ArticleFrontiers in endocrinology2018
Increased Requirement of Replacement Doses of Levothyroxine Caused by Liver Cirrhosis.
Article in Frontiers in endocrinology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.
- ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism.European thyroid journal · 2025Guideline
- The gut-thyroid axis: physiological regulation of barrier function, microbiota, endocrine signaling and the consequences on energy metabolism.Frontiers in physiology · 2026Review
- Interplay between endocrine disorders and liver dysfunction: Mechanisms of damage and therapeutic approaches.World journal of gastroenterology · 2025Review
- Levothyroxine Requirement in a Patient with LRBA Deficiency and GVHD Induced Cholestasis.Sultan Qaboos University medical journal · 2025Article
- Levothyroxine: Conventional and Novel Drug Delivery Formulations.Endocrine reviews · 2023Review
- Medications and Food Interfering with the Bioavailability of Levothyroxine: A Systematic Review.Therapeutics and clinical risk management · 2023Review
- Levothyroxine personalized treatment: is it still a dream?Frontiers in endocrinology · 2023Article
- Evolution of non-thyroidal illness syndrome in acute decompensation of liver cirrhosis and acute-on-chronic liver failure.Frontiers in endocrinology · 2023Article
- Liquid levothyroxine formulations in patients taking drugs interfering with L-T4 absorption.Frontiers in endocrinology · 2022Review
- Thyroid diseases and second to fourth digit ratio in Polish adults.Scientific reports · 2021Article
- Managing symptoms in hypothyroid patients on adequate levothyroxine: a narrative review.Endocrine connections · 2020Review
- Review
- Liquid and softgel capsules of l-thyroxine results lower serum thyrotropin levels more than tablet formulations in hypothyroid patients.Journal of clinical & translational endocrinology · 2019Article
- Review
- Ulcerative Colitis as a Novel Cause of Increased Need for Levothyroxine.Frontiers in endocrinology · 2019Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSince hypothyroidism is a fairly common dysfunction, levothyroxine (L-T4) is one of the most prescribed medications. Approximately 70% of the administered L-T4 dose is absorbed. The absorption process takes place in the small intestine. Some disorders of the digestive system and some medicines, supplements, and drinks cause L-T4 malabsorption, resulting in failure of serum TSH to be normal. Only rarely liver cirrhosis is mentioned as causing L-T4 malabsorption. CASE REPORT: In this study, we report increased requirement of daily doses of l-thyroxine in two patients with the atrophic variant of Hashimoto's thyroiditis and liver cirrhosis. In one patient, this increased requirement could have been contributed by the increased serum levels of the estrogen-dependent thyroxine-binding globulin (TBG), which is the major plasma carrier of thyroid hormones. In the other patient, we switched from tablet L-T4 to liquid L-T4 at the same daily dose. Normalization of TSH levels was achieved, but TSH increased again when she returned to tablet L-T4.
conclusionLiver cirrhosis can cause increased L-T4 requirements. In addition to impaired bile secretion, the mechanism could be increased serum TBG. A similar increased requirement of L-T4 is observed in other situations characterized by elevation of serum TBG. Because of better intestinal absorption, L-T4 oral liquid formulation is able to circumvent the increased need of L-T4 in these patients.
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