Endocrine Abstracts

JOINT218

Background: Levothyroxine (L-thyroxine, ) is a drug of choice for treating primary hypothyroidism, which in developing countries generally occurs due to Hashimoto thyroiditis, thyroidectomy, or iodine deficiency. L-T4 is absorbed in the small intestine, more precisely in jejunum and ileum, and to a small extent also in the stomach. Concomitant gastrointestinal diseases, such as celiac disease, H. pylori infection, lactose intolerance, inflammatory bowel disease, and even parasitic infestation (G. lamblia), etc. may cause L-T4 malabsorption

Case Presentation: The patient was treated for primary hypothyroidism in different endocrinological centers of Georgia for 10 years without significant changes and results. Referring to us, attention was paid to the clinical and laboratory signs characteristic of hypothyroidism, despite the fact that she was receiving 2800 mg of levothyroxine and up to 150 mg of T3 per day. Conducted diagnostic deductions with consultations, the total volume of the thyroid gland is 3.1 ml. Tsh-43.77 (N 0.4-4.0) miu/ml. Ft4 - 1.46 ng/dl (N 1.8-4.2). Antibodies within the norm. Due to the ineffectiveness of the standard scheme of treatment, a test was performed to rule out pseudo-malabsorption of levothyroxine, with a special protocol, thus confirming that the patient really had a syndrome of true malabsorption of levothyroxine oral preparations. An individual thyroxine treatment algorithm was developed. Alleviation of the patient’s condition and compensation of hypothyroidism is possible only with parenteral replacement therapy. A parenteral injection of 500 mg of levothyroxine every third day was prescribed, as soon as hypothyroidism compensation was achieved.

Conclusions: Levothyroxine parenteral injection is an effective and safe way to achieve hypothyroidism compensation in case of levothyroxin malabsorbtion.