Abstract:
OBJECTIVE:For patients who remain hypothyroid despite the administration of what would seem adequate doses of levothyroxine (L-T4), the underlying cause can be difficult to determine. The possibility of a biological cause should first be explored; however, in the majority of cases, poor adherence to medication is likely to be the main cause of treatment failure. When non-adherence is suspected but not volunteered, options to confirm the suspicion are limited. In this study, we identified patients for whom known drugs and pathological causes of L-T4 malabsorption were excluded, and despite often high doses of L-T4, the patients remained hypothyroid. DESIGN:Using a weight-determined oral L-T4 bolus administration, absorption was initially assessed in 23 patients. In nearly all patients, this was shown to be maximal at 120 min post-ingestion. This was then followed by the continued administration of a weekly T4 bolus for a 4-week period after which TSH and free T4 (fT4) levels were recorded. RESULTS:All patients showed a rise in fT4 at 120 min following the administration of the L-T4 bolus, with a mean increase of 54±3% from baseline. Following the treatment period, using an equivalent weekly L-T4 dose, which was significantly less than that of the daily dose taken by the patients before the test, TSH reduced from baseline in ~75% of cases. CONCLUSION:Using this combination of tests allows significant malabsorptive problems to be identified first and then potential non-adherence to be demonstrated. A management plan can then be implemented to increase adherence, aiming to improve treatment outcomes.
journal_name
Eur J Endocrinoljournal_title
European journal of endocrinologyauthors
Walker JN,Shillo P,Ibbotson V,Vincent A,Karavitaki N,Weetman AP,Wass JA,Allahabadia Adoi
10.1530/EJE-12-1035subject
Has Abstractpub_date
2013-05-10 00:00:00pages
913-7issue
6eissn
0804-4643issn
1479-683Xpii
EJE-12-1035journal_volume
168pub_type
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journal_title:European journal of endocrinology
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doi:10.1530/eje.0.1510491
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journal_title:European journal of endocrinology
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pub_type: 临床试验,杂志文章,随机对照试验
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pub_type: 杂志文章
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2004-07-01 00:00:00
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pub_type: 杂志文章
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更新日期:2019-09-01 00:00:00
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pub_type: 杂志文章
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更新日期:2008-07-01 00:00:00
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