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Severe hypothyroidism in patients dependent on prolonged thyroxine infusion through a jejunostomy.
- Source :
-
Clinical nutrition (Edinburgh, Scotland) [Clin Nutr] 2000 Feb; Vol. 19 (1), pp. 65-7. - Publication Year :
- 2000
-
Abstract
- Background and Aims: Enteral absorption of thyroxine (T4) is variable; the duodenum and jejunum appear to be the most important sites of absorption. Our objective is to demonstrate that T4 infused via a standard jejunostomy may occasionally be poorly absorbed.<br />Methods: Two patients underwent esophagolaryngeal resection for carcinoma of the cervical esophagus. The procedure was accompanied by complete removal of the thyroid and parathyroid glands. A neck fistula at the gastropharyngeal anastomosis led to a restriction of oral intake; daily requirements of T4 and nutrients were given via the jejunostomy. T4 plasma levels deteriorated and thyroid-stimulating hormone (TSH) levels increased and in the third postoperative week, T4 (300 microg) was administered via a nasogastric tube.<br />Results: Although given a high dose (300 microg) of T4, both patients developed severe hypothyroidism. Infusion of T4 through the nasogastric tube precipitated the normalization of T4 and TSH plasma levels. Both patients (cases 1 and 2) resumed oral intake during the fifth and sixth postoperative weeks respectively.<br />Conclusion: T4 malabsorption may occur in patients dependent on prolonged T4 infusion via a standard jejunostomy.<br /> (Copyright 2000 Harcourt Publishers Ltd.)
- Subjects :
- Aged
Female
Humans
Hypothyroidism prevention & control
Intestinal Absorption
Jejunostomy
Middle Aged
Postoperative Period
Thyrotropin blood
Thyroxine blood
Thyroxine pharmacokinetics
Enteral Nutrition adverse effects
Esophageal Neoplasms surgery
Hypothyroidism etiology
Malabsorption Syndromes metabolism
Thyroxine administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 0261-5614
- Volume :
- 19
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Clinical nutrition (Edinburgh, Scotland)
- Publication Type :
- Academic Journal
- Accession number :
- 10700537
- Full Text :
- https://doi.org/10.1054/clnu.1999.0087