A 55 year old lady was referred by her general practioner with a six months history of generalised lethargy and cold intolerance.This was associated with abdominal bloating and constipation.She had been more irritable recently and was getting depressed. She also described symptoms suggestive of carpal tunnel syndrome. The only past history of note was of lactose intolerance.There was no family history of thyroid disorder.
On examination she was clinically hypothyroid.Her thyroid function tests confirmed hypothyroidism with TSH of 149 microunits per litre [0.38-4.70]and a Free thyroxine of <5.2 picomol per litre[11.0-20].Thyroid peroxidase antibody was positive at 2302 kunits per litre[0-60].She was initially given thyroxine 50 micrograms by her general practioner.She developed severe abdominal bloating and stopped taking thyroxine.The severe bloating was presumed to be secondary to lactose contained in the tablet as gastrointestinal symptoms settled off thyroxine.She became very lethargic and had developed cerebellar ataxia when reviewed in clinic.
She was admitted and initially given intravenous tri-iodothyronine in view of her profound symptoms.Her speech improved,was less lethargic and her symptoms of carpal tunnel settled.She was rechallenged with thyroxine orally as she felt the injections were painful but her abdominal distension worsened.She was subsequently commenced on 100 micrograms per day of Levoxyl [lactose free preparation of thyroxine] imported from USA.
When she was reviewed two months later she was feeling well and her abdominal distension had disappeared.Her last throid function test showed a TSH of 0.94 microunits per litre.
In summary we present a lady with severe abdominal distension and profound hypothyroidism.She was highly lactose sensitive and as such conventional preparations of thyroxine could not be given to her.
03 - 05 Nov 2003
Society for Endocrinology