Clinical Relevancy of the Levothyroxine–Continuous Enteral Nutrition Interaction

Background: The objective of this study was to determine if patients requiring levothyroxine therapy develop hypothyroidism during concurrent continuous enteral nutrition (EN). Methods: Adult patients with a history of hypothyroidism, given levothyroxine via the feeding tube at the same dose given p...

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Bibliographic Details
Published in:Nutrition in clinical practice 2010-12, Vol.25 (6), p.646-652
Main Authors: Dickerson, Roland N., Maish, George O., Minard, Gayle, Brown, Rex O.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
enteral nutrition
Enteral Nutrition - adverse effects
Enteral Nutrition - methods
Female
food‐drug interactions
Humans
hypothyroidism
Hypothyroidism - epidemiology
Hypothyroidism - etiology
Male
Middle Aged
Nursing
Thyroid Function Tests
thyroxine
Thyroxine - adverse effects
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Summary:Background: The objective of this study was to determine if patients requiring levothyroxine therapy develop hypothyroidism during concurrent continuous enteral nutrition (EN). Methods: Adult patients with a history of hypothyroidism, given levothyroxine via the feeding tube at the same dose given prior to hospital admission and who were referred to the nutrition support service for EN were evaluated. Thyroid function tests (TFTs) were performed prior to administration of levothyroxine–continuous EN, then approximately weekly thereafter. Patients who received less than 14 days of concurrent EN-levothyroxine therapy were excluded from the analysis. Results: Thirteen patients who received 20 ± 5 days of concurrent EN and levothyroxine were evaluated. Two patients developed subclinical hypothyroidism (thyrotropin [TSH] >6 and 10 mcIU/mL + low fT4) within 2 to 3 weeks of concurrent EN-levothyroxine therapy. Five patients remained euthyrotic. Differences between those who developed subclinical or overt hypothyroidism versus those who remained euthyrotic could not be explained by age, weight, levothyroxine dose, type of EN formula, or amount of EN received. Conclusions: More than half of the patients receiving concurrent levothyroxine–continuous EN developed subclinical or overt hypothyroidism requiring therapeutic intervention. Routine weekly monitoring of TFTs for patients receiving concurrent levothyroxine–continuous EN is recommended.
ISSN:0884-5336
1941-2452
DOI:10.1177/0884533610385701