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Kenneth B. Ain, MD; Samuel Refetoff, MD; Henry G. Fein, MD; Bruce D. Weintraub, MD

JAMA. 1991;266(15):2118-2120.

Abstract
Objective.
—The issue of patient compliance with pharmacological therapy vs malabsorption of medication was explored in the context of persistent hypothyroidism despite the administration of large doses of levothyroxine sodium.

Design.
—Retrospective case series.

Setting.
—Referred care in two large tertiary care centers.

Patients.
—Four patients, seen within two decades, with clinical and biochemical hypothyroidism while receiving levothyroxine, were evaluated for selective malabsorption of this hormone.

Interventions.
—Studies included serial measurements of thyroid hormone levels after a loading dose of levothyroxine or liothyronine sodium or evaluation with a double-labeled thyroxine tracer technique. Results were compared with studies of levothyroxine malabsorption in the medical literature.

Results.
—All patients were ultimately found to have normal (82% to 100%) absorption of oral levothyroxine. There was no evidence that malabsorption of levothyroxine can occur as an isolated abnormality.

Conclusions.
—Some patients exhibit a factitious disorder suggesting malabsorption of levothyroxine. When treating hypothyroidism, psychiatric issues may result in noncompliance with levothyroxine therapy.

(JAMA. 1991;266:2118-2120)

Author Affiliations
From the Clinical Endocrinology Branch (Dr Ain) and the Metabolic, Cellular, and Nutritional Endocrinology Branch (Dr Weintraub), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md; the Departments of Medicine and Pediatrics, University of Chicago (Ill) (Dr Refetoff); and the Department of Clinical Physiology, Walter Reed Army Institute of Research, Washington, DC (Dr Fein). Dr Ain is now with the Division of Endocrinology and Metabolism, University of Kentucky Medical Center, Lexington, and the Department of Veterans Affairs Medical Center, Lexington, Ky.

Footnotes
The opinions or assertions contained herein are the private views of the authors and are not to be construed as reflecting the opinions of the Department of the Army or the Department of Defense.

Reprint requests to Division of Endocrinology and Metabolism, Room MN520, University of Kentucky Medical Center, 800 Rose St, Lexington, KY 405360084 (Dr. Ain).

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