L-T4 niet slikken of uitspugen? Dan 1x/pw een spuit in spieren

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Kiek
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Lid geworden op: 12 sep 2013, 11:36

L-T4 niet slikken of uitspugen? Dan 1x/pw een spuit in spieren

Bericht door Kiek »

AN ALTERNATIVE APPROACH IN THE MANAGEMENT OF HYPOTHYROIDISM AFTER FAILURE OF ORAL LEVOTHYROXINE
M.E. Sevilla Alsina 1 , M. Candelario 1 , A. Ramirez 1,2 , J. Gomez-Daspet 1,2
1. Endocrinology, University Of South Florida, Tampa, FL;
2. Endocrinology, James A. Haley Veterans’ Hospital, Tampa, FL

We present a case of Primary Hypothyroidism refractory to oral levothyroxine, successfully treated with weekly intramuscular (IM) levothyroxine (L-T4). 38-year-old woman with a history of benign goiter, underwent resection with subsequent hypothyroidism. She also has morbid obesity, type 2 diabetes mellitus complicated with severe gastroparesis and episodes of daily emesis, often occurring after taking L-T4.

During the last 2 years, Thyroid Stimulating Hormone (TSH) level fluctuated between 28–65 mIU/L. Dose was titrated to 300 mcg daily, later moved to bedtime. Afterwards, 1,000 mcg weekly L-T4 replacement was attempted. Supervised L-T4 intake through a home health nurse assistant was tried, and failed as well. Thyroid function studies demonstrated persistent severe hypothyroidism. Extensive work up for malabsorption was negative.

References suggest starting IM dose that is 50 to 80% of oral dose. A trial of weekly IM 500 mcg L-T4 was started in March 2017.

Baseline TSH, 40.7 mIU/L; free T4, 0.4 ng/dL. After two weeks, both TSH and free-T4 improved to 25.3 mIU/L and 0.7 ng/dL, respectively. Her dose was raised to 750 mcg IM weekly. After four weeks, TSH was 13 mIU/L and f-T4 normalized to 0.9 ng/dL. At the time of this report, her symptoms of hypothyroidism resolved without adverse events. She is scheduled to obtain follow up thyroid function studies.

It is rare for subjects to fail therapy with oral levothyroxine (L-T4) despite progressive dose adjustments. In this subject, vomiting of L-T4 tablets is the apparent only cause for lack of response. Although, the U.S. Food & Drug Administration does not approve the use of intramuscular levothyroxine, in this case the clinical and biochemical response has been successful.

All patients are unique and will benefit by individualized management. This case represents an opportunity to review an effective and so far, safe alternative in cases where patients do not respond to oral therapy in a long-term basis.

http://online.liebertpub.com/doi/pdfplu ... .abstracts
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