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Higher thyroxine dose needed in patients with hypothyroidism and lactose intolerance
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Lactose intolerance may increase the likelihood that patients with hypothyroidism will need oral thyroxine, according to research published in The Journal of Clinical Endocrinology & Metabolism.
In a cohort study at the University of Roma, Latina, Italy, Miriam Cellini, a student in endocrine immunopathology, Marco Centanni, MD, and colleagues, looked at 34 patients with hypothyroidism due to Hashimoto’s thyroiditis (HT) and lactose intolerance (LI).
“The dose of thyroxine required to reach target thyroid-stimulating hormone (TSH) was higher in hypothyroid patients with HT and LI than in patients with isolated HT,” the researchers wrote.
The patients, all non-compliant with their lactose-free diet, were treated in an outpatient endocrinology unit at the institution’s hospital. The researchers evaluated the replacement dose of oral thyroxine between 2009 and 2012 to gauge which was appropriate for individuals.
In all patients, target TSH (median=1.02 mU/l) was reached with a median dose of 1.31 mcg/kg per day. Only five of 34 patients with lactose intolerance reached the desired TSH (median=0.83 mU/l) with a similar dose of 1.29 mcg/kg per day.
With progressive thyroxine dose increases, the remaining 29 patients reached the target TSH (median=1.21 mU/l) with a median of 1.81 mcg/kg per day (+38%, P<.0001). Of these, six were diagnosed with other gastrointestinal disorders and had a higher median dose requirement of 2.04 mcg/kg per day (+55%; P=.0032).
The 23 patients with isolated LI required a median dose of 1.72 mcg/kg per day (+31% P<.0001) to attain pharmacologic thyroid homeostasis.
The pathogenic mechanism leading to the need for increased thyroxine dose in patients with LI remains unclear, the researchers wrote.
Disclosures: This work was supported by the University of Roma, University Grant.
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