Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2014) 34 P390 | DOI: 10.1530/endoabs.34.P390

SFEBES2014 Poster Presentations Thyroid (51 abstracts)

Factors contributing to high levothyroxine doses in primary hypothyroidism; an interventional audit of a large community database

Hannah Robertson 1 , Anil Narayanaswamy 2 , Olivia Pereira 3 , Shirley Copland 1 , Richard Herriot 1 , Alastair McKinlay 1 , John Bevan 1 & Prakash Abraham 1


1Aberdeen Royal Infirmary, Aberdeen, UK; 2Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff, UK; 3Edna Coates Diabetes Centre, Pinderfields Hospital, Wakefield, UK.


Background: While few hypothyroid patients require more than the expected weight related dose of levothyroxine, the underlying causes of larger-than-expected dosing requirements have not been studied in a single cohort. Our aim was to determine and quantify the multiple factors contributing to high dose levothyroxine requirements in a cohort of patients with hypothyroidism.

Methods: The Grampian Automated Follow-Up Register (GAFUR) monitors around 17 500 hypothyroid patients; in 2008, 190 (1%) patients took more than 225 μg of levothyroxine daily. A questionnaire was sent to 174 patients (16 were untraceable) to assess causes and to offer blood tests for endomysial, parietal cell (PCA) and thyroid peroxidase (TPO) auto-antibodies. Primary care surgeries were contacted for medication details. All patients with positive endomysial autoantibodies were referred to a gastroenterologist. Thyroid function tests and levothyroxine doses were re-evaluated in 2011.

Results: 125 questionnaires (72%) were returned. Mean levothyroxine dose was 248 μg daily. 26 patients (20.8%) took medications known to interfere with levothyroxine absorption and 21 patients (16.8%) admitted to compliance issues. Seven patients had positive anti-endomysial antibodies on initial screening with four being new diagnoses of celiac disease and PCA were positive in 27 (21.6%) patients. At follow-up in 2011 the mean levothyroxine dose had decreased in patients on interfering medications and in the four new cases of coeliac disease.

Conclusions: Causes of patients needing high dose levothyroxine replacement include poor compliance, medication interference, PCA (as a marker of atrophic/autoimmune gastritis) and coeliac disease. Doses can be decreased with counselling regarding medications or after management of underlying conditions.

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