Advertisement

Endocrine

, Volume 57, Issue 1, pp 175–178 | Cite as

Patients with lactose intolerance absorb liquid levothyroxine better than tablet levothyroxine

  • Poupak Fallahi
  • Silvia Martina Ferrari
  • Santino Marchi
  • Nicola De Bortoli
  • Ilaria Ruffilli
  • Alessandro AntonelliEmail author
Research Letter

Introduction

The need to use high L-thyroxine (L-T4) doses in the replacement treatment of hypothyroidism is often the very first sign of one of the pathologies that are connected with malabsorption syndrome [1, 2, 3, 4, 5, 6]. Also lactose intolerance (LI) should be considered in the differential diagnosis of gastrointestinal diseases that can cause malabsorption of L-T4 [3]. The prevalence of LI in Caucasian adult patients ranges 7–20 %, but its occurrence may be frequently ignored [3]. In the case of a diagnosis of LI, both a low lactose diet, and a lactose-free L-T4 preparation, should be administered to restore euthyroidism or make it possible to decrease the dose of the L-T4 [7].

Here we report our experience, in 5 patients with LI with an increase in serum thyrotropin [thyroid stimulating hormone (TSH)] levels, while receiving ‘L-T4 in tablet form containing lactose’ (L-T4-Tab+Lactose), that was reversibly resolved by switching to the same dose in a ‘liquid (Tirosint®vial,...

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in this study.

References

  1. 1.
    A. Antonelli, S.M. Ferrari, A. Corrado, A. Di Domenicantonio, P. Fallahi, Autoimmune thyroid disorders. Autoimmun. Rev. 14, 174–180 (2015)CrossRefGoogle Scholar
  2. 2.
    S. Benvenga, L. Bartolone, M.A. Pappalardo, A. Russo, D. Lapa, G. Giorgianni, G. Saraceno, F. Trimarchi, Altered intestinal absorption of L-thyroxine caused by coffee. Thyroid. 18, 293–301 (2008)CrossRefGoogle Scholar
  3. 3.
    S. Benvenga, When thyroid hormone replacement is ineffective? Curr. Opin. Endocrinol. Diabetes. Obes. 20, 467–477 (2013)CrossRefGoogle Scholar
  4. 4.
    P. Colucci, C. Seng Yue, M. Ducharme, S. Benvenga, A review of the pharmacokinetics of levothyroxine for the treatment of hypothyroidism. Eur. Endocrinol. 9, 40–47 (2013)CrossRefGoogle Scholar
  5. 5.
    M. Centanni, M. Marignani, L. Gargano, V.D. Corleto, A. Casini, G. Delle Fave, M. Andreoli, B. Annibale, Atrophic body gastritis in patients with autoimmune thyroid disease: an underdiagnosed association. Arch. Intern. Med. 159, 1726–1730 (1999)CrossRefGoogle Scholar
  6. 6.
    A. Antonelli, C. Ferri, P. Fallahi, M. Cazzato, S.M. Ferrari, M. Sebastiani, E. Ferrannini, Clinical and subclinical autoimmune thyroid disorders in systemic sclerosis. Eur. J. Endocrinol. 156, 431–437 (2007)CrossRefGoogle Scholar
  7. 7.
    M. Ruchała, E. Szczepanek-Parulska, A. Zybek, The influence of lactose intolerance and other gastro-intestinal tract disorders on L-thyroxine absorption. Endokrynol. Pol. 63, 318–323 (2012)PubMedGoogle Scholar
  8. 8.
    M. Cellini, M.G. Santaguida, I. Gatto, C. Virili, S.C. Del Duca, N. Brusca, S. Capriello, L. Gargano, M. Centanni, Systematic appraisal of lactose intolerance as cause of increased need for oral thyroxine. J. Clin. Endocrinol. Metab. 99, E1454–E1458 (2014)CrossRefGoogle Scholar
  9. 9.
    J.H. McDermott, A. Coss, C.H. Walsh, Celiac disease presenting as resistant hypothyroidism. Thyroid. 15, 386–388 (2005)CrossRefGoogle Scholar
  10. 10.
    M. Centanni, L. Gargano, G. Canettieri, N. Viceconti, A. Franchi, G. Delle Fave, B. Annibale, Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis. N. Engl. J. Med. 354, 1787–1795 (2006)CrossRefGoogle Scholar
  11. 11.
    M. Muñoz-Torres, M. Varsavsky, G. Alonso, Lactose intolerance revealed by severe resistance to treatment with levothyroxine. Thyroid. 16, 1171–1173 (2006)CrossRefGoogle Scholar
  12. 12.
    M. Asik, F. Gunes, E. Binnetoglu, M. Eroglu, N. Bozkurt, H. Sen, E. Akbal, C. Bakar, Y. Beyazit, K. Ukinc, Decrease in TSH levels after lactose restriction in Hashimoto’s thyroiditis patients with lactose intolerance. Endocrine. 46, 279–284 (2014)CrossRefGoogle Scholar
  13. 13.
    R. Vita, P. Fallahi, A. Antonelli, S. Benvenga, The administration of L-thyroxine as soft gel capsule or liquid solution. Expert. Opin. Drug. Deliv. 11, 1103–1111 (2014)CrossRefGoogle Scholar
  14. 14.
    S. Morelli, G. Reboldi, S. Moretti, E. Menicali, N. Avenia, E. Puxeddu, Timing of breakfast does not influence therapeutic efficacy of liquid levothyroxine formulation. Endocrine. 52, 571–578 (2016)CrossRefGoogle Scholar
  15. 15.
    C. Cappelli, I. Pirola, L. Daffini, A. Formenti, C. Iacobello, A. Cristiano, E. Gandossi, E. Agabiti Rosei, M. Castellano, A Double-Blind Placebo-Controlled Trial of Liquid Thyroxine Ingested at Breakfast: Results of the TICO Study. Thyroid. 26, 197–202 (2016)CrossRefGoogle Scholar
  16. 16.
    R. Vita, G. Saraceno, F. Trimarchi, S. Benvenga, Switching levothyroxine from the tablet to the oral solution formulation corrects the impaired absorption of levothyroxine induced by proton-pump inhibitors. J. Clin. Endocrinol. Metab. 99, 4481–4486 (2014)CrossRefGoogle Scholar
  17. 17.
    P. Fallahi, S.M. Ferrari, I. Ruffilli, A. Antonelli, Reversible normalisation of serum TSH levels in patients with autoimmune atrophic gastritis who received L-T4 in tablet form after switching to an oral liquid formulation: a case series. BMC. Gastroenterol. 16, 22 (2016)CrossRefGoogle Scholar
  18. 18.
    P. Fallahi, S.M. Ferrari, S. Camastra, U. Politti, I. Ruffilli, R. Vita, G. Navarra, S. Benvenga, A. Antonelli, TSH normalization in bariatric surgery patients after the switch from L-thyroxine in tablet to an oral liquid formulation. Obes. Surg. [in press] (2016).Google Scholar
  19. 19.
    D. Brancato, A. Scorsone, G. Saura, L. Ferrara, A. Di Noto, V. Aiello, M. Fleres, V. Provenzano, Comparison of TSH Levels with Liquid Formulation Versus Tablet Formulations of Levothyroxine in the Treatment of Adult Hypothyroidism. Endocr. Pract. 20, 657–662 (2014)CrossRefGoogle Scholar
  20. 20.
    P. Fallahi, S.M. Ferrari, A. Antonelli, Oral L-thyroxine liquid versus tablet in patients with hypothyroidism without malabsorption: a prospective study. Endocrine. 52, 597–601 (2016)CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Poupak Fallahi
    • 1
  • Silvia Martina Ferrari
    • 1
  • Santino Marchi
    • 2
  • Nicola De Bortoli
    • 2
  • Ilaria Ruffilli
    • 1
  • Alessandro Antonelli
    • 1
    Email author
  1. 1.Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
  2. 2.Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly

Personalised recommendations