Treatment Refractory Hypothyroidism Requiring High Dose Thyroxin Replacement

Abstract

causes of refractory hypothyroidism and approach for its diagnosis and management. Abstract A group of hypothyroid patients fails to achieve euthyroidism despite high doses of levothyroxine. These patients are designated as treatment refractory hypothyroidism. The prevalence of treatment-refractory hypothyroidism is not established. Noncompliance is one of the major issues in such cases .Other than noncompliance; impaired absorption due to gastrointestinal disease is a possibility. To achieve the target TSH or euthyroidism commonly the dose of levothyroxine is gradually increased but it may increase few adverse outcome, cost of investigation, follow up and treatment. Suspected patients should undergo a systematic approach for evaluation and management of this condition. In such a situation, there is a need to search for causes of decreased absorption of thyroxine or increased demand for thyroxine .This evaluation may help to reveal few underlying diseases and management of that disease may help to cure the refractoriness of levothyroxine replacement. An alternative formulation of levothyroxine may be prescribed to overcome the situation before going for detailed investigation. This article is emphasizing the diagnostic approach and management plan of such cases of treatment refractory hypothyroidism. intolerance, atrophic biliary pancreatic diversion, irritable bowel