Informing & Supporting Thyroid Patients Since 1985
Informing & Supporting Thyroid Patients Since 1985
Thyroid Research 
Thyroid Research Archive Thyroid Horme Therapy
(July 2006)
The background of the study. The absorption of thyroxine (T4) may be decreased in patients with gastrointestinal disorders and by drugs. In this study, the effect of Helicobacter pylori–related gastric inflammation (gastritis), gastric atrophy, and omeprazole on T4 absorption was determined.
How the study was done. The study subjects were 248 patients treated with T4 to reduce the size of a goiter. The T4 was given in doses that reduced their serum thyrotropin (TSH) concentrations to 0.05 to 0.2 mU/L (normal, 0.2 to 4.0). While taking T4, 113 had findings suggestive of decreased gastric acid secretion. They included 53 patients with H. pylori gastritis and 60 patients with gastric atrophy. The dose of T4 needed to maintain serum TSH concentrations between 0.05 to 0.2 mU/L in these 113 patients was compared with the dose needed in 135 patients with no gastrointestinal disorders (reference group).
In addition, 11 patients with goiter who were treated with T4 were studied before and at the time of diagnosis, and after successful therapy for H. pylori infection, and 10 patients with goiter who were treated with T4 were studied before and during long-term therapy with omeprazole (which blocks gastric acid secretion) for gastroesophageal reflux disease.
The results of the study. The doses of T4 needed to maintain serum TSH concentrations between 0.05 and 0.2 mU/L in the patients with H. pylori gastritis and those with gastric atrophy were 22 and 34 percent higher, respectively, than in the reference group.
The 11 patients who had H. pylori infection had a higher serum TSH concentration (1.35 mU/L) at the time of diagnosis of the infection, as compared with 0.11 and 0.12 mU/L before and after successful antibiotic and omeprazole therapy, while taking the same dose of T4.
The 10 patients who had gastroesophageal reflux had a serum TSH concentration of 0.10 mU/L, which increased to 1.70 mU/L during treatment with omeprazole.
The conclusions of the study. Patients treated with T4 need higher doses if they have H. pylori gastritis or gastric atrophy or are treated with omeprazole, indicating that gastric secretion of acid facilitates T4 absorption.
The original article. Centanni M, Gargano L, Canettieri G, Viceconti N, Franchi A, Delle Fave G, Annibale B. Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis. N Engl J Med 2006;354:1787-95.
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