How do you approach the problem of TSH elevation in a patient on high‐dose thyroid hormone replacement?
Abstract
Summary: Persistent elevation of TSH levels in patients under treatment for hypothyroidism is a relatively common clinical problem in endocrinology practice. The most common cause for this phenomenon is poor patient compliance with their thyroid hormone tablets. In the compliant patient, however, multiple aetiologies are possible and a methodological and stepwise approach to the patient's problem will uniformly identify a cause, or at least a resolution.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
During normal pregnancy, women experience increased thyroxine requirements that may approach 50%.
“As mentioned above, during normal pregnancy, women experience increased thyroxine requirements that may approach 50% [41, 60].”
From Diagnosis and management of treatment-refractory hypothyroidism: an expert consensus report (2017) · cites this paper as [41]
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 [41]
Cites
Alexander, E. K., Marqusee, E., Lawrence, J., Jarolim, P., Fischer, G. A., & Larsen, P. R. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa040079 · Cited by 633 · see citing works
Motesanib Diphosphate in Progressive Differentiated Thyroid Cancer
Sherman, S. I., Wirth, L. J., Droz, J.-P., Hofmann, M., Bastholt, L., Martins, R. G., Licitra, L., Eschenberg, M. J., Sun, Y.-N., Juan, T., et al. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa075853 · Cited by 470 · see citing works
Thyroxine in Goiter, <i>Helicobacter pylori</i> Infection, and Chronic Gastritis
Centanni, M., Gargano, L., Canettieri, G., Viceconti, N., Franchi, A., Fave, G. D., & Annibale, B. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa043903 · Cited by 329 · see citing works
Levothyroxine Therapy in Patients with Thyroid Disease
Mandel, S. J., Brent, G. A., & Larsen, P. R. (1993) · Annals of Internal Medicine · doi:10.7326/0003-4819-119-6-199309150-00009 · Cited by 324 · see citing works
Lean Body Mass Is a Major Determinant of Levothyroxine Dosage in the Treatment of Thyroid Diseases
Santini, F., Pinchera, A., Marsili, A., Ceccarini, G., Castagna, M. G., Valeriano, R., Giannetti, M., Taddei, D., Centoni, R., Scartabelli, G., et al. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1306 · Cited by 226 · see citing works
Imatinib induces hypothyroidism in patients receiving levothyroxine
DEGROOT, J., ZONNENBERG, B., PLUKKER, J., VANDERGRAAF, W., & LINKS, T. (2005) · Clinical Pharmacology & Therapeutics · doi:10.1016/j.clpt.2005.06.010 · Cited by 159 · see citing works
Treatment of Hypothyroidism with Once Weekly Thyroxine1
Grebe, S. K. G., Cooke, R. R., Ford, H. C., Fagerström, J. N., Cordwell, D. P., Lever, N. A., Purdie, G., & Feek, C. M. (1997) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.82.3.3830 · Cited by 95 · see citing works
New medications which decrease levothyroxine absorption
John-Kalarickal, J., Pearlman, G., & Carlson, H. E. (2007) · Thyroid · doi:10.1089/thy.2007.0060 · Cited by 82 · see citing works
The Acute Effect of Calcium Carbonate on the Intestinal Absorption of Levothyroxine
Singh, N., Weisler, S. L., & Hershman, J. M. (2001) · Thyroid · doi:10.1089/105072501753211046 · Cited by 77 · see citing works
Treatment of Hypothyroidism with Once Weekly Thyroxine
Grebe, S. K. (1997) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.82.3.870 · Cited by 68 · see citing works
Absorption fo Oral Thyroxine in Hypothyroid and Normal Man
READ, D. G., Hays, M. T., & Hershman, J. M. (1970) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-30-6-798 · Cited by 58 · see citing works
Can urinary thyroid hormone loss cause hypothyroidism?
Fonseca, V., Thomas, M., Katrak, A., et al. (1991) · The Lancet · doi:10.1016/0140-6736(91)90546-2 · Cited by 57 · see citing works
Celiac Disease Presenting as Resistant Hypothyroidism
McDermott, J. H., Coss, A., & Walsh, C. H. (2005) · Thyroid · doi:10.1089/thy.2005.15.386 · Cited by 48 · see citing works
Increasing thyroxine requirements in primary hypothyroidism: don't forget the urinalysis!
Junglee, N. A., Scanlon, M., & Rees, D. A. (2007) · PubMed · Cited by 31 · see citing works
Can Sorafenib Cause Hypothyroidism?
Robinson, S. I., Hobday, T. J., Sathananthan, A., Morris, J. C., & Mcwilliams, R. R. (2007) · Journal of Chemotherapy · doi:10.1179/joc.2007.19.3.352 · Cited by 4 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Pitfalls in the measurement and interpretation of thyroid function tests
Koulouri, O., Moran, C., Halsall, D., Chatterjee, K., & Gurnell, M. (2013) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2013.10.003 · Cited by 282 · see citing works
Treatment with thyroid hormone
Biondi, B., & Wartofsky, L. (2014) · Endocrine Reviews · doi:10.1210/er.2013-1083 · Cited by 259 · see citing works
Gastrointestinal malabsorption of thyroxine
Virili, C., Antonelli, A., Santaguida, M. G., Benvenga, S., & Centanni, M. (2019) · Endocrine Reviews · doi:10.1210/er.2018-00168 · Cited by 164 · see citing works
Diagnosis and management of treatment-refractory hypothyroidism: an expert consensus report
Centanni, M., Benvenga, S., & Sachmechi, I. (2017) · Journal of Endocrinological Investigation · doi:10.1007/s40618-017-0706-y · Cited by 113 · see citing works
“What can be difficult is determining how often ‘occasionally’ actually occurs [41].”
BackgroundInfluentialAdequacy of thyroid hormone replacement in a general population
Okosieme, O. E., Belludi, G., Spittle, K., Kadiyala, R., & Richards, J. (2011) · QJM · doi:10.1093/qjmed/hcq222 · Cited by 96 · see citing works
What should be done when thyroid function tests do not make sense?: Atypical thyroid function tests
Gurnell, M., Halsall, D. J., & Chatterjee, V. K. (2011) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2011.04023.x · Cited by 88 · see citing works
When thyroid hormone replacement is ineffective?
Benvenga, S. (2013) · Current Opinion in Endocrinology, Diabetes & Obesity · doi:10.1097/med.0000000000000003 · Cited by 74 · see citing works
Thyroxine replacement: a clinical endocrinologist’s viewpoint
Eligar, V, Taylor, P., Okosieme, O., Leese, G., & Dayan, C. (2016) · Annals of Clinical Biochemistry: International Journal of Laboratory Medicine · doi:10.1177/0004563216642255 · Cited by 72 · see citing works
Ward, L. S. (2010) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302010000500002 · Cited by 53 · see citing works
The levothyroxine absorption test: a four-year experience (2015-2018) at the Mayo Clinic
Gonzales, K. M., Stan, M. N., Morris, J. C., Bernet, V., & Castro, M. R. (2019) · Thyroid · doi:10.1089/thy.2019.0256 · Cited by 46 · see citing works
Benvenga, S., Vita, R., Di Bari, F., Fallahi, P., & Antonelli, A. (2015) · European Thyroid Journal · doi:10.1159/000381310 · Cited by 37 · see citing works
Robertson, H. M. A., Narayanaswamy, A. K. P., Pereira, O., Copland, S. A., Herriot, R., McKinlay, A. W., Bevan, J. S., & Abraham, P. (2014) · Thyroid · doi:10.1089/thy.2013.0661 · Cited by 35 · see citing works
Van Wilder, N., Bravenboer, B., Herremans, S., Vanderbruggen, N., & Velkeniers, B. (2017) · European Thyroid Journal · doi:10.1159/000452489 · Cited by 31 · see citing works
Rapid levothyroxine absorption testing: a case series of nonadherent patients
Balla, M., Jhingan, R. M., & Rubin, D. J. (2015) · International Journal of Endocrinology and Metabolism · doi:10.5812/ijem.31051 · Cited by 30 · see citing works
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
Refractory hypothyroidism due to improper storage of levothyroxine tablets
Benvenga, S., Papi, G., & Antonelli, A. (2017) · Frontiers in Endocrinology · doi:10.3389/fendo.2017.00155 · Cited by 22 · see citing works
Santos Monteiro, S., Santos, T. S., Lopes, A. M., Oliveira, J. C., Freitas, C., & Couto Carvalho, A. (2022) · Endocrine Connections · doi:10.1530/ec-22-0355 · Cited by 9 · see citing works
Refractory hypothyroidism to levothyroxine treatment: five cases of pseudomalabsorption
Elbasan, O. (2020) · Acta Endocrinologica (Bucharest) · doi:10.4183/aeb.2020.339 · Cited by 7 · see citing works
A Report of the Mayo Clinic Experience on the Levothyroxine Absorption Test
Biondi, B. (2020) · Clinical Thyroidology · doi:10.1089/ct.2020;32.6-8 · Cited by 4 · see citing works
- Authors
- Morris, J. C.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Morris, John C.
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2009-03-31
- Volume
- 70
- Issue
- 5
- Pages
- 671-673
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W1999017054
- Cited by
- 59
- References
- 15
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 4 · 2022: 2 · 2021: 6 · 2020: 3 · 2019: 3 · 2018: 3 · 2017: 6 · 2016: 7 · 2015: 2 · 2014: 7 · 2013: 4 · 2012: 2
- FWCI
- 2.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (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 › Adrenal Hormones and Disorders
- Keywords
- TSH elevation, hypothyroidism, thyroid hormone replacement, medication adherence, TSH-secreting pituitary adenoma, thyrotropinoma, differential diagnosis
- MeSH terms
- Drug Interactions, Humans, Hypothyroidism, Intestinal Absorption, Patient Compliance, Thyrotropin, Thyroxine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
