Refractory hypothyroidism.

IF 0.6 4区医学 Q4 PATHOLOGY

Malaysian Journal of Pathology Pub Date : 2024-04-01

Y Y Lai, S C Thambiah, N Mohamed Mokhtar, I N Samsudin

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引用次数: 0

Abstract

Introduction: Persistently elevated thyroid stimulating hormone (TSH) despite levothyroxine (LT4) treatment that exceeds the standard weight-adjusted dose is a common clinical presentation. This may lead to additional testing for LT4 malabsorption or poor LT4 adherence, the latter of which is challenging to confirm because it is predicated on accurate patient accountability.

Case report: A 35-year-old lady, post-radioactive iodine therapy for Graves' disease remained euthyroid for a year on oral LT4. Two years later, she was clinically and biochemically hypothyroid despite claiming LT4 compliance. As all laboratory investigations were within the reference range, pseudomalabsorption was suspected and a LT4 absorption test was done. During the test, her free thyroxine increased significantly at 4 hours, reaching a peak of more than 50% from baseline while TSH decreased appropriately from 0 minute to 360 minutes. This was followed by normalisation of TSH with LT4 treatment under direct observation.

Discussion: The LT4 absorption test is a prompt and economical means to rule out true malabsorption, decrease unwarranted subspecialty referrals and validate the weight-adjusted LT4 dose reduction.

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难治性甲状腺功能减退症

简介：尽管左甲状腺素（LT4）治疗超过了标准体重调整剂量，但促甲状腺激素（TSH）仍持续升高，这是一种常见的临床表现。这可能会导致对 LT4 吸收不良或 LT4 依从性差进行额外检测，而后者的确认具有挑战性，因为这取决于对患者的准确问责：一位 35 岁的女士在接受放射性碘治疗巴塞杜氏病后，口服 LT4 一年，甲状腺功能一直保持良好。两年后，尽管她坚持服用 LT4，但临床和生化指标均出现甲状腺功能减退。由于所有实验室检查结果都在参考范围内，因此怀疑是假性吸收，于是对她进行了LT4吸收试验。在测试过程中，她的游离甲状腺素在4小时时显著增加，达到了比基线高50%以上的峰值，而促甲状腺激素则在0分钟至360分钟时适当下降。随后，在直接观察下使用 LT4 治疗，促甲状腺激素恢复正常：讨论：LT4吸收测试是一种快速、经济的方法，可用于排除真正的吸收不良，减少不必要的亚专科转诊，并验证体重调整后的LT4剂量减少。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Malaysian Journal of Pathology PATHOLOGY-

CiteScore

3.60

自引率

5.60%

发文量

期刊介绍： The Malaysian Journal of Pathology is the official journal of the College of Pathologists, Academy of Medicine Malaysia. The primary purpose of The Journal is to publish the results of study and research in Pathology, especially those that have particular relevance to human disease occurring in Malaysia and other countries in this region. The term PATHOLOGY will be interpreted in its broadest sense to include Chemical Pathology, Cytology, Experimental Pathology, Forensic Pathology, Haematology, Histopathology, Immunology, Medical Microbiology and Parasitology. The Journal aims to bring under one cover publications of regional interest embracing the various sub-specialities of Pathology. It is expected that the articles published would be of value not only to pathologists, but also to medical practitioners in search of a scientific basis for the problems encountered in their practice, and to those with an interest in diseases which occur in the tropics.