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Cited by 10Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryAdrenal Hormones and Disorders

Levothyroxine sodium oral solution normalizes thyroid function in a patient with Hashimoto's disease, gastritis, diabetic gastroparesis, and small intestinal bacterial overgrowth (SIBO)

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Bohinc Henderson, Brittany·2021·International Medical Case Reports Journal
DOI 10.2147/imcrj.s326481PMC PMC8453642
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Abstract

Background: Levothyroxine (L-T4) is used as a standard-of-care treatment in patients with hypothyroidism. L-T4 is absorbed throughout the small intestine, and consistent drug absorption is required for successful treatment. Patients with Hashimoto’s disease (autoimmune thyroiditis) often have food and medication sensitivities, as well as comorbid gastrointestinal (GI) disorders detrimental to L-T4 absorption. Case Presentation: This case report describes a 51-year-old female patient with long-standing Hashimoto’s disease and multiple sensitivities to food chemicals and medications. The patient suffered from GI symptoms and poor thyroid-stimulating hormone (TSH) control. She was switched to compounded thyroxine/triiodothyronine medication due to her multiple allergies, with only mild improvement in thyroid function and no symptom resolution. She was subsequently diagnosed with gastroparesis and small intestinal bacterial overgrowth (SIBO). Because of further worsening of her GI symptoms and weight loss, she was switched to levothyroxine sodium oral solution (Tirosint ® -SOL), which contains only three ingredients—levothyroxine, water, and glycerol—which was well tolerated and led to normalization of TSH levels. Conclusion: Malabsorption of L-T4 is often seen in patients with Hashimoto’s disease-related hypothyroidism and comorbid GI conditions, such as gastroparesis and SIBO. L-T4 tablets and a compounded oral suspension were inefficiently absorbed, leading to suboptimal TSH control. Switching to levothyroxine sodium oral solution resulted in sustained TSH control with subsequent resolution of symptoms. No side effects or reactions to the medication were observed, despite the patient’s multiple allergies and sensitivities to food chemicals and medications. Keywords: levothyroxine malabsorption, small intestinal bacterial overgrowth, hypothyroidism, Hashimoto’s disease, levothyroxine sodium oral solution, L-T4 oral solution, gastroparesis

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  • A medication-related association exists between SIBO and thyroid.

    “A case study highlights the medication-related association between SIBO and thyroid showing the usefulness of targeting this linkage as therapeutic opportunity although no clinical trials have been carried out to this regard (Bohinc Henderson, 2021).”

    From Thyroid disorders and gastrointestinal dysmotility: an old association (2024) · cites this paper as Bohinc Henderson, 2021

    The Discussion describes an association between SIBO and hypothyroidism and explains that SIBO may impair absorption of levothyroxine. The Conclusion reports improved thyroid control after switching this patient to an oral levothyroxine solution, supporting a medication-related therapeutic opportunity. The paper does not establish the citing sentence’s additional claim that no clinical trials have been conducted. (LLM, conf=0.86)

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  • In a patient with SIBO, optimal TSH balance was not achieved with multiple medication changes over 6 months, but symptoms resolved and euthyroidism was achieved after treatment with rifaximin for SIBO plus liquid T4.

    “The patient in question could not achieve optimal TSH balance even after multiple medication changes over a 6-month duration.”

    From Thyroid disorders and gastrointestinal dysmotility: an old association (2024) · cites this paper as Bohinc Henderson, 2021

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Research works printed but not linked: 16

  1. [1]Fallahi P, Ferrari SM, Ruffilli I, et al. Advancements in the treatment of hypothyroidism with L-T4 liquid formulation or soft gel capsule: an update. Expert Opin Drug Deliv. 2017; 14(5): 647– 655. doi: 10.1080/17425247.2016.1227782 27552635 · DOI
  2. [2]Nagy EV, Perros P, Papini E, Katko M, Hegedus L. New formulations of levothyroxine in the treatment of hypothyroidism: trick or treat? Thyroid. 2021; 31(2): 193– 201. doi: 10.1089/thy.2020.0515 33003978 · DOI
  3. [4]Fass R, McCallum RW, Parkman HP. Treatment challenges in the management of gastroparesis-related GERD. Gastroenterol Hepatol (N Y). 2009; 5(10): 4– 16. 37967396 PMC2886367
  4. [5]Brechmann T, Sperlbaum A, Schmiegel W. Levothyroxine therapy and impaired clearance are the strongest contributors to small intestinal bacterial overgrowth: results of a retrospective cohort study. World J Gastroenterol. 2017; 23(5): 842– 852. doi: 10.3748/wjg.v23.i5.842 28223728 PMC5296200 · DOI
  5. [7]Abbott RD, Sadowski A, Alt AG. Efficacy of the autoimmune protocol diet as part of a multi-disciplinary, supported lifestyle intervention for Hashimoto’s thyroiditis. Cureus. 2019; 11(4): e4556. 31275780 PMC6592837
  6. [8]Burek CL, Talor MV. Environmental triggers of autoimmune thyroiditis. J Autoimmun. 2009; 33(3–4): 183– 189. doi: 10.1016/j.jaut.2009.09.001 19818584 PMC2790188 · DOI
  7. [9]Clarke JO. SIBO in gastroparesis: sci-fi or science fact? Dig Dis Sci. 2014; 59(3): 510– 512. doi: 10.1007/s10620-013-3011-4 24435184 · DOI
  8. [11]Lauritano EC, Bilotta AL, Gabrielli M, et al. Association between hypothyroidism and small intestinal bacterial overgrowth. J Clin Endocrinol Metab. 2007; 92(11): 4180– 4184. doi: 10.1210/jc.2007-0606 17698907 · DOI · Paper page
  9. [12]Patil AD. Link between hypothyroidism and small intestinal bacterial overgrowth. Indian J Endocrinol Metab. 2014; 18(3): 307– 309. doi: 10.4103/2230-8210.131155 24944923 PMC4056127 · DOI
  10. [13]Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017; 390(10101): 1550– 1562. doi: 10.1016/S0140-6736(17)30703-1 28336049 PMC6619426 · DOI · Paper page
  11. [16]McMillan M, Rotenberg KS, Vora K, et al. Comorbidities, concomitant medications, and diet as factors affecting levothyroxine therapy: results of the CONTROL surveillance project. Drugs R D. 2016; 16(1): 53– 68. doi: 10.1007/s40268-015-0116-6 26689565 PMC4767717 · DOI · Paper page
  12. [17]Ruchala M, Szczepanek-Parulska E, Zybek A. The influence of lactose intolerance and other gastro-intestinal tract disorders on L-thyroxine absorption. Endokrynol Pol. 2012; 63(4): 318– 323. 22933169
  13. [18]Reardon DP, Yoo PS. Levothyroxine tablet malabsorption associated with gastroparesis corrected with gelatin capsule formulation. Case Rep Endocrinol. 2016; 2016: 1316724. 27293919 PMC4884855
  14. [19]Virili C, Giovanella L, Fallahi P, et al. Levothyroxine therapy: changes of TSH levels by switching patients from tablet to liquid formulation. A systematic review and meta-analysis. Front Endocrinol (Lausanne). 2018; 9: 10. doi: 10.3389/fendo.2018.00010 29434573 PMC5790785 · DOI · Paper page
  15. [20]Virili C, Trimboli P, Centanni M. Novel thyroxine formulations: a further step toward precision medicine. Endocrine. 2019; 66(1): 87– 94. doi: 10.1007/s12020-019-02049-x 31617168 · DOI · Paper page
  16. [22]Yue CS, Scarsi C, Ducharme MP. Pharmacokinetics and potential advantages of a new oral solution of levothyroxine vs. other available dosage forms. Arzneimittelforschung. 2012; 62(12): 631– 636. doi: 10.1055/s-0032-1329951 23154888 · DOI

Cited by

Sorted by citations

Authors
Bohinc Henderson, B.
Venue
International Medical Case Reports Journal
Publisher
Informa UK Limited
Published
2021-09
Volume
Volume 14
Pages
627-632
ISSN
1179-142X (ISSN-L)
DOI
10.2147/imcrj.s326481
PMC
PMC8453642
OpenAlex
W3201215180
Cited by
10
References
4
Citations by year
2026: 1 · 2024: 3 · 2023: 2 · 2022: 4
FWCI
1.68
Type
journal article
Language
en
Open access
Licence
Locations
  • International Medical Case Reports Journal (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
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
Hashimoto's thyroiditis, hypothyroidism, small intestinal bacterial overgrowth, diabetic gastroparesis, drug hypersensitivity, thyroid function normalization

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