Levothyroxine sodium oral solution to control thyroid function in a patient with hypothyroidism and celiac disease

[helvella]

How can it take over twelve years to get to an adequate dose? Yes, I recognise that Tirosint Sol was not available in 2007, but the failure even to consider gluten for so long is unforgivable.

(Tirosint Sol seems limited to the USA at present. Certainly not heard of anyone in the UK getting it.)

Clin Case Rep. 2021 May; 9(5): e04170.

Published online 2021 May 28. doi: 10.1002/ccr3.4170

PMCID: PMC8163109

PMID: 34094556

Levothyroxine sodium oral solution to control thyroid function in a patient with hypothyroidism and celiac disease

Ernest Asamoah

Abstract

Implementing a gluten‐free diet and switching to the levothyroxine oral solution significantly improved malabsorptive and hypothyroid symptoms in a patient with hypothyroidism, Addison's disease, and celiac disease without the need to increase levothyroxine dosage.

Keywords: case report, celiac disease, Hashimoto's thyroiditis, levothyroxine sodium oral solution (L‐T4 oral solution), malabsorption

Full paper freely available here:

ncbi.nlm.nih.gov/pmc/articl...

[tattybogle]

This is a case of treatment‐resistant or refractory hypothyroidism, because when the patient did not feel well, the TSH levels were in the normal range (August 2018 to May 2019; Table 4). Although TSH levels were in the normal range, there was considerable fluctuation despite the patient's treatment compliance.

Gosh, i'm surprised they use that as a definition of 'treatment resistant /refractory hypothyroidism'

The more usual 'explanation' of these events is "patient probably non compliant despite saying otherwise / moaning about nothing"

I had thought you would have to have 'TSH that refused to lower on Levo' to get described as 'refractory'

As for the "12 years without using their Brains"... i think they missed a bit from the 'conclusion'....

Surely it should say ... " Patients with malabsorption on L‐T4 therapy who present with fluctuating TSH levels prompting L‐T4 dose changes should be assessed for concurrent autoimmune conditions such as celiac disease. ... Instead of ignoring what they say for years and just assuming 'failure to take the tablets regularly' is the cause of any unexplained result you get "

But the paper is another useful reference to support the trial use of Liquid Levo in problematic cases. So that's good.

....Shame it reads like they are so pleased with themselves for their ' amazing discovery'.

Duh !