Therapy Resistant Hypothyroidism

Year 2018, Volume: 18 Issue: 2, 235 - 241, 25.06.2018

Oya Topaloğlu , Bekir Çakır

https://doi.org/10.17098/amj.435289

Abstract

Hypothyroidism is a common problem in
the population. Standard therapy for hypothyroidism is the replacement with
synthetic L-thyroxine (L-T4) sodium preparations. The target of the treatment is
to maintain TSH levels between normal reference values. Detection of the
underlying reason can be difficult in patients with higher L-T4 dose
requirement than expected. In these patients, primarily non-adherence to the
therapy should be remembered and then, whether there is an underlying reason or
not should be investigated. 

Keywords

Hypothyroidism, therapy, resistant

Tedaviye Dirençli Hipotiroidi

Abstract

Hipotiroidi toplumda sık görülen bir
problemdir. Hipotiroidinin standart tedavisi sentetik L-tiroksin (L-T4) sodyum
preparatları ile replasmandır. Tedavide hedef TSH’yı normal referans değerleri
arasında tutmaktır. Beklenen dozların üzerinde L-T4 gereksinimi olan hastalarda
altta yatan nedeni tespit etmek zor olabilir. Bu hastalarda öncelikli olarak
ilaç alımında uyumsuzluk düşünülmeli ve sonra da altta yatan biyolojik bir
neden olup olmadığı da araştırılmalıdır.

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Keywords

Hipotiroidi, tedavi, dirençli

References

• 1. Jonklaas J, Bianco AC, Bauer AJ et al. Guidelines for the treatment of hypothyroidism. Thyroid 2014;24(12):1670-751.
• 2. Türkiye Endokrinoloji ve Metabolizma Derneği, Tiroid Hastalıkları Tanı ve Tedavi Kılavuzu, Ankara: Ortadoğu Reklam Tanıtım Yayıncılık; 2017.
• 3. Read DG, Hays MT, Hershman JM. Absorption of oral thyroxine in hypothyroid and normal man. J Clin Endocrinol Metab 1970;30:798-9.
• 4. Centanni M, Benvenga S, Sachmechi I. Diagnosis and management of treatment refractory hypothyroidism: an expert consensus report. J Endocrinol Invest 2017;40:1289-301.
• 5. Vaisman F, Coeli CM, Ward LS et al. How good is the levothyroxine replacement in primary hypothyroidism patients in Brasil? Data of a multicentre study. J Endocrinol Invest 2013;36:485-8. 6. Morris LS, Schulz RM. Medication compliance: the patient’s perspective. Clin Therapeutics 1993;15:593-606.
• 7. Lips DJ, van Reisen MT, Voigt V, Venekamp W. Diagnosis and treatment of levothyroxine pseudomalabsorption. Netherlands J Med 2004;62:114-8.
• 8. Grebe SK, Cooke RR, Ford HC et al. Treatment of hypothyroidism with once weekly thyroxine. J Clin Endocrinol Metab 1997;82(3):870-5.
• 9. Garber JR, Cobin RH, Gharib H et al. Clinical Practice Guidelines for hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012;22:1200-35.
• 10. Mc Dermott JH, Coss A, Walsh JH. Case History: Celiac disease presenting as resistant hypothyroidism. Thyroid 2005;15(4):386-8.
• 11. Virili C, Bassotti G, Santaguida MG et al. Atypical celiac disease as cause of increased need for thyroxine: A systematic study. J Clin Endocrinol Metab 2012;97(3):419-22.
• 12. Zubarik R, Ganguly E, Nathan M, Vecchio J. Celiac disease detection in hypothyroid patients requiring elevated thyroid supplementation: A prospective cohort study. Eur J Intern Med 2015; 26(10): 825-9.
• 13. Cellini M, Santaguida MG, Gatto I et al. Systemic appraisal of lactose intolerance as cause of increased need for oral thyroxine. J Clin Endocrinol Metab 2014;99(8):1454-8.
• 14. Asik M, Gunes F, Binnetoglu E et al. Decrease in TSH levels after lactose restriction in Hashimoto’s thyroiditis patients with lactose intolerance. Endocrine 2014;46:279-84.
• 15. Centanni M, Gargano L, Canettieri G et al. Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis. N Engl J Med 2006;354:1787-95.
• 16. Benvenga S, Papi G, Antonelli A. Refractory hypothyroidism due to improper storage of levothyroxine tablets. Front Endocrinol 2017;8:155.
• 17. U.S. Food and Drug Administration 2008 Tirosint (Levothyroxine Sodium) Capsules. Available at: www.accessdata.fda.gov/drugsatfda_docs/nda/2006/021924s000TOC.cfm, Access date: August 19, 2012.
• 18. Vita R, Saraceno S, Trimarchi F, Benvenga S. Switching Levothyroxine from the tablet to the oral solution formulation corrects the impaired absorption of levothyroxine induced by proton-pump inhibitors. J Clin Endocrinol Metab 2014;99(12):4481-6.
• 19. Benvenga S, Di Bari F, Vita R. Undertreated hypothyroidism due to calcium or iron supplementation corrected by oral liquid levothyroxine. Endocrine 2017;56:138-45.
• 20. Virili C, Giovanella L, Fallahi P, Antonelli A, Santaguida MG, Centanni M, et al. Levothyroxine therapy: Changes of TSH levels by switching patients from tablet to liquid formulation. A systematic review and meta-analysis. Front Endocrinol 2017;9:10.
• 21. Brancato D, Scorsone A, Saura G, Ferrara L, Di Noto A, Aiello V, et al. Comparison of TSH levels with liquid formulation versus tablet formulations of levothyroxine in the treatment of adult hypothyroidism. Endocr Pract 2014;20(7):657-62.
• 22. Fallahi P, Ferrari SM, Antonelli A. In patients with subclinical hypothyroidism while in therapy with tablet L-T4, the liquid L-T4 formulation is more effective in restoring euthyroidism. Endocr Pract 2017;23:170-4.
• 23. Fallahi P, Ferrari SM, Camastra S et al. TSH normalization in bariatric surgery patients after the switch from L-thyroxine in tablet to an oral liquid formulation. Obes Surg 2017;27(1):78-82.
• 24. Vita R, Di Bari F, Benvenga S. Oral liquid levothyroxine solves the problem of tablet levothyroxine malabsorption due to concomitant intake of multiple drugs. Expert Opin Drug Deliv 2017;14(4):467-72.