Thyroxine Absorption Test by Khaled Aljenaee in BJSTR

Abstract

Poor compliance with #Levothyroxinetherapy leading to apparently ‘resistant’ #hypothyroidism, termed ‘pseudomalabsorption’, is a common clinical conundrum.. A thyroxine absorption test may aid clinicians in confirming suspected poor compliance with greater objectivity, but there is a lack of uniformity in practice and interpretation of this test. We herein report a case of suspected #pseudomalabsorption where a #thyroxineabsorption test helped to confirm the diagnosis. A 29-year-old female was diagnosed with primary hypothyroidism in 2009 with TSH at diagnosis of 180 microIU/L. #Euthyroidism was achieved by Levothyroxine administration, which was gradually increased to 175mcg/day. In the subsequent 2 years, however, she remained persistently hypothyroid despite doses of #Levothyroxine well exceeding her estimated weight adjusted requirement. A thyroxine absorption test was performed, where once weekly directly observed #administration of a weight-adjusted dosage of levothyroxine was performed over a consecutive 4 week period. TSH fell from a baseline of 18 microIU/L to 0.8 microIU/L in the fifth week. This finding confirmed pseudomalabsorption and excluded the need for a potentially exhaustive search for an organic underlying cause for the persistently elevated TSH.

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#Thyroxine Absorption Test by Khaled Aljenaee in BJSTR