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[L-thyroxine pseudomalabsorption: a factitious disease].

Laurent Molines1, Isabelle Fromont, Nathalie Morlet-Barla

  • 1Service de nutrition, maladies métaboliques et endocrinologie, Hôpital La Timone, Marseille. lmolines77@yahoo.fr

Presse Medicale (Paris, France : 1983)
|April 21, 2007
PubMed
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Thyroid hormone malabsorption can occur even with consistent L-thyroxine (thyroid hormone) treatment. This condition, known as pseudomalabsorption, may stem from hidden non-adherence to medication, impacting hypothyroidism management.

Area of Science:

  • Endocrinology
  • Internal Medicine
  • Pharmacology

Background:

  • Levothyroxine (L-thyroxine) is standard treatment for hypothyroidism.
  • Some patients exhibit persistent elevated TSH despite adequate L-thyroxine dosage.
  • This suggests potential challenges in thyroid hormone replacement therapy.

Observation:

  • A 71-year-old woman with a history of thyroidectomy presented with recurrent severe hypothyroidism.
  • Despite reported adherence to L-thyroxine, absorption tests confirmed pseudomalabsorption.
  • This highlights the possibility of non-organic causes for treatment failure.

Findings:

  • L-thyroxine pseudomalabsorption was diagnosed in a patient with hypothyroidism.
  • The condition was linked to concealed poor treatment adherence.

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  • Thyroid hormone absorption tests were crucial for confirming the diagnosis.

    • Implications:

    • Clinicians should consider L-thyroxine pseudomalabsorption in non-responsive hypothyroidism cases.
    • Ruling out drug/dietary interactions and organic malabsorption is essential.
    • Recognizing factitious disease aids in appropriate patient management and treatment adjustment.