l-Thyroxine Requirement in Patients with Autoimmune Hypothyroidism and Parietal Cell Antibodies
Abstract
BACKGROUND: Hypothyroid patients on l-T(4) therapy may require replacement doses exceeding the theoretical needs to normalize serum TSH due to low patient compliance, drugs interference, and malabsorption. OBJECTIVE: We examined whether autoimmune gastritis might cause increased l-T(4) requirement in patients with autoimmune thyroiditis receiving l-T(4) replacement. PATIENTS: We studied 391 patients with clinical or subclinical hypothyroidism from autoimmune thyroiditis who had achieved normal serum TSH concentration (0.3-3.0 microU/ml) under l-T(4) for at least 6 months. Patients were screened for serum parietal cell antibodies (PCA) as a marker of autoimmune gastritis, and the PCA status was correlated with the l-T(4) dose. We also studied a group of 60 patients receiving l-T(4) replacement after total thyroidectomy. RESULTS: PCA-positive (155 of 391) and PCA-negative (236 of 391) patients did not differ for pretherapy serum TSH levels and thyroid volume. The l-T(4) requirement was significantly (P = 0.002) higher in PCA-positive (1.24 +/- 0.40 microg/kg x d) than in PCA-negative patients (1.06 +/- 0.36 microg/kg x d), and a significant positive correlation was found between l-T(4) requirement and serum PCA levels. Among PCA-positive patients, l-T(4) requirement was even higher in those with proven gastritis (1.52 +/- 0.40 microg/kg x d) compared with those without gastric damage (1.15 +/- 0.33 microg/kg x d) (P < 0.0001). The increased l-T(4) requirement was confirmed also in PCA-positive thyroidectomized patients (1.81 +/- 0.27 microg/kg x d) compared with PCA-negative thyroidectomized patients (1.52 +/- 0.24 microg/kg x d). Independent variables affecting l-T(4) requirement were PCA and serum TSH at diagnosis. CONCLUSIONS: Autoimmune gastritis is an additional factor affecting l-T(4) requirement in patients with autoimmune thyroiditis. Serum PCA measurement should be considered in patients with an unexplained high requirement of l-T(4).
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Higher LT4 doses are required in patients with positive parietal cell antibodies, and LT4 dose is positively associated with antibody titer and severity of gastritis.
“Higher LT4 doses were required in those with positive antibodies, and the LT4 dose was positively associated with the antibody titer and the severity of the gastritis.”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [154]
In LT4-treated patients, LT4 requirement correlates with presence or absence of serum parietal cell antibodies.
“In addition, in patients receiving LT4 therapy, the magnitude of their LT4 requirement was correlated with the presence or absence of serum parietal cell antibodies (154).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [154]
Many patients with malabsorption can have a serum TSH level in the target range with an increased dose of LT4.
“Many patients with malabsorption can have a serum TSH level in the target range with an increased dose of LT4 (64, 70).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [70]
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- Authors
- Checchi, S., Montanaro, A., Pasqui, L., Ciuoli, C., De Palo, V., Chiappetta, M. C., & Pacini, F.
- Affiliations
- University of Siena (IT)
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, 53100 Siena, Italy
- Corresponding author
- Pacini, Furio
- ORCID
- Pacini, Furio
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2008-02-01
- Volume
- 93
- Issue
- 2
- Pages
- 465-469
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W1983054324
- Cited by
- 89
- References
- 36
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 4 · 2022: 5 · 2021: 7 · 2020: 2 · 2019: 1 · 2018: 4 · 2017: 3 · 2016: 11 · 2015: 4 · 2014: 12 · 2013: 6 · 2012: 2
- FWCI
- 4.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (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
- autoimmune hypothyroidism, autoimmune thyroiditis, parietal cell antibodies, autoimmune gastritis, thyroid hormone replacement, serum TSH, total thyroidectomy, subclinical hypothyroidism
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Autoantibodies, Child, Female, Gastritis, Humans, Hypothyroidism, Male, Middle Aged, Thyroiditis, Autoimmune, Thyrotropin, Thyroxine, Triiodothyronine, Cohort Studies, Statistics, Nonparametric, Hormone Replacement Therapy
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