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Cited by 13Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryParasitic Infections and Diagnostics

Switch from tablet levothyroxine to oral solution resolved reduced absorption by intestinal parasitosis

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Tortora, Anna, La Sala, Domenico, Vitale, Mario·2019·Endocrinology, Diabetes & Metabolism Case Reports
DOI 10.1530/edm-19-0026PMC PMC6432983
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Abstract

Reduced intestinal absorption of levothyroxine (LT4) is the most common cause of failure to achieve an adequate therapeutic target in hypothyroid patients under replacement therapy. We present the case of a 63-year-old woman with autoimmune hypothyroidism previously well-replaced with tablet LT4 who became unexpectedly no more euthyroid. At presentation, the patient reported the onset of acute gastrointestinal symptoms characterized by nausea, loss of appetite, flatulence, abdominal cramps and diarrhea, associated with increase of thyrotropin levels (TSH: 11 mIU/mL). Suspecting a malabsorption disease, a thyroxine solid-to-liquid formulation switch, at the same daily dose, was adopted to reach an optimal therapeutic target despite the gastrointestinal symptoms persistence. Oral LT4 solution normalized thyroid hormones. Further investigations diagnosed giardiasis, and antibiotic therapy was prescribed. This case report is compatible with a malabsorption syndrome caused by an intestinal parasite (Giardia lamblia). The reduced absorption of levothyroxine was resolved by LT4 oral solution. Learning points: The failure to adequately control hypothyroidism with oral levothyroxine is a common clinical problem. Before increasing levothyroxine dose in a patient with hypothyroidism previously well-controlled with LT4 tablets but no more in appropriate therapeutic target, we suggest to investigate non adhesion to LT4 therapy, drug or food interference with levothyroxine absorption, intestinal infection, inflammatory intestinal disease, celiac disease, lactose intolerance, short bowel syndrome after intestinal or bariatric surgery, hepatic cirrhosis and congestive heart failure. LT4 oral solution has a better absorptive profile than the tablet. In hypothyroid patients affected by malabsorption syndrome, switch of replacement therapy from tablet to liquid LT4 should be tested before increasing the dose of LT4.

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  • A switch from LT4 tablets to liquid preparations can restore thyroid function in patients with gastrointestinal dysfunction.

    “In addition, a switch from LT4 tablets to liquid preparations can restore thyroid function in patients with gastrointestinal dysfunction (Fig. 3) (32, 49, 50, 60, 65, 66).”

    From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [66]

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Authors
Tortora, A., La Sala, D., & Vitale, M.
Affiliations
  • University of Salerno (IT)
  • Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
Corresponding author
Vitale, Mario
ORCID
Vitale, Mario
Venue
Endocrinology, Diabetes & Metabolism Case Reports
Publisher
Bioscientifica
Published
2019-03-21
Volume
2019
ISSN
2052-0573 (ISSN-L)
DOI
10.1530/edm-19-0026
PMC
PMC6432983
OpenAlex
W2923831923
Cited by
13
References
15
Citations by year
2024: 3 · 2023: 1 · 2022: 5 · 2021: 2 · 2020: 1 · 2019: 1
FWCI
1.83
Type
journal article
Language
en
Open access
Licence
Locations
  • Endocrinology Diabetes and Metabolism 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)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
  • Life Sciences › Immunology and Microbiology › Parasitology › Parasitic Infections and Diagnostics
Keywords
levothyroxine, hypothyroidism, malabsorption, Giardia lamblia, giardiasis, intestinal parasitic infections, thyroid hormone replacement, drug absorption, autoimmune hypothyroidism, thyroid-stimulating hormone

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