Serum TSH Levels Normalisation in Patients Affected by Autoimmune Atrophic Gastritis, After the Switch From Oral L-T4 in Tablet Form to L-T4 in Liquid Formulation

Abstract Patients affected by autoimmune atrophic gastritis could have some issues in L-thyroxine (L-T4) absorption, due to drug malabsorption, induced by the increased gastric pH. Different factors influence L-T4 absorption, such as dietary habits, interference with other drugs, absorption kinetics, age of the patient, adherence to therapy, and others. We enrolled 36 patients affected by autoimmune atrophic gastritis with high serum thyrotropin (TSH) levels under therapy with L-T4 in the tablet formulation. L-T4 tablets were changed to an oral liquid L-T4 preparation, maintaining the same dose. The switch from L-T4 in tablet formulation to the liquid one, at the same L-T4 dosage, led to the normalisation/reduction of circulating TSH levels. Then 14 patients, who were switched back again to receive L-T4 in tablets (with the same dose), had a worsening of TSH values, falling in the hypothyroid range. In conclusion, our findings led to hypothesize that the pH alteration issue caused by autoimmune atrophic gastritis could be overcome by the oral L-T4 liquid formulation administration.

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Reversible normalisation of serum TSH levels in patients with autoimmune atrophic gastritis who received L-T4 in tablet form after switching to an oral liquid formulation: a case series

BMC Gastroenterology ◽

10.1186/s12876-016-0439-y ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 20

Author(s):

Poupak Fallahi ◽

Silvia Martina Ferrari ◽

Ilaria Ruffilli ◽

Alessando Antonelli

Keyword(s):

Atrophic Gastritis ◽

Case Series ◽

Liquid Formulation ◽

Tablet Form ◽

Oral Liquid ◽

Autoimmune Atrophic Gastritis ◽

Serum Tsh ◽

Tsh Levels

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Oral Liquid L-Thyroxine (L-T4) May Be Better Absorbed in Comparison to L-T4 Tablets in Patients With Lactose Intolerance

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1696 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A832-A832

Author(s):

Poupak Fallahi ◽

Silvia Martina Ferrari ◽

Giusy Elia ◽

Francesca Ragusa ◽

Sabrina Rosaria Paparo ◽

...

Keyword(s):

Differential Diagnosis ◽

Coeliac Disease ◽

Atrophic Gastritis ◽

Lactose Intolerance ◽

Liquid Formulation ◽

Oral Liquid ◽

Tsh Levels

Abstract In patients with lactose intolerance (LI), L-thyroxine (L-T4) malabsorption is often present, that leads to the necessity to use elevated L-T4 doses in the substitutional treatment of hypothyroidism. After excluding non-compliance, the differential diagnosis should include such disorders as LI, atrophic gastritis, coeliac disease, and others. In case of a diagnosis of LI, a low lactose diet and a lactose-free L-T4 preparation should be administered, to decrease the dose of the L-T4 formulation, and restore euthyroidism. We report the normalisation of circulating thyrotropin (TSH) levels in 8 patients with LI who received L-T4 tablets, after switching to an oral liquid lactose-free formulation. After switching from oral tablets to the liquid L-T4 (at the same dose, 30 minutes before breakfast) TSH was significantly reduced (TSH, evaluated 1-3 months after the switch, decreased: from 7.5±3.1 to 3.2±2.4 μIU/mL, P<0.05). The return back to tablets (at the same dosage, 30 minutes before breakfast) caused thyrotropin levels to worsen again. This result leads us to believe that the absorption of oral liquid formulation of thyroxine is greater in these patients. In conclusion, these data suggest that the L-T4 oral liquid formulation could bypass the issue of malabsorption in patients with lactose intolerance.

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Stability of an Alternative Extemporaneous Captopril Fast-Dispersing Tablet Formulation Versus an Extemporaneous Oral Liquid Formulation

Clinical Therapeutics ◽

10.1016/j.clinthera.2012.10.005 ◽

2012 ◽

Vol 34 (11) ◽

pp. 2221-2229 ◽

Cited By ~ 5

Author(s):

Ritesh M. Pabari ◽

Claire McDermott ◽

James Barlow ◽

Zebunnissa Ramtoola

Keyword(s):

Tablet Formulation ◽

Liquid Formulation ◽

Oral Liquid

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T01.01.12 ANTI-PARIETAL CELL ANTIBODIES MAY BE NEGATIVE DESPITE HISTOLOGICAL CONFIRMATION OF AUTOIMMUNE ATROPHIC GASTRITIS: ROLE OF OLDER AGE

Digestive and Liver Disease ◽

10.1016/s1590-8658(20)30620-4 ◽

2020 ◽

Vol 52 ◽

pp. S56-S57

Author(s):

L. Conti ◽

M.V. Lenti ◽

A. Di Sabatino ◽

E. Miceli ◽

G. Galli ◽

...

Keyword(s):

Atrophic Gastritis ◽

Parietal Cell ◽

Older Age ◽

Parietal Cell Antibodies ◽

Autoimmune Atrophic Gastritis ◽

Histological Confirmation

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High serum cholesterol levels in persons with 'high-normal' TSH levels: should one extend the definition of subclinical hypothyroidism?

Acta Endocrinologica ◽

10.1530/eje.0.1380141 ◽

1998 ◽

pp. 141-145 ◽

Cited By ~ 81

Author(s):

G Michalopoulou ◽

M Alevizaki ◽

G Piperingos ◽

D Mitsibounas ◽

E Mantzos ◽

...

Keyword(s):

Total Cholesterol ◽

Serum Cholesterol ◽

Subclinical Hypothyroidism ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

High Serum ◽

High Serum Cholesterol ◽

Cholesterol Levels ◽

Group D ◽

Tsh Levels

OBJECTIVE: The association between established hypothyroidism and high cholesterol levels is well known. The aim of the present study was to investigate the effect of thyroxine (T4) administration on cholesterol levels in hypercholesterolemic subjects with TSH levels within the normal range ('high-normal' TSH compared with 'low-normal' TSH). DESIGN AND METHODS: We determined TSH levels in 110 consecutive patients referred for hypercholesterolemia (serum cholesterol >7.5 mmol/l). Those with 'high-normal' TSH (2.0-4.0 microU/ml) as well as those with 'low-normal' TSH (0.40-1.99 microU/ml) were randomly assigned to receive either 25 or 50 microg T4 daily for two months. Thus, groups A and B (low-normal TSH) received 25 and 50 microg T4 respectively and groups C and D (high-normal TSH) received 25 and 50 microg T4 respectively. Serum T4, tri-iodothyronine (T3), TSH, free thyroxine index, resin T3 uptake and thyroid autoantibodies (ThAab) as well as total cholesterol, high and low density lipoprotein cholesterol (HDL, LDL), and triglycerides were determined before and at the end of the two-month treatment period. RESULTS: TSH levels were reduced in all groups. The most striking effect was observed in group D (TSH levels before: 2.77+/-0.55, after: 1.41+/-0.85 microU/ml, P < 0.01). Subjects in groups C and D had a higher probability of having positive ThAabs. A significant reduction in total cholesterol (P < 0.01) and LDL (P < 0.01) was observed after treatment only in group D. In those subjects in group D who were ThAab negative, there was no significant effect of thyroxine on cholesterol levels. CONCLUSIONS: Subjects with high-normal TSH levels combined with ThAabs may, in fact, have subclinical hypothyroidism presenting with elevated cholesterol levels. It is possible that these patients might benefit from thyroxine administration.

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Efficacy and safety of DFN-15, an oral liquid formulation of celecoxib, in adults with migraine: a multicenter, randomized, placebo-controlled, double-blind, crossover study

Neuropsychiatric Disease and Treatment ◽

10.2147/ndt.s151834 ◽

2017 ◽

Vol Volume 13 ◽

pp. 2797-2802 ◽

Cited By ~ 5

Author(s):

Sagar Munjal ◽

Alix Bennett

Keyword(s):

Crossover Study ◽

Efficacy And Safety ◽

Liquid Formulation ◽

Double Blind ◽

Oral Liquid ◽

Blind Crossover Study ◽

Double Blind Crossover Study

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Proteomics signature of autoimmune atrophic gastritis: towards a link with gastric cancer

Gastric Cancer ◽

10.1007/s10120-020-01148-3 ◽

2021 ◽

Author(s):

Ombretta Repetto ◽

Valli De Re ◽

Paolo Giuffrida ◽

Marco Vincenzo Lenti ◽

Raffaella Magris ◽

...

Keyword(s):

Gastric Cancer ◽

Atrophic Gastritis ◽

Tricarboxylic Acid Cycle ◽

Differential Abundance ◽

Expression Levels ◽

2D Dige ◽

Gastric Corpus ◽

Gastric Biopsies ◽

H Pylori ◽

Autoimmune Atrophic Gastritis

Abstract Background Autoimmune atrophic gastritis (AAG) is a chronic disease that can progress to gastric cancer (GC). To better understand AAG pathology, this proteomics study investigated gastric proteins whose expression levels are altered in this disease and also in GC. Methods Using two-dimensional difference gel electrophoresis (2D-DIGE), we compared protein maps of gastric corpus biopsies from AAG patients and controls. Differentially abundant spots (|fold change|≥ 1.5, P < 0.01) were selected and identified by LC–MS/MS. The spots were further assessed in gastric antrum biopsies from AAG patients (without and with Helicobacter pylori infection) and from GC patients and unaffected first-degree relatives of GC patients. Results 2D-DIGE identified 67 differentially abundant spots, with 28 more and 39 less abundant in AAG-corpus than controls. LC–MS/MS identified these as 53 distinct proteins. The most significant (adjusted P < 0.01) biological process associated with the less abundant proteins was “tricarboxylic acid cycle”. Of the 67 spots, 57 were similarly differentially abundant in AAG-antrum biopsies irrespective of H. pylori infection status. The differential abundance was also observed in GC biopsies for 14 of 28 more abundant and 35 of 39 less abundant spots, and in normal gastric biopsies of relatives of GC patients for 6 and 25 spots, respectively. Immunoblotting confirmed the different expression levels of two more abundant proteins (PDIA3, GSTP gene products) and four less abundant proteins (ATP5F1A, PGA3, SDHB, PGC). Conclusion This study identified a proteomics signature of AAG. Many differential proteins were shared by GC and may be involved in the progression of AAG to GC.

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