SFEBES2014 Poster Presentations Thyroid (51 abstracts)
Factors contributing to high levothyroxine doses in primary hypothyroidism; an interventional audit of a large community database
Hannah Robertson 1 , Anil Narayanaswamy 2 , Olivia Pereira 3 , Shirley Copland 1 , Richard Herriot 1 , Alastair McKinlay 1 , John Bevan 1 & Prakash Abraham 1
1Aberdeen Royal Infirmary, Aberdeen, UK; 2Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff, UK; 3Edna Coates Diabetes Centre, Pinderfields Hospital, Wakefield, UK.
Background: While few hypothyroid patients require more than the expected weight related dose of levothyroxine, the underlying causes of larger-than-expected dosing requirements have not been studied in a single cohort. Our aim was to determine and quantify the multiple factors contributing to high dose levothyroxine requirements in a cohort of patients with hypothyroidism.
Methods: The Grampian Automated Follow-Up Register (GAFUR) monitors around 17 500 hypothyroid patients; in 2008, 190 (1%) patients took more than 225 μg of levothyroxine daily. A questionnaire was sent to 174 patients (16 were untraceable) to assess causes and to offer blood tests for endomysial, parietal cell (PCA) and thyroid peroxidase (TPO) auto-antibodies. Primary care surgeries were contacted for medication details. All patients with positive endomysial autoantibodies were referred to a gastroenterologist. Thyroid function tests and levothyroxine doses were re-evaluated in 2011.
Results: 125 questionnaires (72%) were returned. Mean levothyroxine dose was 248 μg daily. 26 patients (20.8%) took medications known to interfere with levothyroxine absorption and 21 patients (16.8%) admitted to compliance issues. Seven patients had positive anti-endomysial antibodies on initial screening with four being new diagnoses of celiac disease and PCA were positive in 27 (21.6%) patients. At follow-up in 2011 the mean levothyroxine dose had decreased in patients on interfering medications and in the four new cases of coeliac disease.
Conclusions: Causes of patients needing high dose levothyroxine replacement include poor compliance, medication interference, PCA (as a marker of atrophic/autoimmune gastritis) and coeliac disease. Doses can be decreased with counselling regarding medications or after management of underlying conditions.
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more