Switching from the tablet to the powder formulation of levothyroxine corrects severe hypothyroidism in a patient with lactose intolerance
Open accessAbstract
We describe a case of a 38-year-old woman who, after radioactive iodine therapy for Graves' disease, developed severe hypothyroidism despite receiving a high dose of levothyroxine (L-T4) tablet as replacement therapy. Her thyroid stimulating hormone (TSH) remained to be high despite the dose of L-T4 tablets to 400 μg/day after treatment for hypothyroidism, and the patient complained of general malaise and edema of the legs. Reduced intestinal absorption of L-T4 is the most common cause of failure to achieve the therapeutic target in hypothyroid patients receiving replacement therapy. She was admitted to our hospital for severe hypothyroidism due to resistance to treatment with L-T4 tablet. Our patient was found to have lactose intolerance (LI) by a detailed examination during hospitalization. Therefore, we assumed that LI was impairing intestinal absorption of L-T4 tablet in our patient, leading to severe hypothyroidism. The patient was switched to the powder formulation of L-T4 at the same daily dose, and serum levels of thyroid-stimulating hormone and thyroid hormones normalized. This is the case in which hypothyroidism due to reduced absorption of L-T4 tablet in a patient with LI was resolved by switching to L-T4 powder formulation.
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Crushed tablet powder might also resolve hypothyroidism due to bariatric surgery and lactose intolerance.
“Similarly, crushed tablet powder might also resolve hypothyroidism due to bariatric surgery and lactose intolerance (49, 67).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [67]
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Cites
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Levothyroxine: conventional and novel drug delivery formulations.
Liu, H., Li, W., Zhang, W., Sun, S., & Chen, C. (2023) · Endocrine Reviews · doi:10.1210/endrev/bnac030 · Cited by 63 · see citing works
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Ma, B., Ma, Z., Liang, P., Gong, R., & Wu, H. (2025) · Naunyn-Schmiedeberg s Archives of Pharmacology · doi:10.1007/s00210-025-04840-2 · Cited by 1 · see citing works
(2022) · Reactions Weekly · doi:10.1007/s40278-022-24076-3
- Authors
- Jojima, T., Shinzawa, T., Ohira, E., Sakurai, S., Tomaru, T., Iijima, T., Kogai, T., Usui, I., & Aso, Y.
- Affiliations
- Dokkyo Medical University (JP)
- ORCID
- Kogai, Takahiko
- Venue
- Endocrine Journal
- Publisher
- Japan Endocrine Society
- Published
- 2022
- Volume
- 69
- Issue
- 8
- Pages
- 941-945
- ISSN
- 0918-8959 (ISSN-L)
- 1348-4540
- OpenAlex
- W4214931123
- Cited by
- 6
- References
- 14
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 1 · 2022: 2
- FWCI
- 1.12
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Endocrine Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Japan Society for the Promotion of Science (21K07325)
- 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
- levothyroxine, lactose intolerance, hypothyroidism, intestinal absorption, Graves' disease, radioiodine therapy, thyroid-stimulating hormone, drug formulation switching
- MeSH terms
- Adult, Female, Humans, Hypothyroidism, Iodine Radioisotopes, Lactose Intolerance, Powders, Tablets, Thyroid Neoplasms, Thyrotropin, Thyroxine
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