Successful management of hypothyroidism in gastric outlet obstruction using levothyroxine rectal enemas: a case report
Open accessAbstract
BACKGROUND Hypothyroidism is the second most common endocrine disorder following diabetes. Appropriate hormone replacement therapy is the cornerstone of its management and is typically in the form of oral preparations of levothyroxine. Intravenous replacement is a well-known alternative in patients who are unable to take medication orally for long periods. However, effective and safe alternatives to oral preparations of levothyroxine should be sought in the absence of the parenteral alternative. The aim of this report is to describe an alternative route for levothyroxine supplementation when the oral and parenteral routes are not available. CASE REPORT This study reports a hypothyroid patient with symptomatic malignant gastric outlet obstruction requiring surgery. However, the patient's surgical condition precluded oral administration of levothyroxine and the parenteral alternative was unavailable. Hormone replacement therapy was administered rectally in the form of enemas in preparing the patient for surgery. CONCLUSIONS Rectal administration of levothyroxine using enemas can be a safe and effective alternative for patients in whom administration via the oral route is not feasible, especially when parenteral formulas are unavailable.
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Plasma thyroid hormone levels are normalized only with an additional 100% of the dose or more when LT4 is administered rectally.
“Interestingly, although rectal administration can bypass the hepatic first-pass effect, plasma TH levels are normalized only with an additional 100% of the dose or more (257, 258).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [258]
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- Authors
- Obeidat, K. A., Saadeh, N. A., As\'ad, A., & Bakkar, S.
- Affiliations
- Jordan University of Science and Technology (JO)
- Department of General Surgery, King Abdullah University Hospital (KAUH), Jordan University of Science and Technology (JUST), Irbid, Jordan
- Hashemite University (JO)
- Corresponding author
- Obeidat, Khaled A.
- Venue
- American Journal of Case Reports
- Published
- 2018-08-01
- Volume
- 19
- Pages
- 903-905
- ISSN
- 1941-5923 (ISSN-L)
- PMC
- PMC6083943
- OpenAlex
- W2885457033
- Cited by
- 12
- References
- 9
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 1
- FWCI
- 0.80
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- American Journal of Case Reports (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- 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
- hypothyroidism, levothyroxine, rectal enema, gastric outlet obstruction, malignant gastric outlet obstruction, hormone replacement therapy, preoperative preparation
- MeSH terms
- Administration, Rectal, Enema, Humans, Hypothyroidism, Male, Middle Aged, Preoperative Care, Stomach Neoplasms, Thyroid Hormones, Thyroxine, Gastric Outlet Obstruction, Hormone Replacement Therapy
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