American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: https://www.sciepub.com/journal/ajmcr Editor-in-chief: Apply for this position
Open Access
Journal Browser
Go
American Journal of Medical Case Reports. 2014, 2(11), 253-255
DOI: 10.12691/ajmcr-2-11-8
Open AccessCase Report

Clinical Application of the Levothyroxine Absorption Test in the Diagnosis of Pseudo-Malabsorption

Muhammad Imran Butt1, Nidhi Gupta1, Hiang Leng Tan2, and Najeeb Waheed3

1Department of Diabetes and Endocrinology, Peterborough City Hospital, Peterborough, UK

2Department of Diabetes and Endocrinology, Weston General Hospital, Weston-super-Mare, UK

3Department of Diabetes and Endocrinology, Hereford County Hospital, Hereford, UK

Pub. Date: November 11, 2014

Cite this paper:
Muhammad Imran Butt, Nidhi Gupta, Hiang Leng Tan and Najeeb Waheed. Clinical Application of the Levothyroxine Absorption Test in the Diagnosis of Pseudo-Malabsorption. American Journal of Medical Case Reports. 2014; 2(11):253-255. doi: 10.12691/ajmcr-2-11-8

Abstract

We present a variation and clinical application of the Levothyroxine Absorption Test (LAT) in the identification of pseudo-malabsorption of levothyroxine in uncontrolled hypothyroidism, for which there is no current gold standard protocol, and a variety of methods proposed in the literature. The LAT was conducted over 5-days with thyroid function tests conducted pre-LAT, then at day 1 and 5. The thyroid stimulating hormone levels became completely suppressed indicating that there had been previous non-compliance with medication.

Keywords:
levothyroxine absorption test non-compliance pseudo-malabsorption

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Roti E, Minelli R, Gardini E, Braverman LE. The use and misuse of Thyroid Hormone. Endocr Rev 1993; 14: 401-23.
 
[2]  Baron DN. Hypothyroidism; its aetiology and relation to hypometabolism, hypercholesterolaemia, and increase in body-weight. Lancet 1956; 271: 277-81.
 
[3]  Molsey R, Swinbourne J & Orme S. Endocrine Abstracts 2007; 13: P298.
 
[4]  Deiana L, Marini S, Mariotti S. Ingestion of large amounts of papaya fruit and impaired effectiveness of levothyroxine therapy. Endocr Pract 2012; 18: 98-100.
 
[5]  Liel Y, Harman-Boehm I, Shany S. Evidence for a clinically important adverse effect of fiber-enriched diet on the bioavailability of levothyroxine in adult hypothyroid patients. J Clin Endocrinol Metab 1996; 81: 857-859.
 
[6]  John-Kalarickal, J., Pearlman, G. & Carlson, H.E. (2007) New medications which decrease levothyroxine absorption. Thyroid, 17, 763-765.
 
[7]  Diagnosis and treatment of Levothroxine Malabsorption. The Netherlands Journal of Medicine 2004; 62 (4) 114-118.
 
[8]  Elmahi E, Vas P & Oyibo S. Levothyroxine absorption testing: a 5-day (suual dose) test as an alternative to the 1-day (100 g) test. Endocrine Abstracts 2013; 31: P372.
 
[9]  Walker JN, Shillo P, Ibbotson V, Vincent A, Karavitaki N, Weetman AP, Wass JA & Allahabadia A. A thyroxine absorption test followed by weekly thyroxine administration: a method to assess non-adherence to treatment. Eur J endocrinol 2013; 168 (6): 913-917.
 
[10]  Ain KB, Refetoff S, Fein HG, Weintraub BD. Pseudomalabsorption of levothyroxine. JAMA 1991; 266: 2118-20.