Levothyroxine malabsorption induced by gastroparesis in type one diabetic patient: effect of intravenous levothyroxine therapy case report


Levothyroxine malabsorption induced by gastroparesis in type one diabetic patient: effect of intravenous levothyroxine therapy case report


Homaid Alsahafi, Bandar Damanhori, Faisal AL Malky, Ashjan Alrogi, Khulood Alkhuzaie

Department of Endocrinology & Diabetology, Hera General Hospital, Makkah, Saudi Arabia


International-Journal-of-Case-Reports-2d code

19 year old female known case of primary hypothyroidism on levothyroxine replacement, type one diabetes on insulin pump with good glycemic control and stable thyroid function, developed diabetic gastroparesis with worsening response to oral levothyroxine therapy. Her symptoms of hypothyroidism and her thyroid function improved dramatically by intravenous levothyroxine three times weekly for 4 weeks then she restarted on her usual dose of oral levothyroxine.
Intravenous levothyroxine three times weekly for 4 weeks followed by oral levothyroxine therapy maintained her euthyroid, improved hypothyroidism and gastroparesis symptoms till the date of editing of this report (more than 15 months.).


Keywords: Levothyroxine malabsorption, gastroparesis,  type one diabetic patient, intravenous levothyroxine therapy, case report

Free Full-text PDF


How to cite this article:

Homaid Alsahafi, Bandar Damanhori, Faisal AL Malky, Ashjan Alrogi, Khulood Alkhuzaie. Levothyroxine malabsorption induced by gastroparesis in type one diabetic patient: effect of intravenous levothyroxine therapy case report. International Journal of Case Reports, 2019 4:102. DOI: 10.28933/ijcr-2019-10-1504


References:

1. Parkman HP, Hasler WL, Fisher RS; American Gastroenterological Association. American Gastroenterological Association Technical Review on the Diagnosis and Treatment of Gastroparesis. Gasteroenterology 2004; 127: 1592-1622.
2. Kim PJ, Sachmechi I. Levothyroxine malabsorption induced by diabetic gastroparesis exacerbated during pregnancies: effect of of intramuscular Levothyroxine injections and Levothyrxine soft gel capsules. AACE Clinical Case Reports: Winter 2015; 1(1): e73-e78.
3. Camilleri M, Bharucha AE, Farrugia G. Epidemiology, mechanisms and management of diabetic gastroparesis. Clin Gastroenterol Hepatol. 2011; 9:5-12; quiz e7.
4. Shin AS, Camilleri M. Diagnostic assessment of diabetic gastroparesis. Diabetes 2013; 62: 2667-2673.
5. Roldan MB, Alonso M, Barrio R. Thyroid autoimmunity in children and adolescents with type 1 diabetes mellitus. Diabetes Nutr Metab. 1999; 12:27-31.
6. Kordonouri O, Hartmann R, Deiss D, Wilms, M, Gruters-Kieslich A. Natural course of autoimmune thyroiditis in type 1 diabetes association with gender, age, diabetes duration and puberty. Arch Dis Child. 2005; 90:411-414.
7. Ianiro G, Mangiola F, Di Rienzo TA, Bibbo S, Franceschi F, Greco AV, et al. Levothyroxine absorption in health and disease, and new therapeutic perspectives. European Review for Medical and Pharmacological Sciences, 2014; 18: 451-456
8. Lips DJ, van Reisen MT, Voigt V, Venekamp W. Diagnosis and treatment of levothyroxine pseudomalabsorption. Neth J Med. 2004; 62:114-118.
9. Eligar PV, Eligar VS. Levothyroxine: Factors affecting its intestinal absorption and metabolism. The West London Medical Journal 2011; 3 (4):9 -14
10. Srinivas V, Oyibo SO. Levothyroxine pseudomalabsorption and thyroxine absorption testing with use of high dose levothyroxine: case report and discussion. Endocrine Pract. 2010;16:1012-1015.
11. Thorsten Brechmann, Andre Sperlbaum, Wolff Schmiegel. Levothyroxine therapy and impaired clearance are the strongest contributors to small intestinal bacterial overgrowth: Results of a retrospective cohort study, World J Gastroenterol 2017 February 7; 23(5): 842-852.
12. Salvatore Benvenga, Giampaolo Papi, Alessandro Antonelli. Refractory hypothyroidism due to Improper storage of Levothyroxine tablets. Front Endocrinol (Lausanne). 2017 Jul 10;8:155. doi: 10.3389/fendo.2017.00155.
13. Subhadra Mandadi, Syed Sattar, Basim Towfiq, Ghassan Bachuwa. A case of nausea and vomiting to remember. BMJ Case Rep. 2015 Jan 22;2015.. doi: 10.1136/bcr-2014-207251.
14. O S K, M M AM, A N P, T K P. Gastroparesis – a novel cause of persistent thyroid stimulating hormone elevation in hypothyroidism. J La State Med Soc. 2015 Mar-Apr;167(2):47-9.
15. David P. Reardon, Peter S. Yoo. Levothyroxine Tablet Malabsorption Associated with Gastroparesis Corrected with Gelatin Capsule Formulation. Hindawi Publishing Corporation Case Reports in Endocrinology Volume 2016, Article ID 1316724. http://dx.doi.org/ 10.1155/2016/13167