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Is Parenteral Levothyroxine Therapy Safe in Intractable Hypothyroidism?
Hande Peynirci1, Bengur Taskiran2, Erdinc Erturk3
1Kastamonu State Hospital, Department of Endocrinology, Turkey.
Journal of the National Medical Association
|May 21, 2018
Summary
This case study highlights a patient with isolated levothyroxine (L-thyroxine) malabsorption, successfully treated with intramuscular injections. It also notes potential neurologic side effects from high-dose oral L-thyroxine therapy.
Area of Science:
- Endocrinology
- Thyroid disorders
- Pharmacology
Background:
- Intractable hypothyroidism can be challenging to manage, especially when standard oral therapies fail.
- Papillary thyroid cancer treatment often involves thyroidectomy and radioactive iodine, necessitating lifelong levothyroxine replacement.
- Isolated levothyroxine malabsorption is a rare condition that can mimic non-adherence or other absorption issues.
Observation:
- A patient presented with severe hypothyroidism unresponsive to high-dose oral levothyroxine.
- Diagnostic tests ruled out non-adherence and malabsorption, yet levothyroxine absorption tests showed no response.
- Neurologic symptoms, including three distinct attacks, occurred during high-dose levothyroxine administration.
Findings:
- The patient was diagnosed with isolated levothyroxine malabsorption.
- Intramuscular administration of levothyroxine twice weekly successfully normalized thyroid hormone levels.
- High-dose levothyroxine therapy was associated with transient neurologic side effects.
Implications:
- This case suggests intramuscular levothyroxine as a viable alternative for patients with documented malabsorption.
- It underscores the importance of considering alternative administration routes when oral therapy fails.
- The neurologic side effects observed warrant further investigation in the context of high-dose levothyroxine treatment.
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