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Thyroxine softgel capsule in patients with gastric-related T4 malabsorption

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Abstract

The key role of an intact gastric acid secretion for subsequent intestinal T4 absorption is supported by an increased requirement of thyroxine in patients with gastric disorders. A better pH-related dissolution profile has been described in vitro for softgel T4 preparation than for T4 tablets. Our study was aimed at comparing softgel and tablet T4 requirements in patients with gastric disorders. A total of 37 patients with gastric-related T4 malabsorption were enrolled, but only 31 (28F/3M; median age = 50 years; median T4 dose = 2.04 μg/kg/day) completed the study. All patients were in long-lasting treatment (>2 years) with the same dose of T4 tablets when treatment was switched to a lower dose of softgel T4 capsules (−17 %; p = 0.0002). Assessment of serum FT4 and TSH was carried out at baseline and after 3, 6, 12, and 18 months after the treatment switch. In more than 2/3 of patients (good-responders n = 21), despite the reduced dose of T4, median TSH values were similar at each time point (p = 0.3934) with no change in FT4 levels. In the remaining patients (poor-responders n = 10), TSH levels were significantly higher at each time point than at baseline (p < 0.0001). To note, in five of them intestinal comorbidity was subsequently detected. Comorbidity associated with poor-responders status was the only significant predictor in multivariate analysis (OR = 11.333). Doses of softgel T4 capsules lower than T4 tablet preparation are required to maintain the therapeutic goal in 2/3 of patients with impaired gastric acid secretion.

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Acknowledgement

The support of native English Jaclyn McLoughlin in revising the manuscript is gratefully acknowledged. This study was supported by a University Grant from “Sapienza” University of Rome.

Conflict of interest

Marco Centanni received Symposia Honorarium from IBSA Institut Biochimique SA in the years 2010, 2011, and 2012. Nothing to disclose for all other authors.

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Authors and Affiliations

  1. Department of Medico-surgical Sciences and Biotechnologies, “Sapienza” University of Rome, Latina, Italy

    Maria Giulia Santaguida, Camilla Virili, Susanna Carlotta Del Duca, Miriam Cellini, Ilenia Gatto, Nunzia Brusca & Marco Centanni

  2. Epidemiology Section, Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy

    Corrado De Vito

  3. Endocrinology Unit, AUSL Latina, Latina, Italy

    Lucilla Gargano & Marco Centanni

  4. c/o Department of Experimental Medicine, V.le R. Elena 324, 00161, Rome, Italy

    Marco Centanni

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  1. Maria Giulia Santaguida
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Correspondence to Marco Centanni.

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Santaguida, M.G., Virili, C., Duca, S.C.D. et al. Thyroxine softgel capsule in patients with gastric-related T4 malabsorption. Endocrine 49, 51–57 (2015). https://doi.org/10.1007/s12020-014-0476-7

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