Transient hypothyroidism can present itself as clinically asymptomatic or with few symptoms. Early treatment with levothyroxine (L-T4) prevents complications related to this disorder. We report a case of a male infant with concomitant short bowel syndrome and transient hypothyroidism treated with rectal L-T4. A 4-month-and-10-day-old boy with previous gastroschisis underwent multiple surgical approaches for small bowel resection and developed short bowel syndrome. We suspected hypothyroidism because of jaundice (direct bilirubin up to 59 mg/dL), the absence of evacuation, oral diet intolerance, and intestinal dysmotility. Because of a thyrotropin level of 34.45 μIU/mL and a free thyroxine level of 0.64 ng/dL, the diagnosis was confirmed. Because fasting was demanding, we started the patient on rectal diluted L-T4. After 4 weeks, the patient had spontaneous peristalsis, improvement of jaundice (direct bilirubin: 4.6 mg/dL), and normalized free thyroxine and thyrotropin values. In the present case, the patient was diagnosed with hypothyroidism and was on absolute fasting. An alternative route of drug administration was warranted. We empirically prescribed rectal diluted L-T4 when intravenous and suppository L-T4 were not available. This method was proven to be safe and effective in improving the patient’s clinical and biochemical status. Rectal L-T4 is a possible alternative route of administration to treat hypothyroidism in patients who are unable to take the medication orally.
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August 2018
Case Report|
August 01 2018
Rectal Levothyroxine for the Treatment of Hypothyroidism: A Case Study
Marina Ybarra, MD;
Pediatric Endocrinology Unit, Children’s Institute, University of São Paulo, São Paulo, Brazil
Address correspondence to Marina Ybarra, MD, MSc, Children's Institute - 647, Dr. Enéas de Carvalho Aguiar Avenue - São Paulo, SP, 05403-000, Brasil. E-mail: [email protected]
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Tiago Jeronimo dos Santos, MD;
Tiago Jeronimo dos Santos, MD
Pediatric Endocrinology Unit, Children’s Institute, University of São Paulo, São Paulo, Brazil
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Claudia Teixeira Cabido Pinheiro, MD;
Claudia Teixeira Cabido Pinheiro, MD
Pediatric Endocrinology Unit, Children’s Institute, University of São Paulo, São Paulo, Brazil
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Vaê Dichtchekenian, MD;
Vaê Dichtchekenian, MD
Pediatric Endocrinology Unit, Children’s Institute, University of São Paulo, São Paulo, Brazil
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Durval Damiani, MD
Durval Damiani, MD
Pediatric Endocrinology Unit, Children’s Institute, University of São Paulo, São Paulo, Brazil
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Address correspondence to Marina Ybarra, MD, MSc, Children's Institute - 647, Dr. Enéas de Carvalho Aguiar Avenue - São Paulo, SP, 05403-000, Brasil. E-mail: [email protected]
Dr Ybarra’s current affiliation is the Research Center of the Sainte-Justine University Hospital, Montreal, Canada.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pediatrics (2018) 142 (2): e20173317.
Article history
Accepted:
April 11 2018
Citation
Marina Ybarra, Tiago Jeronimo dos Santos, Claudia Teixeira Cabido Pinheiro, Vaê Dichtchekenian, Durval Damiani; Rectal Levothyroxine for the Treatment of Hypothyroidism: A Case Study. Pediatrics August 2018; 142 (2): e20173317. 10.1542/peds.2017-3317
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