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Lobasso A, Nappi L, Barbieri L, et al. Severe Hypothyroidism due to the Loss of Therapeutic Efficacy of l-Thyroxine in a Patient with Esophageal Complication Associated with Systemic Sclerosis. Front Endocrinol (Lausanne). 2017;8:241doi: 10.3389/fendo.2017.00241.
Lobasso, A., Nappi, L., Barbieri, L., Peirce, C., Ippolito, S., Arpaia, D., Rossi, F. W., de Paulis, A., & Biondi, B. (2017). Severe Hypothyroidism due to the Loss of Therapeutic Efficacy of l-Thyroxine in a Patient with Esophageal Complication Associated with Systemic Sclerosis. Frontiers in endocrinology, 8241. https://doi.org/10.3389/fendo.2017.00241
Lobasso, Antonio, et al. "Severe Hypothyroidism due to the Loss of Therapeutic Efficacy of l-Thyroxine in a Patient with Esophageal Complication Associated with Systemic Sclerosis." Frontiers in endocrinology vol. 8 (2017): 241. doi: https://doi.org/10.3389/fendo.2017.00241
Lobasso A, Nappi L, Barbieri L, Peirce C, Ippolito S, Arpaia D, Rossi FW, de Paulis A, Biondi B. Severe Hypothyroidism due to the Loss of Therapeutic Efficacy of l-Thyroxine in a Patient with Esophageal Complication Associated with Systemic Sclerosis. Front Endocrinol (Lausanne). 2017 Sep 20;8:241. doi: 10.3389/fendo.2017.00241. eCollection 2017. PMID: 28979239; PMCID: PMC5611405.
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Front Endocrinol (Lausanne). 2017 Sep 20;8:241. doi: 10.3389/fendo.2017.00241. eCollection 2017.

Severe Hypothyroidism due to the Loss of Therapeutic Efficacy of l-Thyroxine in a Patient with Esophageal Complication Associated with Systemic Sclerosis.

Frontiers in endocrinology

Antonio Lobasso, Liliana Nappi, Letizia Barbieri, Carmela Peirce, Serena Ippolito, Debora Arpaia, Francesca Wanda Rossi, Amato de Paulis, Bernadette Biondi

Affiliations

  1. Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.
  2. Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.

PMID: 28979239 PMCID: PMC5611405 DOI: 10.3389/fendo.2017.00241

Abstract

BACKGROUND: Thyroid function abnormalities and thyroid autoantibodies have been frequently described in patients with systemic autoimmune diseases as systemic sclerosis (SSc). Serum TSH levels are higher in SSc patients with more severe skin diseases and a worse modified Rodnan skin score. Asymptomatic esophageal involvement due to SSc has never been described as a cause of severe hypothyroidism due to l-thyroxine (l-T4) malabsorption in patients with Hashimoto's thyroiditis (HT) and SSc.

CASE REPORT: Here, we report a case of a 56-year-old female affected by both SSc and HT who developed severe hypothyroidism due to the loss of therapeutic efficacy of l-T4. Therapeutic failure resulted from the altered l-T4 absorption because of SSc esophageal complications. Clinical findings improved after the administration of oral liquid l-T4. Thyroid function completely normalized with a full clinical recovery, the disappearance of the pericardial effusion and the improvement of the pulmonary pressure.

CONCLUSION: A recognition of a poor absorption is crucial in patients with hypothyroidism and SSc to reduce the risk of the subsequent adverse events. This case suggests the importance of clinical and laboratory surveillance in patients with SSc and HT because the systemic complications of these dysfunctions may worsen the prognosis of hypothyroid SSc/HT patients.

Keywords: autoimmunity; hashomoto thyroiditis; hypothyrodism; l-thyroxine liquid formulation; sclerosis systemic; systemic sclerosis

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