TSH-Suppressive Therapy: A Thorny Issue
  • Itala Marina Baldini
    UOC Medicina Interna, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano
  • Cristina Cocino
    UOC Medicina Interna, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano
  • Sonia Seghezzi
    ICH Humanitas, EAS Pronto Soccorso, Rozzano (MI)
  • Maria Domenica Cappellini
    UOC Medicina Interna, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano

Keywords

thyroid carcinoma, TSH-suppressive therapy, intestinal malabsorption

Abstract

Thyroid stimulating hormone (TSH)-suppressive therapy with levothyroxine is a cornerstone of thyroid carcinoma follow-up therapy, but the achievement of therapeutic goals must be balanced against L-T4 side effects. We describe the case of a 64-year-old cardiopathic patient with papillary thyroid carcinoma and autoimmune thyroiditis, whose cardiac condition worsened during TSH-suppressive therapy. TSH concentrations also fluctuated widely because of changing intestinal absorption due to coeliac disease.

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References

  • Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. The American Thyroid Association Guidelines Taskforce. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006;16:121–125.
  • Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. The American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1180–1187.
  • Biondi B, Wartofsky L. Treatment with thyroid hormone. Endocr Rev 2014;35:433–512.
  • Pacini F, Castagna MG. Approach to and treatment of differentiated thyroid carcinoma. Med Clin North Am 2012;96:369–383.
  • Garber JR, Cobin RH, Gharib H, et al. American Association of Clinical Endocrinologists and American Thyroid Association Task Force on Hypothyroidism in Adults. Clinical practice guidelines for hypothyroidism in adults: co-sponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract 2012;18:988–1028.
  • Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:48,72–73.
  • Jiskra J, Limanova Z, Vanickova Z, Kocna P. IgA and IgG antigliadin, IgA anti-tissue transglutaminase and antiendomysial antibodies in patients with autoimmune thyroid diseases and their relationship to thyroidal replacement therapy. Physiol Res 2003;52:79–88.
  • d’Esteve-Bonetti L, Bennet AP, Malet D, et al. Gluten-induced enteropathy (coeliac disease) revealed by resistance to treatment with levothyroxine and alfacalcidol in a sixty-eight-year old patient: a case report. Thyroid 2002;12:633–636.
  • McDermott JH, Coss A, Walsh CH. Celiac disease presenting as resistant hypothyroidism. Thyroid 2005;15:386–388.
  • Chamberland D, Weight C, Rasmussen M, et al. Thyroxine malabsorption in a patient with type 1 diabetes and celiac disease. Endocr Pract 2005;11:203–204.
  • Caputo M, Brizzolara R, Schiavo M, et al. Occurrence of overt celiac disease in the elderly following total thyroidectomy. J Endocrinol Invest 2006;29:831–833.
  • Collins D, Wilcox R, Nathan M, Zubarik R. Celiac disease and hypothyroidism. Am J Med 2012;125:278–282.
  • Centanni M, Gargano L, Canettieri G, et al. Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis. N Engl J Med 2006;354:1787–1795.
  • Hays MT, Nielsen RK. Human thyroxine absorption: age effects and methodological analyses. Thyroid 1994;4:55–64.
  • Benvenga S, Bartolone L, Squadrito S, et al. Delayed intestinal absorption of levothyroxine. Thyroid 1995;5:249–253.
  • Hays MT. Localization of human thyroxine absorption. Thyroid 1991;1:241–248.
  • Vita R, Saraceno G, Trimarchi F, Benvenga S. A novel formulation of L-thyroxine (L-T4) reduces the problem of L-T4 malabsorption by coffee observed with traditional tablet formulations. Endocrine 2013;43:154–160.
  • Colucci P, D’Angelo P, Mautone G, et al. Pharmacokinetic equivalence of a levothyroxine sodium soft capsule manufactured using the new Food and Drug Administration potency guidelines in healthy volunteers under fasting conditions. Ther Drug Monit 2011;33:355–361.
  • Santaguida M, Virili C, Gatto I, et al. A novel therapeutic approach for patients with gastric disorders and T4 malabsorption: thyroxine softgel preparation. Thyroid 2013;23(S1):A53.
  • Bernareggi A, Grata E, Pinorini MT, et al. Oral liquid formulation of levothyroxine is stable in breakfast and may improve thyroid patient compliance. Pharmaceutics 2013;5:621–633.
  • Yue CS, Scarsi C, Ducharme MP. Pharmacokinetics and potential advantages of a new oral solution of levothyroxine vs. other available dosage forms. Arzneimittelforschung 2012;62:631–636.
  • Brancato D, Scorsone A, Saura G, et al. Comparison of TSH levels with liquid formulation versus tablet formulations of levothyroxine in the treatment of adult hypothyroidism. Endocr Pract 2014;20:657–662.

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    Published: 2017-03-27
    Issue: Vol. 4 No. 2 (view)

    How to cite:
    1.
    Baldini IM, Cocino C, Seghezzi S, Cappellini MD. TSH-Suppressive Therapy: A Thorny Issue. EJCRIM 2017;4 doi:10.12890/2016_000547.

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