Chronic intestinal giardiasis with isolated levothyroxine malabsorption as reason for severe hypothyroidism—implications for localization of thyroid hormone absorption in the gut
Abstract
We report a case of isolated levothyroxine malabsorption in the course of chronic intestinal giardiasis, leading to severe hypothyroidism. Infection with Giardia lamblia was proved histologically by jejunal biopsy. Treatment with metronidazole resulted in complete elimination of parasites and recovery of regular intestinal thyroid hormone absorption. Stable euthyroidism was accomplished with common replacement doses of orally administered levothyroxine.
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Inflammatory injury and apoptosis of mucosal cells caused by Giardia intestinalis has been suggested to reversibly affect levothyroxine absorption.
“The inflammatory injury and the apoptosis of mucosal cells caused by the protozoan Giardia intestinalis has been suggested to reversibly affect levothyroxine absorption. (114).”
From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [114]
Unusual administration routes, including intravenous (IV) injection and IM injection, can also decrease unsuppressed TSH levels in patients with digestive tract disorders.
“Unusual administration routes, including intravenous (IV) injection and IM injection, can also decrease unsuppressed TSH levels in patients with digestive tract disorders (55, 58, 68, 69).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [69]
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Biondi, B., & Wartofsky, L. (2014) · Endocrine Reviews · doi:10.1210/er.2013-1083 · Cited by 259 · see citing works
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Lactose intolerance revealed by severe resistance to treatment with levothyroxine
Muñoz-Torres, M., Varsavsky, M., & Alonso, G. (2006) · Thyroid · doi:10.1089/thy.2006.16.1171 · Cited by 54 · see citing works
Ward, L. S. (2010) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302010000500002 · Cited by 53 · see citing works
Centanni, M., Duntas, L., Feldt-Rasmussen, U., Koehrle, J., Peeters, R. P., Razvi, S., Trimboli, P., & Virili, C. (2025) · European Thyroid Journal · doi:10.1530/etj-25-0123 · Cited by 38 · see citing works
“(114).”
Increased requirement of replacement doses of levothyroxine caused by liver cirrhosis.
Benvenga, S., Capodicasa, G., Perelli, S., Ferrari, S. M., Fallahi, P., & Antonelli, A. (2018) · Frontiers in Endocrinology · doi:10.3389/fendo.2018.00150 · Cited by 25 · see citing works
Trimboli, P., Virili, C., Centanni, M., & Giovanella, L. (2018) · Frontiers in Endocrinology · doi:10.3389/fendo.2018.00118 · Cited by 21 · see citing works
Ulcerative colitis as a novel cause of increased need for levothyroxine
Virili, C., Stramazzo, I., Santaguida, M. G., Bruno, G., Brusca, N., Capriello, S., Cellini, M., Severi, C., Gargano, L., & Centanni, M. (2019) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00233 · Cited by 20 · see citing works
Radaeli, R. D. F., & Diehl, L. A. (2011) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302011000100012 · Cited by 17 · see citing works
Tortora, A., La Sala, D., & Vitale, M. (2019) · Endocrinology, Diabetes & Metabolism Case Reports · doi:10.1530/edm-19-0026 · Cited by 13 · see citing works
- Authors
- Seppel, T., Rose, F., & Schlaghecke, R.
- Affiliations
- Heinrich Heine University Düsseldorf (DE)
- Venue
- Experimental and Clinical Endocrinology & Diabetes
- Publisher
- Georg Thieme Verlag KG
- Published
- 2009-07-15
- Volume
- 104
- Issue
- 02
- Pages
- 180-182
- ISSN
- 0947-7349 (ISSN-L)
- 1439-3646
- OpenAlex
- W2078449511
- Cited by
- 30
- References
- 0
- Citations by year
- 2025: 1 · 2022: 1 · 2019: 2 · 2018: 4 · 2017: 1 · 2015: 1 · 2014: 2 · 2012: 2
- FWCI
- 1.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Experimental and Clinical Endocrinology & Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Life Sciences › Immunology and Microbiology › Parasitology › Parasitic Infections and Diagnostics
- Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
- Keywords
- Giardia lamblia, hypothyroidism, thyroid hormone absorption, metronidazole, jejunal biopsy
- MeSH terms
- Antiprotozoal Agents, Female, Giardiasis, Graves Disease, Humans, Hypothyroidism, Intestinal Absorption, Malabsorption Syndromes, Metronidazole, Middle Aged, Thyrotropin, Thyroxine
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