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Severe hypothyroidism in patients dependent on prolonged thyroxine infusion through a jejunostomy
V Smyrniotis1, N Vaos, N Arkadopoulos
1Second Department of Surgery, Athens University School of Medicine, Aretaieion Hospital, Athens, Greece.
Background And Aims:
Enteral absorption of thyroxine (T4) is variable; the duodenum and jejunum appear to be the most important sites of absorption. Our objective is to demonstrate that T4 infused via a standard jejunostomy may occasionally be poorly absorbed.
Methods:
Two patients underwent esophagolaryngeal resection for carcinoma of the cervical esophagus. The procedure was accompanied by complete removal of the thyroid and parathyroid glands. A neck fistula at the gastropharyngeal anastomosis led to a restriction of oral intake; daily requirements of T4 and nutrients were given via the jejunostomy. T4 plasma levels deteriorated and thyroid-stimulating hormone (TSH) levels increased and in the third postoperative week, T4 (300 microg) was administered via a nasogastric tube.
Results:
Although given a high dose (300 microg) of T4, both patients developed severe hypothyroidism. Infusion of T4 through the nasogastric tube precipitated the normalization of T4 and TSH plasma levels. Both patients (cases 1 and 2) resumed oral intake during the fifth and sixth postoperative weeks respectively.
Conclusion:
T4 malabsorption may occur in patients dependent on prolonged T4 infusion via a standard jejunostomy.