Endocrine Abstracts

The objective of our study was to evaluate the potential benefit of short-term combined treatment with LT4plusLT3 in patients with persistent hypothyroidism and malabsorption. We report ten cases of patients with hypothyroidism secondary to total thyroidectomy, in which high doses of L-T4 (2,7-3.5 mcg/kg/die) were not adequate to normalize thyroid function. TSH was persistently high (from 10 to 100 mU/L) with low serum levels of thyroid hormones.

All of the patients presented severe symptoms of hypothyroidism and did not have history of recent intake of drugs interfering with gastric function or history of previous gastric surgery, other disorders or alcohol abuse.

Anti-endomysium and anti-tissue transglutaminase tests, lactose hydrogen and 13C-Urea breath test, parasitic search in the stool were performed in all of the patients. Gastric endoscopy was necessary in few patients. An Helicobacter pylori infection was found in 4 of the patients. One patient presented a gastroesophageal reflux associated with congestive gastropathy, whereas lactose intolerance was found to be responsible for the malabsorption in 2 patients. In 3 of the patients the cause of malabsorption was not identified.

Combined therapy with L-T4 and L-T3 (45 drops of LT4 and 30 drops of LT3 mean dose) was started in all of the patients to improve the severity of hypothyroidism. This combined treatment was able to normalize serum TSH, improving the symptoms of hypothyroidism in all of the cases in about two weeks. TSH values progressively normalized, and L-T3 administration was withdrawal. Specific treatment for the causes responsible for malabsorption was contemporary performed and we were able to shift treatment to L-T4 in tablets.

Our results support the potential benefit of combined treatment with LT4plusLT3 in patients with persistent hypothyroidism due to malabsorption.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector