Abstract
Background: Oral levothyroxine (L-T4) supplementation is usually an effective therapy in pediatric hypothyroidism, except in patients with malabsorption or pseudomalabsorption. In these cases, parenteral L-T4 may be required, but there is a paucity of information about this delivery method in the pediatric population.
Case presentation: We present three cases of pediatric patients with primary hypothryoidism unresponsive to oral L-T4 that were successfully treated with intramuscular (IM) L-T4.
Conclusions: This is the first pediatric case series of successful IM L-T4 therapy in refractory primary hypothyroidism. Our case series demonstrates that once weekly IM L-T4 dosing may be a safe and well tolerated treatment regimen for pediatric patients.
References
1. Lifshitz F. Pediatric endocrinology, 5th ed. New York, NY: Informa Healthcare, 2009:787.Search in Google Scholar
2. Mussa GC, Corrias A, Mostert M, Pellegrino D, Silvestro L. Patients with Hashimoto’s disease treated with L-thyroxine and followed for three years. J Pediatr Endocr Met 1998;11:59–62.10.1515/JPEM.1998.11.1.59Search in Google Scholar PubMed
3. Ellerbroek V, Warncke K, Kohle J, Bonfig W. A levothyroxine dose recommendation for the treatment of children and adolescents with autoimmune thyroiditis induced hypothyroidism. J Pediatr Endocr Met 2013;26:1023–8.10.1515/jpem-2013-0038Search in Google Scholar PubMed
4. Anderson L, Joseph F, Goenka N, Patel V. Isolated thyroxine malabsorption treated with intramuscular thyroxine injections. Am J Med Sci 2009;337:150–2.10.1097/MAJ.0b013e31817ee556Search in Google Scholar PubMed
5. Ramadhan A, Tamilia M. Treatment-refractory hypothyroidism. Can Med Assoc J 2012;184:205–9.10.1503/cmaj.110994Search in Google Scholar PubMed PubMed Central
6. Eledrisi MS, Szymajda A, Alshanti M, Urban RJ. Noncompliance with medical treatment: pseudomalabsorption of levothyroxine. Southern Med J 2001;94:833–6.10.1097/00007611-200194080-00017Search in Google Scholar
7. Payer J, Sladekova K, Kinova S, Cesnakova Z, Killinger Z, et al. Autoimmune thyroiditis with severe hypothyroidism resistant to the treatment with high peroral doses of thyroxine: case report. Endocr Regul 2000;34:189–93.Search in Google Scholar
8. Kalathil D, Rajeev S, Chattington P. Hypothyroidism treated with intramuscular thyroxine injections. Endocr Abst 2012;28:359.Search in Google Scholar
9. Damle N, Bal C, Soundararajan R, Kumar P, Durgapal P. A curious case of refractory hypothyroidism due to selective malabsorption of oral thyroxine. Indian J Endocrinol Metab 2012;16:466–8.10.4103/2230-8210.95716Search in Google Scholar PubMed PubMed Central
10. Nagaoka T, Miyakoshi H, Takamura T, Nagai Y, Matsushita S, et al. A case of refractory hypothyroidism requiring daily intravenous thyroxine. J Int Med Res 2002;30:463–5.10.1177/147323000203000418Search in Google Scholar PubMed
11. Tonjes A, Karger S, Koch CA, Paschke R, Tannapfel A, et al. Impaired enteral levothyroxine absorption in hypothyroidism refractory to oral therapy after thyroid ablation for papillary thyroid cancer: case report and kinetic studies. Thyroid 2006;16:1047–51.10.1089/thy.2006.16.1047Search in Google Scholar PubMed
12. Groener JB, Lehnhoff D, Piel D, Nawroth PP, Schanz J, et al. Subcutaneous application of levothyroxine as successful treatment option in a patient with malabsorption. Am J Case Rep 2013;14:48–51.10.12659/AJCR.883788Search in Google Scholar PubMed PubMed Central
13. Taylor PN, Tabasum A, Sanki G, Burberry D, Tennant BP, et al. Weekly intramuscular injection of levothyroxine following myxoedema: a practical solution to an old crisis. Case Rep Endocrinol 2015;2015:169194.10.1155/2015/169194Search in Google Scholar PubMed PubMed Central
14. Grebe SK, Cooke RR, Ford HC, Fagerstrom JN, Cordwell DP, et al. Treatment of hypothyroidism with once weekly thyroxine. J Clin Endocr Metab 1997;82:870–5.10.1210/jc.82.3.870Search in Google Scholar
15. Balla M, Jhingan RM, Rubin DJ. Rapid levothyroxine absorption testing: a case series of nonadherent patients. Int J Endocrinol Metab 2015;13:e31051.10.5812/ijem.31051Search in Google Scholar PubMed PubMed Central
16. Lewandowski KC, Dabrowska K, Komorowska-Dudek I, Lewinski A. A single bolus of high dose levothyroxine (L-T4) as a test in cases of suspected poor compliance to L-T4 therapy. Thyroid Res 2015;8:16.10.1186/s13044-015-0028-0Search in Google Scholar PubMed PubMed Central
17. Walker JN, Shillo P, Ibbotson V, Vincent A, Karavitaki N, et al. A thyroxine absorption test followed by weekly thyroxine administration: a method to assess non-adherence to treatment. Eur J Endocrinol 2013;168:913–7.10.1530/EJE-12-1035Search in Google Scholar PubMed
©2016 by De Gruyter
Articles in the same Issue
- Frontmatter
- Review
- Medullary thyroid carcinoma: a review on ethical considerations in treatment of children
- Original Articles
- Monocyte chemoattractant protein 1 and macrophage migration inhibitory factor in children with type 1 diabetes
- Organ-specific autoimmunity in relation to clinical characteristics in children with long-lasting type 1 diabetes
- Seasonality of diagnosis of type 1 diabetes mellitus in the Netherlands (Young Dudes-2)
- Health-related quality of life in children and adolescents with type 1 diabetes mellitus from Montenegro: relationship to metabolic control
- Relation of fetuin A levels with cardiac, subcutaneous lipid accumulation and insulin resistance parameters in Turkish obese children
- Prooxidant-antioxidant balance in patients with phenylketonuria and its correlation to biochemical and hematological parameters
- Serum vaspin concentrations in girls with anorexia nervosa
- Effect of intramuscular cholecalciferol megadose in children with nutritional rickets
- Focus on BMI and subclinical hypothyroidism in adolescent girls first examined for amenorrhea or oligomenorrhea. The emerging role of polycystic ovary syndrome
- Absence of a relationship between thyroid hormones and vitamin D levels
- Parathyroid hormone-ionized calcium dynamics over the first year of life
- Biochemical markers of bone turnover in children with clinical bone fragility
- Adipocytokines and bone metabolism markers in relation to bone mineral values in early pubertal boys with different physical activity
- Bone mineral density in young Chilean patients with type 1 diabetes mellitus
- Case Reports
- A case of mature teratoma with a falsely high serum estradiol value measured with an immunoassay
- Leigh syndrome associated with a novel mutation in the COX15 gene
- More than one way to skin a thyroid. Managing pediatric hypothyroidism with weekly intramuscular levothyroxine
- First case report of rare congenital adrenal insufficiency caused by mutations in the CYP11A1 gene in the Czech Republic
- Arg924X homozygous mutation in insulin receptor gene in a Tunisian patient with Donohue syndrome
- Corrigendum
- Corrigendum to: Exposure to sunshine early in life prevented development of type 1 diabetes in Danish boys
Articles in the same Issue
- Frontmatter
- Review
- Medullary thyroid carcinoma: a review on ethical considerations in treatment of children
- Original Articles
- Monocyte chemoattractant protein 1 and macrophage migration inhibitory factor in children with type 1 diabetes
- Organ-specific autoimmunity in relation to clinical characteristics in children with long-lasting type 1 diabetes
- Seasonality of diagnosis of type 1 diabetes mellitus in the Netherlands (Young Dudes-2)
- Health-related quality of life in children and adolescents with type 1 diabetes mellitus from Montenegro: relationship to metabolic control
- Relation of fetuin A levels with cardiac, subcutaneous lipid accumulation and insulin resistance parameters in Turkish obese children
- Prooxidant-antioxidant balance in patients with phenylketonuria and its correlation to biochemical and hematological parameters
- Serum vaspin concentrations in girls with anorexia nervosa
- Effect of intramuscular cholecalciferol megadose in children with nutritional rickets
- Focus on BMI and subclinical hypothyroidism in adolescent girls first examined for amenorrhea or oligomenorrhea. The emerging role of polycystic ovary syndrome
- Absence of a relationship between thyroid hormones and vitamin D levels
- Parathyroid hormone-ionized calcium dynamics over the first year of life
- Biochemical markers of bone turnover in children with clinical bone fragility
- Adipocytokines and bone metabolism markers in relation to bone mineral values in early pubertal boys with different physical activity
- Bone mineral density in young Chilean patients with type 1 diabetes mellitus
- Case Reports
- A case of mature teratoma with a falsely high serum estradiol value measured with an immunoassay
- Leigh syndrome associated with a novel mutation in the COX15 gene
- More than one way to skin a thyroid. Managing pediatric hypothyroidism with weekly intramuscular levothyroxine
- First case report of rare congenital adrenal insufficiency caused by mutations in the CYP11A1 gene in the Czech Republic
- Arg924X homozygous mutation in insulin receptor gene in a Tunisian patient with Donohue syndrome
- Corrigendum
- Corrigendum to: Exposure to sunshine early in life prevented development of type 1 diabetes in Danish boys