A case of H. pylori infection presenting as refractory hypothyroidism
Open accessAbstract
We present the case of a 45-year-old lady with long standing hypothyroidism who was euthyroid on replacement for many years, but stopped responding even to supraphysiological doses of LT4 since the last five years. She complained of abdominal discomfort, bloating, and nausea. She did not have diarrhea or weight loss. Levothyroxine absorption test was done which was suggestive of malabsorption and she was started on triple therapy for H. pylori eradication after confirmation of diagnosis. After 10 days of treatment initiation, she developed symptoms of thyrotoxicosis with her supraphysiological dose of LT4, which was then tapered to a lower dose. Euthyroid state was ultimately achieved with lower doses of LT4 replacement.
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Elevated pH due to H. pylori infection, autoimmune gastritis, and proton pump inhibitors antagonizes subsequent LT4 absorption.
“Several studies have demonstrated that an elevated pH due to Heliobacter pylori infection, autoimmune gastritis, and proton pump inhibitors (PPIs) antagonize the subsequent absorption (11–13).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [12]
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 [12]
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Cites
A review of the pharmacokinetics of levothyroxine for the treatment of hypothyroidism
Colucci, P., Yue, C. S., Ducharme, M., Benvenga, S., Principal Scientist, L. A. C. I., Principal Scientist, L. A. C. I. A. P. C., President and CEO, L. A. C. I., & Professor of Medicine, D. (2010) · European Endocrinology · doi:10.17925/ee.2013.09.01.40 · Cited by 167 · 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
Diagnosis and management of treatment-refractory hypothyroidism: an expert consensus report
Centanni, M., Benvenga, S., & Sachmechi, I. (2017) · Journal of Endocrinological Investigation · doi:10.1007/s40618-017-0706-y · Cited by 113 · cited 1× · see citing works
“[4] In this situation after ensuring adequate adherence to therapy, factors interfering with drug absorption and/ or increased drug metabolism should be sought.[5] H.”
BackgroundHuman Thyroxine Absorption: Age Effects and Methodological Analyses
HAYS, M. T., & NIELSEN, K. R. K. (1994) · Thyroid · doi:10.1089/thy.1994.4.55 · Cited by 67 · see citing works
Bugdaci, M. S., Zuhur, S. S., Sokmen, M., Toksoy, B., Albayrak, B., & Altuntas, Y. (2011) · Helicobacter · doi:10.1111/j.1523-5378.2011.00830.x · Cited by 41 · see citing works
Treatment-refractory hypothyroidism
McNally, L. J., Ofiaeli, C. I., & Oyibo, S. O. (2019) · BMJ · doi:10.1136/bmj.l579 · Cited by 5 · see citing works
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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
Medications and Food Interfering with the Bioavailability of Levothyroxine: A Systematic Review
Liu, H., Lu, M., Hu, J., Fu, G., Feng, Q., Sun, S., & Chen, C. (2023) · Therapeutics and Clinical Risk Management · doi:10.2147/tcrm.s414460 · Cited by 29 · see citing works
- Authors
- Gupta, P., Johnson, J. T., Soumya, S. L., Cherian, K. E., Kapoor, N., & Paul, T. V.
- Affiliations
- Christian Medical College, Vellore (IN)
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
- Corresponding author
- Cherian, Kripa Elizabeth
- Venue
- Journal of Family Medicine and Primary Care
- Published
- 2020-07
- Volume
- 9
- Issue
- 7
- Pages
- 3770-3772
- ISSN
- 2249-4863 (ISSN-L)
- 2278-7135
- PMC
- PMC7567260
- OpenAlex
- W3044560225
- Cited by
- 6
- References
- 6
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1 · 2022: 2 · 2021: 1
- FWCI
- 0.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Family Medicine and Primary Care (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Helicobacter pylori-related gastroenterology studies
- Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
- Keywords
- Helicobacter pylori infection, refractory hypothyroidism, thyrotoxicosis, triple therapy, euthyroidism
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