Adequate timing and constant supervision are the keys for successful implementation of levothyroxine or levothyroxine/paracetamol absorption test
Abstract Background Levothyroxine (LT4) pseudomalabsorption due to medication non-adherence results in significant costs for Health Service. High dose LT4 or LT4/paracetamol absorption test is used in such cases. Hence, establishment of an optimal test protocol and timing of sample collection is of...
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| Format: | Article |
| Language: | English |
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BMC
2020-05-01
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| Series: | Thyroid Research |
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| Online Access: | http://link.springer.com/article/10.1186/s13044-020-00079-6 |
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| author | Krzysztof C. Lewandowski Katarzyna Dąbrowska Magdalena Basińska-Lewandowska Marek Bolanowski Marek Ruchała Andrzej Lewiński |
| author_facet | Krzysztof C. Lewandowski Katarzyna Dąbrowska Magdalena Basińska-Lewandowska Marek Bolanowski Marek Ruchała Andrzej Lewiński |
| author_sort | Krzysztof C. Lewandowski |
| collection | DOAJ |
| description | Abstract Background Levothyroxine (LT4) pseudomalabsorption due to medication non-adherence results in significant costs for Health Service. High dose LT4 or LT4/paracetamol absorption test is used in such cases. Hence, establishment of an optimal test protocol and timing of sample collection is of utmost importance. Case presentation A 34-year old woman was admitted to our Department because of severe hypothyroidism [on admission thyrotropin (TSH) > 100 μIU/ml, free thyroxine (FT4) 0.13 ng/dl (ref. range 0.93–1.7)] despite apparently taking 1000 μg of LT4 a day. Autoimmune hypothyroidism had been diagnosed 4 years before during post-partum thyroiditis. Subsequently, it was not possible to control her hypothyroidism despite several admissions to two University Hospitals and despite vehement denial of compliance problems. There was no evidence of coeliac disease or other malabsorption problems, though gluten-free and lactose-free diet was empirically instigated without success. A combined paracetamol (1000 mg)/LT4 (1000 μg) absorption test was performed in one of these Hospitals. This showed good paracetamol absorption (from < 2 μg/ml to 14.11 μg/ml at 120 min), with inadequate LT4 absorption (FT4 increase from 5.95 pmol/l to 9.92 pmol/l at 0 and 120 min respectively). About 2 years prior to admission to our Department the patient was treated with escalating doses of levothyroxine [up to 3000 μg of T4 and 40 μg of triiodothyronine (T3) daily] without significant impact on TSH (still > 75 μIU/ml, and FT4 still below reference range). After admission to our Department we performed a 2500 μg LT4 absorption test with controlled ingestion of crushed tablets, strict patient monitoring and sampling at 30 min intervals. We observed a quick and striking increase in FT4 from 0.13 to 0.46, 1.78, 3.05 and 3.81 ng/dl, at 0, 30, 60, 90 and 120 min, respectively. Her TSH concentration decreased to 13.77 μIU/ml within 4 days. When informed, that we had managed to “overcome” her absorption problems, she discharged herself against medical advice and declined psychiatric consultation. Conclusions Adequate patient supervision and frequent sampling (e.g. every 30 min for 210 min) is the key for successful implementation of LT4 absorption test. Paracetamol coadministration appears superfluous in such cases. |
| first_indexed | 2024-12-10T18:55:22Z |
| format | Article |
| id | doaj.art-865dc833465d46f1b17c1060deb34d27 |
| institution | Directory Open Access Journal |
| issn | 1756-6614 |
| language | English |
| last_indexed | 2024-12-10T18:55:22Z |
| publishDate | 2020-05-01 |
| publisher | BMC |
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| series | Thyroid Research |
| spelling | doaj.art-865dc833465d46f1b17c1060deb34d272022-12-22T01:37:10ZengBMCThyroid Research1756-66142020-05-011311710.1186/s13044-020-00079-6Adequate timing and constant supervision are the keys for successful implementation of levothyroxine or levothyroxine/paracetamol absorption testKrzysztof C. Lewandowski0Katarzyna Dąbrowska1Magdalena Basińska-Lewandowska2Marek Bolanowski3Marek Ruchała4Andrzej Lewiński5Department of Endocrinology and Metabolic Diseases, Medical University of LodzDepartment of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital - Research InstituteDepartment of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital - Research InstituteDepartment of Endocrinology, Diabetes and Isotope Therapy, Medical University of WroclawDepartment of Endocrinology and Metabolic Diseases, Medical University of PoznanDepartment of Endocrinology and Metabolic Diseases, Medical University of LodzAbstract Background Levothyroxine (LT4) pseudomalabsorption due to medication non-adherence results in significant costs for Health Service. High dose LT4 or LT4/paracetamol absorption test is used in such cases. Hence, establishment of an optimal test protocol and timing of sample collection is of utmost importance. Case presentation A 34-year old woman was admitted to our Department because of severe hypothyroidism [on admission thyrotropin (TSH) > 100 μIU/ml, free thyroxine (FT4) 0.13 ng/dl (ref. range 0.93–1.7)] despite apparently taking 1000 μg of LT4 a day. Autoimmune hypothyroidism had been diagnosed 4 years before during post-partum thyroiditis. Subsequently, it was not possible to control her hypothyroidism despite several admissions to two University Hospitals and despite vehement denial of compliance problems. There was no evidence of coeliac disease or other malabsorption problems, though gluten-free and lactose-free diet was empirically instigated without success. A combined paracetamol (1000 mg)/LT4 (1000 μg) absorption test was performed in one of these Hospitals. This showed good paracetamol absorption (from < 2 μg/ml to 14.11 μg/ml at 120 min), with inadequate LT4 absorption (FT4 increase from 5.95 pmol/l to 9.92 pmol/l at 0 and 120 min respectively). About 2 years prior to admission to our Department the patient was treated with escalating doses of levothyroxine [up to 3000 μg of T4 and 40 μg of triiodothyronine (T3) daily] without significant impact on TSH (still > 75 μIU/ml, and FT4 still below reference range). After admission to our Department we performed a 2500 μg LT4 absorption test with controlled ingestion of crushed tablets, strict patient monitoring and sampling at 30 min intervals. We observed a quick and striking increase in FT4 from 0.13 to 0.46, 1.78, 3.05 and 3.81 ng/dl, at 0, 30, 60, 90 and 120 min, respectively. Her TSH concentration decreased to 13.77 μIU/ml within 4 days. When informed, that we had managed to “overcome” her absorption problems, she discharged herself against medical advice and declined psychiatric consultation. Conclusions Adequate patient supervision and frequent sampling (e.g. every 30 min for 210 min) is the key for successful implementation of LT4 absorption test. Paracetamol coadministration appears superfluous in such cases.http://link.springer.com/article/10.1186/s13044-020-00079-6LevothyroxineParacetamolAcetaminophenAbsorption testPseudomalabsorptionNon-adherence |
| spellingShingle | Krzysztof C. Lewandowski Katarzyna Dąbrowska Magdalena Basińska-Lewandowska Marek Bolanowski Marek Ruchała Andrzej Lewiński Adequate timing and constant supervision are the keys for successful implementation of levothyroxine or levothyroxine/paracetamol absorption test Thyroid Research Levothyroxine Paracetamol Acetaminophen Absorption test Pseudomalabsorption Non-adherence |
| title | Adequate timing and constant supervision are the keys for successful implementation of levothyroxine or levothyroxine/paracetamol absorption test |
| title_full | Adequate timing and constant supervision are the keys for successful implementation of levothyroxine or levothyroxine/paracetamol absorption test |
| title_fullStr | Adequate timing and constant supervision are the keys for successful implementation of levothyroxine or levothyroxine/paracetamol absorption test |
| title_full_unstemmed | Adequate timing and constant supervision are the keys for successful implementation of levothyroxine or levothyroxine/paracetamol absorption test |
| title_short | Adequate timing and constant supervision are the keys for successful implementation of levothyroxine or levothyroxine/paracetamol absorption test |
| title_sort | adequate timing and constant supervision are the keys for successful implementation of levothyroxine or levothyroxine paracetamol absorption test |
| topic | Levothyroxine Paracetamol Acetaminophen Absorption test Pseudomalabsorption Non-adherence |
| url | http://link.springer.com/article/10.1186/s13044-020-00079-6 |
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