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l-thyroxine malabsorption due to calcium carbonate impairs blood pressure, total cholesterolemia, and fasting glycemia

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Abstract

Purpose

Calcium carbonate was previously shown to interfere with l-thyroxine absorption. To estimate the magnitude of tablet l-thyroxine malabsorption caused by calcium carbonate, with resulting increase in serum thyrotropin (TSH), we performed a cohort study in a referral care center.

Methods

Fifty postmenopausal hypothyroid l-thyroxine-treated women (age 71.7 ± 5.1 years) who added calcium supplementation (600–1000 mg/day) were considered. They were taking l-thyroxine 45–60 min before breakfast (setting 1). After 4.4 ± 2.0 years from initiation of l-thyroxine therapy, they took calcium supplemaentation within 2 h after l-thyroxine taking (setting 2) for 2.3 ± 1.1 years. Hence, we recommended postponing calcium intake 6–8 h after l-thyroxine (setting 3). We evaluated TSH levels, the prevalence of women with elevated TSH (>4.12 mU/L), total cholesterolemia, fasting glycemia, blood pressure, and the prevalence of hypercholesterolemia, hyperglycemia, and hypertension.

Results

TSH levels were 3.33 ± 1.93 mU/L versus 1.93 ± 0.51 or 2.16 ± 0.54 comparing setting 2 with setting 1 or 3 (P < 0.001, both). In setting 2, 18% women had elevated TSH versus none in setting 1 or 3 (P < 0.01). Total cholesterolemia, fasting glycemia, systolic, and diastolic blood pressure were also significantly higher in setting 2 compared to settings 1 and 3. For every 1.0 mU/L increase within the TSH range of 0.85–6.9 mU/L, total cholesterolemia, glycemia, systolic, and diastolic blood pressure increased by 12.1, 3.12 mg/dL, 2.31, and 2.0 mmHg, respectively.

Conclusions

Monitoring of hypothyroid patients who ingest medications that decrease l-thyroxine absorption should not be restricted to solely measuring serum TSH.

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Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Elisabetta Morini, Antonino Catalano, Antonino Lasco, Nunziata Morabito & Salvatore Benvenga

  2. Master Program on Childhood, Adolescent and Women’s Endocrine Health, University of Messina, Viale Gazzi, 98125, Messina, Italy

    Salvatore Benvenga

  3. Interdepartmental Program of Molecular & Clinical Endocrinology, and Women’s Endocrine Health, University Hospital Policlinico G. Martino, Messina, Italy

    Salvatore Benvenga

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  1. Elisabetta Morini
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Correspondence to Salvatore Benvenga.

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

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Morini, E., Catalano, A., Lasco, A. et al. l-thyroxine malabsorption due to calcium carbonate impairs blood pressure, total cholesterolemia, and fasting glycemia. Endocrine 64, 284–292 (2019). https://doi.org/10.1007/s12020-018-1798-7

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