 1 · 2022: 1 · 2017: 1 · 2014: 2
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- severe hypothyroidism, jejunostomy, nasogastric tube administration, total thyroidectomy, postoperative complications, esophageal cancer, thyroid-stimulating hormone, enteral nutrition
- MeSH terms
- Aged, Enteral Nutrition, Esophageal Neoplasms, Female, Humans, Hypothyroidism, Intestinal Absorption, Jejunostomy, Malabsorption Syndromes, Middle Aged, Postoperative Period, Thyrotropin, Thyroxine
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