Levothyroxine treatment and gastric juice pH in humans: the proof of concept.
Atrophic gastritis
Gastric juice pH
Helicobacter pylori
Hypothyroidism
Levothyroxine dose
Levothyroxine malabsorption
Journal
Endocrine
ISSN: 1559-0100
Titre abrégé: Endocrine
Pays: United States
ID NLM: 9434444
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
received:
11
02
2022
accepted:
04
04
2022
pubmed:
29
4
2022
medline:
2
7
2022
entrez:
28
4
2022
Statut:
ppublish
Résumé
Despite the absorption of oral thyroxine (T4) occurs in the small bowel, several patients with gastric disorders show an increased need for T4. In vitro evidence suggested that medium pH variations interfere with T4 dissolution. This study was aimed at finding the proof of concept of a direct relationship between the minimal effective dose of T4 and the actual gastric juice pH. Among 311 consecutively thyroxine-treated patients, 61 bearing Hashimoto's thyroiditis (52 F/9 M; median age = 51 years) who complained persistent dyspepsia and/or upper abdominal symptoms following a noninvasive workup for gastrointestinal disorders, underwent EGDS with multiple biopsies and gastric juice pH measurement. All patients accepted to take thyroxine in fasting conditions, abstaining from eating or drinking for one hour. Thyroxine requirement increased along with the rising gastric pH (ρ = 0.4229; p = 0.0007). A multivariate analysis revealed that gastric pH was, beside body mass index, the far more important independent variable in determining the effective dose of T4 (p = 0.001). The ROC curve revealed that the pH threshold for an increased thyroxine requirement was at 2.28, being the AUC by 78%. Subdividing patients by the histologic findings, it appeared a significant increase (p = 0.0025) along with the progressive damage of gastric mucosa. The in vivo measurement of gastric pH highlighted its key role in determining the minimal effective dose of oral T4 and may explain the interference of food, of some drugs and gut disorders on levothyroxine treatment.
Identifiants
pubmed: 35477833
doi: 10.1007/s12020-022-03056-1
pii: 10.1007/s12020-022-03056-1
pmc: PMC9242941
doi:
Substances chimiques
Thyroxine
Q51BO43MG4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
102-111Informations de copyright
© 2022. The Author(s).
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