Increased levothyroxine requirement in a woman with previously well-controlled hypothyroidism and intestinal giardiasis
Open accessAbstract
The most common cause of apparent inefficiency or resistance to oral therapy with levothyroxine for hypothyroidism is nonadhesion. However, in some subjects in whom the control of hypothyroidism is extremely difficult, levothyroxine bioavailability defects should be considered. We report here the case of a 57-year-old woman with hypothyroidism that was well-controlled for the previous 6 years but suddenly presented with poor hormonal control and abdominal symptoms, despite repeatedly reporting good compliance to therapy. Adequate control of thyroid function was only obtained after intestinal giardiasis was diagnosed and treated.
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There are case reports of increased LT4 requirements in individuals with celiac disease, lactose intolerance, and intestinal giardiasis, with reduction in LT4 requirement after institution of gluten-free or lactose-restricted diet and treatment of infection.
“There are also case reports of increased LT4 requirements in individuals with celiac disease (158,159), lactose intolerance (160), and intestinal giardiasis (161) with reduction in the LT4 requirement occurring after institution of a gluten-free or lactose-restricted diet and treatment of the infection, respectively.”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [161]
In patients with celiac disease, intestinal parasitosis, or other intestinal dysfunctions, TSH concentrations remained elevated even after treatment with increased doses.
“In patients with celiac disease, intestinal parasitosis, or other intestinal dysfunctions, TSH concentrations remained elevated, even after treatment with increased doses (19, 23–26).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [23]
In hypothyroid patients with parasitosis or H. pylori infection, TSH levels usually return to the target range with a normal dose after antiparasitic or antibiotic therapy.
“In hypothyroid patients with parasitosis or H. pylori infection, TSH levels usually return to the target range with a normal dose after antiparasitic or antibiotic therapy (12, 23).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [23]
Giardiasis and Enterobius vermicularis can damage intestinal mucosal cells and subsequently decrease LT4 absorption.
“Giardiasis and Enterobius vermicularis can damage intestinal mucosal cells and subsequently decrease LT4 absorption (23, 56).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [23]
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Cites
Gardner, T. B., & Hill, D. R. (2001) · Clinical Microbiology Reviews · doi:10.1128/cmr.14.1.114-128.2001 · Cited by 565 · see citing works
Carvalho‐Costa, F. A., Gonçalves, A. Q., Lassance, S. L., Neto, L. M. D. S., Salmazo, C. A. A., & Bóia, M. N. (2007) · Revista do Instituto de Medicina Tropical de São Paulo · doi:10.1590/s0036-46652007000300003 · Cited by 138 · see citing works
Pathophysiology of enteric infections withGiardia duodenalis
Buret, A. G. (2008) · Parasite · doi:10.1051/parasite/2008153261 · Cited by 133 · see citing works
Ali, A., & Hill, D. R. (2003) · Current Opinion in Infectious Diseases · doi:10.1097/00001432-200310000-00012 · Cited by 119 · see citing works
Pseudomalabsorption of levothyroxine
Ain, K. B. (1991) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1991.03470150090036 · Cited by 100 · see citing works
Tendência secular das parasitoses intestinais na infância na cidade de São Paulo (1984-1996)
Ferreira, M. U., Ferreira, C. D. S., & Monteiro, C. A. (2000) · Revista de Saúde Pública · doi:10.1590/s0034-89102000000700010 · Cited by 97 · see citing works
The relative merits of faecal and duodenal juice microscopy in the diagnosis of giardiasis
Goka, A. K. J., Rolston, D. D. K., Mathan, V. I., et al. (1990) · Transactions of the Royal Society of Tropical Medicine and Hygiene · doi:10.1016/0035-9203(90)90386-s · Cited by 90 · see citing works
Lactose intolerance revealed by severe resistance to treatment with levothyroxine
Muñoz-Torres, M., Varsavsky, M., & Alonso, G. (2006) · Thyroid · doi:10.1089/thy.2006.16.1171 · Cited by 54 · see citing works
Ward, L. S. (2010) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302010000500002 · Cited by 53 · see citing works
Pereira, M. D. G. C., Atwill, E. R., & Barbosa, A. P. (2007) · Revista do Instituto de Medicina Tropical de São Paulo · doi:10.1590/s0036-46652007000300002 · Cited by 50 · see citing works
Seppel, T., Rose, F., & Schlaghecke, R. (2009) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/s-0029-1211442 · Cited by 30 · see citing works
Estudo de adesão ao tratamento do hipotiroidismo
Bagattoli, R. M., Vaisman, M., Lima, J. S., & Ward, L. S. (2000) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302000000600006 · Cited by 25 · see citing works
Interference with the absorption of levothyroxine
Singh, N. K., & Hershman, J. M. (2003) · Current Opinion in Endocrinology & Diabetes · doi:10.1097/00060793-200310000-00008 · Cited by 15 · see citing works
Suzuki, Y., Takeshita, E., Kano, S., Hirata, S., & Sato, S. (1982) · Folia Endocrinologica Japonica · doi:10.1507/endocrine1927.58.12_1487 · Cited by 14 · see citing works
Pseudomalabsorção de levotiroxina: relato de um caso
Pedrosa, W., & Santana, G. (2005) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302005000200020 · Cited by 6 · see citing works
[Malabsorption syndrome and intestinal parasitosis].
Aubry, P. (1984) · PubMed · Cited by 2 · see citing works
Giardíase: considerações práticas
Castro, H. C. (2001) · DOAJ (DOAJ: Directory of Open Access Journals) · doi:10.32385/rpmgf.v17i1.9823 · Cited by 1 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Ain KB, Refetoff S, Fein HG, Weintraub BD. Pseudomalabsortion of levothyroxine. JAMA. 1991;266:2118-20.
- Buret AG. Pathophysiology of enteric infections with Giardia duo- denalis. Parasite. 2008;15:261-5.
Cited by
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Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., Cooper, D. S., Kim, B. W., Peeters, R. P., Rosenthal, M. S., et al. (2014) · Thyroid® · doi:10.1089/thy.2014.0028 · Cited by 1,928 · see citing works
Gastrointestinal malabsorption of thyroxine
Virili, C., Antonelli, A., Santaguida, M. G., Benvenga, S., & Centanni, M. (2019) · Endocrine Reviews · doi:10.1210/er.2018-00168 · Cited by 164 · see citing works
Factors Affecting Gastrointestinal Absorption of Levothyroxine: A Review
Skelin, M., Lucijanić, T., Amidžić Klarić, D., Rešić, A., Bakula, M., Liberati-Čizmek, A.-M., Gharib, H., & Rahelić, D. (2017) · Clinical Therapeutics · doi:10.1016/j.clinthera.2017.01.005 · Cited by 133 · see citing works
When thyroid hormone replacement is ineffective?
Benvenga, S. (2013) · Current Opinion in Endocrinology, Diabetes & Obesity · doi:10.1097/med.0000000000000003 · Cited by 74 · see citing works
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
Tortora, A., La Sala, D., & Vitale, M. (2019) · Endocrinology, Diabetes & Metabolism Case Reports · doi:10.1530/edm-19-0026 · Cited by 13 · see citing works
- Authors
- Radaeli, R. D. F., & Diehl, L. A.
- Affiliations
- Universidade Estadual de Londrina (BR)
- Venue
- Arquivos Brasileiros de Endocrinologia & Metabologia
- Publisher
- FapUNIFESP (SciELO)
- Published
- 2011-02
- Volume
- 55
- Issue
- 1
- Pages
- 81-84
- ISSN
- 0004-2730 (ISSN-L)
- OpenAlex
- W1966501641
- Cited by
- 17
- References
- 17
- Citations by year
- 2024: 1 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 1 · 2017: 2 · 2016: 2 · 2014: 2 · 2013: 3 · 2012: 2
- FWCI
- 1.83
- 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, cc-by-nc)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- hypothyroidism, levothyroxine, giardiasis, drug bioavailability, medication non-adherence, thyroid hormone replacement, abdominal symptoms
- MeSH terms
- Female, Giardiasis, Humans, Hypothyroidism, Intestinal Absorption, Malabsorption Syndromes, Middle Aged, Thyroxine, Treatment Failure, Medication Adherence
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