Evidence map›Paper›PMID 35477833›Full record

ArticleEndocrine2022

Levothyroxine treatment and gastric juice pH in humans: the proof of concept.

Camilla Virili, Giovanni Bruno, Maria Giulia Santaguida, Lucilla Gargano, Ilaria Stramazzo, Corrado De Vito, Alessia Cicenia, Giulia Scalese, Barbara Porowska, Carola Severi and 1 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Endocrine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Article
  3. Article
  4. Article
  5. Review
  6. Review
  7. Article
  8. Article
  9. Review
  10. Review
  11. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Camilla Virili *Department of Medico-surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy.
Giovanni Bruno *Department of Translational and Precision Medicine, Gastroenterology Unit, 'Sapienza" University of Rome, Rome, Italy.
Maria Giulia SantaguidaEndocrine Unit, AUSL Latina, Latina, Italy.
Lucilla GarganoEndocrine Unit, AUSL Latina, Latina, Italy.
Ilaria StramazzoDepartment of Medico-surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy.
Corrado De VitoDepartment of Public Health and Infectious Diseases, University of Rome, Rome, Italy.
Alessia CiceniaDepartment of Translational and Precision Medicine, Gastroenterology Unit, 'Sapienza" University of Rome, Rome, Italy.
Giulia ScaleseDepartment of Translational and Precision Medicine, Gastroenterology Unit, 'Sapienza" University of Rome, Rome, Italy.
Barbara PorowskaGeneral and Specialistic Surgery 'Paride Stefanini', University of Rome, Rome, Italy.
Carola SeveriDepartment of Translational and Precision Medicine, Gastroenterology Unit, 'Sapienza" University of Rome, Rome, Italy.
Marco CentanniDepartment of Medico-surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy. marco.centanni@uniroma1.it.ORCID 0000-0003-0661-1649

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeDespite the absorption of oral thyroxine (T4) occurs in the small bowel, several patients with gastric disorders show an increased need for T4. In vitro evidence suggested that medium pH variations interfere with T4 dissolution. This study was aimed at finding the proof of concept of a direct relationship between the minimal effective dose of T4 and the actual gastric juice pH. PATIENTS AND

methodsAmong 311 consecutively thyroxine-treated patients, 61 bearing Hashimoto's thyroiditis (52 F/9 M; median age = 51 years) who complained persistent dyspepsia and/or upper abdominal symptoms following a noninvasive workup for gastrointestinal disorders, underwent EGDS with multiple biopsies and gastric juice pH measurement. All patients accepted to take thyroxine in fasting conditions, abstaining from eating or drinking for one hour.

resultsThyroxine requirement increased along with the rising gastric pH (ρ = 0.4229; p = 0.0007). A multivariate analysis revealed that gastric pH was, beside body mass index, the far more important independent variable in determining the effective dose of T4 (p = 0.001). The ROC curve revealed that the pH threshold for an increased thyroxine requirement was at 2.28, being the AUC by 78%. Subdividing patients by the histologic findings, it appeared a significant increase (p = 0.0025) along with the progressive damage of gastric mucosa.

conclusionThe in vivo measurement of gastric pH highlighted its key role in determining the minimal effective dose of oral T4 and may explain the interference of food, of some drugs and gut disorders on levothyroxine treatment.

Indexed as

Hashimoto DiseaseThyroxineGastric JuiceHumansHydrogen-Ion ConcentrationMiddle AgedThyroxineAtrophic gastritisGastric juice pHHelicobacter pyloriHypothyroidismLevothyroxine doseLevothyroxine malabsorption

Identifiers

PMID35477833
PMCPMC9242941

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.