Effect of gastrointestinal disorders in autoimmune thyroid diseases Carvalho Translational Gastrointestinal Cancer

Effect of gastrointestinal disorders in autoimmune thyroid diseases Carvalho Translational Gastrointestinal Cancer

Iodine can’t be synthesized, and the amount of iodine you absorb from your food can be a rate-limiting factor in the ability of the thyroid to make its hormones. CV, MC, and SC conceived, designed the study, and wrote the final version of the synthroid 0.150 manuscript. GB performed endoscopies, GB and CS collected gastroenterological data and revised the manuscript.

• In recent years, bariatric surgery has been sought by a large number of obese patients, particularly after the development of laparoscopic techniques.
• Kelly Austin, a naturopathic doctor, recommends a moderate- to low-carbohydrate diet that focuses on complex carbohydrates and avoids simple sugars.
• Thyroid cancer may be the first finding in patients with FAP, and 30% of thyroid carcinomas are diagnosed 4 to 12 years before the diagnosis of polyposis15.
• However, low calories can cause stress and decrease thyroid hormone production.
• This is likely the reason for the lack of response observed in this patient as subsequent meals may have sequestered appropriately administered doses and decreased absorption.

Helicobacter pylori infection

• This is because thyrotoxicosis can cause muscle weakness, triggering dysphagia (swallowing difficulties).
• Thus, the most appropriate approach to date is individual dose adjustment after surgery (57).
• Patients with hypothyroidism are at risk of becoming severely hypothyroid when faced with gastrointestinal diseases that lead to malabsorption.
• Levothyroxine sodium tablet ranks among the most prescribed drugs worldwide and represents a critical-dose drug, as little variations in the blood concentration may cause treatment failure, as well as iatrogenic thyrotoxicosis 2–5.

Oral levothyroxine sodium is absorbed in the small intestine, mainly in the jejunum and the ileum being lower the absorption rate at duodenal level. The time interval between the ingestion of oral thyroxine and its appearance in the plasma renders unlike a gastric absorption of the hormone. However, several evidence confirm the key role of the stomach as a prerequisite for an efficient absorption of oral levothyroxine. In the stomach, in fact, occur key steps leading to the dissolution of thyroxine from the solid form, the process bringing the active ingredient from the pharmaceutical preparation to the aqueous solution. In particular, gastric juice pH, volume, viscosity, as well as gastric emptying time seem to be the most important limiting factors. Levothyroxine sodium monotherapy is usually prescribed as treatment in replacement mode for hypothyroid patients worldwide (1).

How to Suspect Gastric Disorders Affecting Levothyroxine Absorption

Specifically, the thyroid gland makes thyroxine (T4) and triiodothyronine (T3). Mostly, the thyroid produces T4 (80%), but it also makes a small amount of the much stronger T3 (20%). In summary, endocrine disorders of the thyroid and pancreas often have significant gastrointestinal symptoms. Given the often vague and general quality of these symptoms, diagnosing their endocrine etiology requires a high index of suspicion.

• Endoscopic ultrasound has rapidly come to the forefront in localization studies.
• Inflammation, hyperplasia of crypts and villous atrophy are some of the histological findings, which may regress or even disappear with the removal of gluten from the diet (9).
• More recently, a pharmacokinetic study in healthy euthyroid subjects by Chon et al. 52 showed that simultaneous milk ingestion decreases oral levothyroxine absorption.

This can be caused by a variety of issues but is usually a result of Graves’ disease, where the body creates antibodies to its own receptors and stimulates the excessive production of T3 and T4. We know that the thyroid can cause gastrointestinal diseases because thyroid diseases and gastrointestinal diseases tend to occur together. The GI tract can also have an effect on thyroid diseases by influencing which micronutrients are available for the thyroid gland. When the level of thyroid hormones drops too low, the brain will signal to the thyroid gland through other hormones (thyroid stimulating hormone known as TSH) that it needs to produce more T3 and T4 and vice versa. In particular, the thyroid gland is responsible for taking iodine and turning it into thyroid hormones.

Greater awareness and understanding of medication-induced GI symptoms may limit unnecessary, invasive and expensive diagnosis and treatment. Localization can be accomplished with CT scanning, as these tumors are typically large and located in the distal pancreas. Preoperative preparation involves control of hyperglycemia, treatment of thrombosis, and optimization of nutritional status with total parenteral nutrition. Octreotide has occasionally been used to aide in reduction of plasma glucagons levels, allowing improvement of nutritional status, and alleviation of the rash46.

While these procedures can be invasive and technically challenging, the results are reliable and specific42,43. Dose escalation was attempted in the patient presented in this case report without clinical efficacy. After the change in levothyroxine sodium formulation was attempted, the patient had a rapid response in her TSH and T4 levels. She was eventually placed on a maintenance dose of 225 mcg (3.3 mcg/kg) orally once a day. Although this dose is still higher than those commonly used in clinical practice, this was a significant reduction compared to the patient’s previous dose. In recent years, bariatric surgery has been sought by a large number of obese patients, particularly after the development of laparoscopic techniques.

Does Thyroid Cause Gastrointestinal Problems?

Overproduction of this inhibitory peptide leads to vague symptoms, marked by a decrease in gastrointestinal function. Clinically, it may present with cholelithiasis (70%), mild diabetes (60%), steatorrhea (30%-68%), hypochlorhydria (33%-53%) and weight loss46. Many of these tumors are identified incidentally on imaging studies for vague abdominal complaints, or at the time of cholecystectomy. Most of these tumors are located in the head of the pancreas or duodenum, and are usually solitary.

Hormonal effects on the GI tract may be a direct result of thyroid hormone, or as a result of synergistic effects of catecholamines. Tenore et al. investigated the effect of thyroxin (T4) on the intestinal chloride/bicarbonate exchange in hypo- and hyperthyroid rats. They found that alterations in intestinal ion exchange, mainly the flux of chloride, led to mucosal effects and resultant diarrhea. These findings were not seen when T4 was added ex vivo to rat ileum, suggesting that the effect on electrolyte transport likely requires systemic factors10. Furthermore, the beta-adrenergic antagonist propranolol inhibits intestinal transit in hyperthyroidism, thereby indicating that some of the dysmotility may be mediated through the adrenergic/catecholamine system11. Dysfunction of the autonomic nervous system (ANS) may modify the neuro-hormonal milieu, and result in alterations of myoelectric activity.

Proper treatment of these pathologies can then improve control of hypothyroidism, and increase patient’s quality of life. How specific is the effect of gastric pH changes in determining the minimal effective dose of thyroxine? From a pharmacologic standpoint, the role of gastric pH was highlighted by Seng et al., who suggested that a bioequivalence in healthy volunteers might differ from the one in patients bearing altered gastric pH 50.

Data availability statement

We report a case of a 42-year-old female who presented with a living unrelated kidney transplant evaluation with myxedema while being treated with levothyroxine sodium tablets. She was noted to have gastroparesis secondary to Type I diabetes mellitus which may have contributed to levothyroxine malabsorption. Changing to a gelatin capsule formulation quickly corrected her thyroid function assays. This case suggests that gastroparesis may affect absorption of levothyroxine tablets and the gelatin capsules may be an effective alternative therapy.