The Journal of clinical endocrinology and metabolism · 2014
Systematic appraisal of lactose intolerance as cause of increased need for oral thyroxine.
Клиническое исследованиеСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Cellini Miriam, Santaguida Maria Giulia, Gatto Ilenia, Virili Camilla, Del Duca Susanna Carlotta, Brusca Nunzia, Capriello Silvia, Gargano Lucilla, Centanni Marco
Аннотация
CONTEXT: An increased need for T4 has been described in patients with different gastrointestinal disorders. However, there is a lack of systematic studies assessing the need for T4 in hypothyroid patients with lactose intolerance, a widespread and often occult disorder.
OBJECTIVE: The objective of the study was to assess the replacement T4 dose required in hypothyroid patients with lactose intolerance.
DESIGN: This was a cohort study.
SETTING: The study was conducted at an outpatient endocrinology unit in a University Hospital.
PATIENTS: The replacement T4 dose has been analyzed, from 2009 to 2012, in 34 hypothyroid patients due to Hashimoto's thyroiditis and lactose intolerance and being noncompliant with a lactose-free diet.
MAIN OUTCOME MEASURE: An individually tailored T4 dose was measured.
RESULTS: In all patients with isolated Hashimoto's thyroiditis, target TSH (median TSH 1.02 mU/L) was obtained at a median T4 dose of 1.31 μg/kg/d. In patients with lactose intolerance, only five of 34 patients reached the desired TSH (median TSH 0.83 mU/L) with a similar T4 dose (1.29 μg/kg/d). In the remaining 29 patients, the T4 dose was progressively increased and the target TSH (median TSH 1.21 mU/L) was attained at a median T4 dose of 1.81 μg/kg/d (+38%, P < .0001). In six of these patients, other gastrointestinal disorders were diagnosed, and their median T4 requirement was higher (2.04 μg/kg/d; +55%; P = .0032). In the remaining 23 patients with isolated lactose intolerance, a median T4 dose of 1.72 μg/kg/d (+31% P < .0001) has been required to attain pharmacological thyroid homeostasis.
CONCLUSIONS: These findings show that lactose intolerance significantly increased the need for oral T4 in hypothyroid patients.
OBJECTIVE: The objective of the study was to assess the replacement T4 dose required in hypothyroid patients with lactose intolerance.
DESIGN: This was a cohort study.
SETTING: The study was conducted at an outpatient endocrinology unit in a University Hospital.
PATIENTS: The replacement T4 dose has been analyzed, from 2009 to 2012, in 34 hypothyroid patients due to Hashimoto's thyroiditis and lactose intolerance and being noncompliant with a lactose-free diet.
MAIN OUTCOME MEASURE: An individually tailored T4 dose was measured.
RESULTS: In all patients with isolated Hashimoto's thyroiditis, target TSH (median TSH 1.02 mU/L) was obtained at a median T4 dose of 1.31 μg/kg/d. In patients with lactose intolerance, only five of 34 patients reached the desired TSH (median TSH 0.83 mU/L) with a similar T4 dose (1.29 μg/kg/d). In the remaining 29 patients, the T4 dose was progressively increased and the target TSH (median TSH 1.21 mU/L) was attained at a median T4 dose of 1.81 μg/kg/d (+38%, P < .0001). In six of these patients, other gastrointestinal disorders were diagnosed, and their median T4 requirement was higher (2.04 μg/kg/d; +55%; P = .0032). In the remaining 23 patients with isolated lactose intolerance, a median T4 dose of 1.72 μg/kg/d (+31% P < .0001) has been required to attain pharmacological thyroid homeostasis.
CONCLUSIONS: These findings show that lactose intolerance significantly increased the need for oral T4 in hypothyroid patients.