Endocrine Abstracts

Hypothyroidism therapy is based on the administration of appropriate dose of L-thyroxine (L-T4). Absorption of L-T4 takes place in the duodenum and upper tract of the small intestine (jejunum), is maximal when stomach is empty, and is affected by a number of gastrointestinal disorders, including Helicobacter pylori–related gastritis, as well as ingestion of drugs, dietary fibers, and herbal remedies. Failure to achieve a good control of disease may be due to malabsorption in 40% of cases, or to poor compliance to L-T4 therapy in 60% of cases. During the past few years, various L-T4 formulations (in tablets, soft-gel capsules and liquid solution) have become available for clinical use. Liquid or gel formulations may be considered in subjects with hampered L-T4 absorption or who are not adherent to breakfast waiting time after L-T4 administration. Questionnaires to assess adherence to therapies are available and also adapted to patients with hypothyroidism. On the contrary, there are no tools available to detect malabsorption disorders and then addressing the endocrinologist in choosing the most appropriate therapy. Here we present EMPATHY (Evaluation of Malabsorption in PATients with HYpothyroidism): a questionnaire consisting of 13 questions which may help the endocrinologist to identify malabsorption disorders and then choose the most appropriate L-T4 formulation for each patient. EMPATHY allows to evaluate not only lactose and gluten intolerances but also some other allergies (nickel, histamine, citric acid, cornstarch) and alcohol intolerance. We administered EMPATHY to 150 newly diagnosed hypothyroid patients (50 males and 100 females). Exclusion criteria were previous thyroidectomy for thyroid cancer, central hypothyroidism, diabetes, obesity, current L-T4 therapy and pregnancy. We recorded more than 3 dose adjustments in six months in 21 out of 150 (14%) patients completing questionnaire and in 42 out of 150 (28%) not completing questionnaire (P=0.01). After two months of replacement therapy, most of patients in the group completing questionnaire (110 out of 150, 73%) and 82 out of 150 (54%) in the other group achieve a good control of disease (P=0.001). EMPATHY resulted extremely useful in the clinical practice allowing a better personalization of L-T4 replacement therapy and then a more rapid achievement of good control of the disease with smaller need of subsequent dose adjustments.