[Autoimmune hypothyroidism nonresponsive to high doses of levothyroxine and severe hypocalcemia].
The factors that make difficult the normalization of TSH in hypothyroidism need special attention because some patients on thyroxine replacement do not maintain a normal TSH. We report a 50 year-old woman with autoimmune hypothyroidism of difficult compensation, associated with anemia, hypocalcemia with a previous episode of tetany, hypomagnesemia, psychologic alterations and important weight loss. After compensation of the hypothyroidism with doses of L-thyroxine as high as 325 microg/day, the hypothesis of a malabsorptive syndrome was raised. Celiac disease was confirmed by elevated serum antigliadin antibody. A gluten-free diet was instituted which improved the symptoms associated with malabsorption and reduced the L-thyroxine requirement to 125 microg/day. Because several studies have shown an association of both diseases, a routine screening for celiac disease has been widely proposed in patients with autoimmune thyroid disease.
Silva
Cintia M dos Santos
CM
Serviço de Endocrinologia, Instituto Estadual de Diabetes e Endocrinologia Luis Capriglione, Rio de Janeiro, RJ.
Souza
Marcus Vinicius L de
MV
D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis / Q000178:diet therapy; D004351:Drug Resistance; D005260:Female; D050031:Hashimoto Disease / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D006996:Hypocalcemia / Q000150:complications*; D008875:Middle Aged; D012720:Severity of Illness Index; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000008:administration & dosage* / Q000493:pharmacokinetics
D013972:Thyrotropin; D013974:Thyroxine