Refractory hypothyroidism: True malabsorption or pseudo-malabsorption?
1 Department of Endocrinology, Oued Eddahab Military Hospital, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco.
2, Department of Endocrinology, Souss Massa university hospital center, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco.
3 Department of Endocrinology, Mohamed V Military Hospital, Rabat. Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
Research Article
World Journal of Advanced Research and Reviews, 2024, 21(02), 320–323
Publication history:
Received on 26 December 2023; revised on 03 February 2024; accepted on 05 February 2024
Abstract:
Hypothyroidism is one of the most common endocrinopathies. Its treatment consists of hormonal supplementation with levothyroxine. Despite the simplicity and accessibility of this treatment, cases of refractory hypothyroidism have been reported despite high doses. Our case is a new observation exposing this problem while discussing the modalities of its management.
Patient aged 34, followed for 6 months for hypothyroidism post total thyroidectomy. She was taking 300 μg/day of levothyroxine. The patient reported compliance with her treatment. She did not report taking any other medications. Clinical examination revealed that the patient was profoundly hypothyroid. Biological tests showed TSH > 100 μUI/mL (0.35-4.94), FT4 less than 0.40 (0.7-1.48) and FT3< 1.07 pg/mL (1.71-3.71). After eliminating all obvious causes, an oral thyroid hormone absorption test was performed in hospital, with FT4 measurements at H0, H2, H4 and H6 after levothyroxine intake. The results showed increasing FT4 elevation, eliminating the diagnosis of malabsorption and testifying to our patient's poor compliance with treatment. We report on a case that highlights the value of the thyroid hormone absorption test, which can help distinguish between true malabsorption and pseudo-malabsorption, in which case re- education on proper compliance and possible psychological follow-up are required.
Keywords:
Profound hypothyroidism; Thyroid hormone absorption test; Chronic disease; Diagnostic strategy; Therapeutic compliance
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