Pseudomalabsorption of levothyroxine.
OBJECTIVE.--The issue of patient compliance with pharmacological therapy vs malabsorption of medication was explored in the context of persistent hypothyroidism despite the administration of large doses of levothyroxine sodium. DESIGN.--Retrospective case series. SETTING.--Referred care in two large tertiary care centers. PATIENTS.--Four patients, seen within two decades, with clinical and biochemical hypothyroidism while receiving levothyroxine, were evaluated for selective malabsorption of this hormone. INTERVENTIONS.--Studies included serial measurements of thyroid hormone levels after a loading dose of levothyroxine or liothyronine sodium or evaluation with a double-labeled thyroxine tracer technique. Results were compared with studies of levothyroxine malabsorption in the medical literature. RESULTS.--All patients were ultimately found to have normal (82% to 100%) absorption of oral levothyroxine. There was no evidence that malabsorption of levothyroxine can occur as an isolated abnormality. CONCLUSIONS.--Some patients exhibit a factitious disorder suggesting malabsorption of levothyroxine. When treating hypothyroidism, psychiatric issues may result in noncompliance with levothyroxine therapy.[1]References
- Pseudomalabsorption of levothyroxine. Ain, K.B., Refetoff, S., Fein, H.G., Weintraub, B.D. JAMA (1991) [Pubmed]
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