The difficult patient: drug interaction and the influence of concomitant diseases on the treatment of hypothyroidism

Ward, Laura S.

doi:10.1590/s0004-27302010000500002

Cited by 53Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryThyroid Cancer Diagnosis and Treatment

The difficult patient: drug interaction and the influence of concomitant diseases on the treatment of hypothyroidism

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Ward, Laura S.·2010·Arquivos Brasileiros de Endocrinologia & Metabologia

DOI 10.1590/s0004-27302010000500002

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Abstract

Although most hypothyroid patients do well with one single tablet of thyroxine daily, approximately 10% are dissatisfied and another important group of patients is difficult to control. We reviewed the most common causes for frequent-dose adjustment or high-dose requirement, including poor compliance with therapy and inadequate medication. Since these two causes have been ruled out, drug interaction and other concomitant diseases need to be investigated. Requirements of thyroxine increase in all conditions characterized by impaired gastric acid secretion. Proton-pump inhibitors, antacids and a long list of drugs may decrease thyroxine absorption. In addition, a series of diseases including celiac disease and chronic inflammatory intestinal diseases, as well as nutritional habits may be important in patient control. Finally, we mention the effects of a growing list of drugs and thyroid disruptors that may also affect thyroid hormone metabolism at many levels.

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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 [51]

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Authors: Ward, L. S.
Affiliations: Universidade Estadual de Campinas (UNICAMP) (BR)
Corresponding author: Ward, Laura S.
ORCID: Ward, Laura S.
Venue: Arquivos Brasileiros de Endocrinologia & Metabologia
Publisher: FapUNIFESP (SciELO)
Published: 2010
Volume: 54
Issue: 5
Pages: 435-442
ISSN: 0004-2730 (ISSN-L)
DOI: 10.1590/s0004-27302010000500002
OpenAlex: W2036524590
Cited by: 53
References: 57
Citations by year: 2025: 1 · 2024: 2 · 2022: 3 · 2021: 3 · 2020: 3 · 2019: 2 · 2018: 5 · 2017: 8 · 2016: 3 · 2015: 4 · 2014: 5 · 2013: 5 · 2012: 4
FWCI: 3.36
Type: journal article
Language: en
Open access: diamond
doi.org
Licence: cc-by-nc
Locations: Arquivos Brasileiros de Endocrinologia & Metabologia (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
Americanae (AECID Library) (submittedVersion, other-oa)
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 › Thyroid Cancer Diagnosis and Treatment
Keywords: hypothyroidism, thyroxine, drug interactions, concomitant disease, thyroid hormone absorption, proton pump inhibitors, antacids, gastric acid secretion, celiac disease, inflammatory bowel disease, dietary habits, thyroid hormone metabolism, thyroid disruptors, treatment non-adherence
MeSH terms: Drug Interactions, Humans, Hypothyroidism, Patient Compliance, Thyroxine

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The difficult patient: drug interaction and the influence of concomitant diseases on the treatment of hypothyroidism

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