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Cited by 112Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryPituitary Gland Disorders and Treatments

Effect of Proton Pump Inhibitors on Serum Thyroid-Stimulating Hormone Level in Euthyroid Patients Treated with Levothyroxine for Hypothyroidism

Sachmechi, Issac, Reich, David M., Aninyei, Michael, Wibowo, Francisca, Gupta, Garima, Kim, Paul J.·2007·Endocrine Practice
DOI 10.4158/ep.13.4.345
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Abstract

Objective To examine retrospectively the effect of proton pump inhibitors (PPIs) on thyrotropin (thyroid-stimulating hormone or TSH) values in patients with hypothyroidism and normal TSH levels receiving levothyroxine (LT4) replacement therapy.Methods The data collection was done by retrospective review of electronic medical records from the period of December 2002 to August 2005 from patients with hypothyroidism who were receiving at least 25 mug of LT4 replacement daily at Queens Hospital Center. The first 92 patients meeting all inclusion and exclusion criteria were included in the study. The study group (N = 37) patient data were collected by selecting euthyroid patients who had received stable LT4 replacement for at least 6 months and in whom PPI therapy (lansoprazole) was later initiated. TSH levels were collected before and at least 2 months after the PPI treatment was started. The control group (N = 55) patient data were collected by reviewing TSH levels among euthyroid patients with a history of hypothyroidism receiving stable LT4 therapy and not receiving a PPI during the period of data collection. The statistical analysis was done by comparing the mean change in TSH level in each group with use of the Student t test.Results In the study group, the mean change in the TSH level from before to at least 2 months after initiation of PPI therapy, 0.69 +/- 1.9 micro IU/mL, was statistically significant (P = 0.035). In the control group, the mean change in the TSH level during the study period, 0.11 +/- 1.06 micro IU/mL, was not statistically significant (P = 0.45).Conclusion To our best knowledge, this is the first study in humans with hypothyroidism demonstrating the effect of PPIs on serum TSH levels. PPIs should be added to the list of medications affecting the level of thyroid hormone in patients with hypothyroidism treated with LT4 replacement. Patients with hypothyroidism and normal TSH values during LT4 replacement therapy may need additional thyroid function testing after treatment with PPIs and may need adjustment of their LT4 dose.

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  • The list of medications that can alter the absorption of LT4 is extensive and includes calcium carbonate, PPIs, bile acid sequestrants (cholestyramine and colesevelam), phosphate binders, ferrous sulfate, aluminum-containing antacids, and sucralfate.

    “The list of medications that can alter the absorption of LT4 is extensive and includes calcium carbonate (132-134), PPIs (135), bile acid sequestrants (cholestyramine and colesevelam) (136,137), phosphate binders (138,139), ferrous sulfate (140,141), aluminum-containing antacids (142,143), and sucralfate (144,145).”

    From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [135]

  • In a retrospective analysis, initiation of therapy with a PPI was associated with an increase in serum TSH values of LT4-treated patients, compared with a control group in whom such therapy was not initiated (135).

    “In a retrospective analysis, initiation of therapy with a PPI was associated with an increase in the serum TSH values of LT4-treated patients, compared with a control group in whom such therapy was not initiated (135).”

    From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [135]

  • In 37 primary hypothyroidism patients under stable L-T4 replacement who subsequently received proton-pump inhibitors, TSH increased by 28%, with seven patients (19%) having post-PPI TSH >5 mU/L; a mean increase of 20 μg/d L-T4 (+35%) was necessary.

    “Confirming previous data (45), in 37 PH patients under stable L-T4 replacement and in whom PPIs were administered subsequently, TSH increased by 28%, with seven patients (19%) having post-PPI TSH levels >5 mU/L (46). A mean increase of 20 μg/d L-T4 (+35%) was necessary (46).”

    From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [46]

  • There is a large body of evidence that PPIs are prominent interfering substances that raise TSH levels and/or LT4 dose requirement.

    “There is a large body of evidence (from general practice patient databases, electronic medical record reviews, and clinical trials) to indicate that PPIs are prominent interfering substances that raise TSH levels and/or the LT4 dose requirement [ 63 , 72 , 73 ].”

    From Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults (2022) · cites this paper as [72]

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Authors
Sachmechi, I., Reich, D. M., Aninyei, M., Wibowo, F., Gupta, G., & Kim, P. J.
Affiliations
Queens Hospital Center (US)
Corresponding author
Kim, Paul J.
ORCID
Venue
Endocrine Practice
Publisher
Elsevier BV
Published
2007-07
Volume
13
Issue
4
Pages
345-349
ISSN
1530-891X (ISSN-L)
DOI
10.4158/ep.13.4.345
OpenAlex
W1986528632
Cited by
112
References
14
Citations by year
2026: 3 · 2025: 6 · 2024: 5 · 2023: 7 · 2022: 8 · 2021: 10 · 2020: 6 · 2019: 3 · 2018: 6 · 2017: 10 · 2016: 5 · 2015: 7 · 2014: 12 · 2013: 3 · 2012: 6
FWCI
3.17
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Endocrine Practice (publishedVersion)
  • PubMed (publishedVersion)
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 › Pituitary Gland Disorders and Treatments
Keywords
proton pump inhibitors, thyroid-stimulating hormone, levothyroxine, hypothyroidism, lansoprazole, drug interactions, thyroid function tests, euthyroid patients, levothyroxine dose adjustment
MeSH terms
Aged, Drug Interactions, Enzyme Inhibitors, Female, Humans, Hypothyroidism, Male, Middle Aged, Retrospective Studies, Thyrotropin, Thyroxine, 2-Pyridinylmethylsulfinylbenzimidazoles, Proton Pump Inhibitors, Lansoprazole

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