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Cited by 74Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryThyroid Cancer Diagnosis and Treatment

When thyroid hormone replacement is ineffective?

Benvenga, Salvatore·2013·Current Opinion in Endocrinology, Diabetes & Obesity
DOI 10.1097/med.0000000000000003
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Abstract

PURPOSE OF REVIEW: In this article, we will consider the failure of thyroid hormone replacement therapy to normalize serum thyroid stimulating hormone concentrations. We will review circumstances and causes for failures, discuss pertinent unpublished personal cases of didactical value, and provide practical suggestions for providers encountering patients with similar presentations. RECENT FINDINGS: Recent data are available on the benefit of novel formulations of levothyroxine therapy on malabsorption. SUMMARY: Most frequently, reasons for ineffectiveness are noncompliance, inappropriate administration of levothyroxine, gastrointestinal disorders, and drug interactions. The diagnostic work-up should include careful history to elucidate the potential reasons for the ineffective therapy.

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Registry

Crossref · 10.1097/med.0000000000000003

Cites

90 of 90 references verified0 citation errors · 0 not checkable

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  • The thyroxine absorption test is not standardized and is unlikely to be associated with a specific etiology.

    “Because it is not standardized, and unlikely to be associated with a specific etiology, the absorption test should not be used routinely [9, 41, 51].”

    From Diagnosis and management of treatment-refractory hypothyroidism: an expert consensus report (2017) · cites this paper as [9]

  • Of 210 L-T4-treated adult patients referred to SB in one year, 27 (13%) had undertreated hypothyroidism.

    “Of 210 L-T4-treated adult patients (tablet formulations) who were referred to SB in one year, 27 (13%) had UTH (11).”

    From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [11]

  • In 8 of 27 patients with undertreated hypothyroidism (30%; 4% of 210), the explanation was pharmacological, all eight taking at least one drug that causes L-T4 malabsorption (proton-pump inhibitors, calcium carbonate, ferrous sulfate).

    “In 8/27 (30%; 4% of 210), the explanation was pharmacological, all eight taking ≥1 drug that causes L-T4 malabsorption (proton-pump inhibitors [PPIs], calcium carbonate, ferrous sulfate) (11).”

    From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [11]

  • Approximately 20% of patients with primary hypothyroidism and approximately 20% or 40% of patients with central hypothyroidism are undertreated, with co-administration of interfering medications being one major cause.

    “≈20% of patients with PH (10–13) and ≈20% (14) or 40% (15) of patients with CH are undertreated, co-administration of interfering medications (IM) being one major cause.”

    From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [11]

  • In 10% to 20% of refractory hypothyroidism patients, no cause is identified, a situation called idiopathic refractory hypothyroidism.

    “Studies indicate that in 10% to 20% of patients with RH, no identifiable cause is found, which is referred to as”

    From Refractory hypothyroidism: unraveling the complexities of diagnosis and management (2023) · cites this paper as [69]

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Authors
Benvenga, S.
Affiliations
University of Messina (IT)
Corresponding author
Benvenga, Salvatore
ORCID
Benvenga, Salvatore
Venue
Current Opinion in Endocrinology, Diabetes & Obesity
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2013-10
Volume
20
Issue
5
Pages
467-477
ISSN
1752-296X (ISSN-L)
DOI
10.1097/med.0000000000000003
OpenAlex
W2140226203
Cited by
74
References
91
Citations by year
2026: 2 · 2025: 3 · 2024: 2 · 2023: 2 · 2022: 7 · 2021: 5 · 2020: 5 · 2019: 5 · 2018: 12 · 2017: 15 · 2016: 8 · 2015: 5 · 2014: 3
FWCI
0.79
Type
journal article
Language
en
Open access
closed
Locations
  • Current Opinion in Endocrinology Diabetes and Obesity (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
Keywords
thyroid hormone replacement, levothyroxine, treatment failure, thyroid-stimulating hormone, non-compliance, drug interactions, gastrointestinal diseases, malabsorption, hypothyroidism
MeSH terms
Chemistry, Pharmaceutical, Digestive System Diseases, Humans, Hypothyroidism, Patient Compliance, Thyroid Hormones, Treatment Failure, Hormone Replacement Therapy, Endpoint Determination, Bariatric Surgery

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