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What Causes Malabsorption Due To Inflammation In Bowel And Hypothyroidism?
Question: Hi I have a history of Hypothyroidism, in the last year my blood tests have see sawed between Hypo and Hyper suspected cause is malabsorption due to inflammation in the bowel. My recent blood test is Ft4 is 18.8 (Ref range 12.00 to 22.00) my Tsh is 4.65 ( ref range .27 to 4.2) my doctor said no need to adjust my medication, I am concerned that I need a slight increase in my medication at present I am taking 100mg of eltroxin I have Coeliac Disease possibly Crohns awaiting diagnosis and episodes of Atrial Fibriliation.
Brief Answer:
No increase
Detailed Answer:
Thanks for contacting HCM with your health care concerns
You have a history of hypothyroidism and have been placed on eltroxin. Your most recent blood work shows your Ft4 to be within normal limits and that your TSH is just ever so slightly elevated at 4.65. You are concerned that the TSH is high and that you may need a slight raise in your dose to compensate for the high TSH. I have to agree with your doctor that no change is needed. The TSH is a really sensitive test for hypothyroid but the actual interpretation varies. The normal range is up to 4.2 and then there is a large gap between 4.2 and 6.2 that we don't usually diagnose with hypothyroidism. In my practice I will not start a person on thyroid medication unless the TSH is elevated above 6 and only after 2 blood draws are above 6. This is because the body is changing the levels every single day and one days test does not show the true level of thyroid function. I recommend that you have your TSH recheck again in 4-6 weeks and if TSH is still elevated then maybe consider a dose change.
You are also concerned about the absorption of eltroxin. A dose of eltroxin is absorbed in the small intestines and then even in normal people will be about 40-80% absorbed. Since Crohn's disease can affect the small intestine there maybe a small difference in you absorption rates. But what off sets the absorption is the long excretion phase. It takes 7-10 days to completely eliminate the medication. So despite varying amount of absorption your body keeps it so long in the body that your overall levels stay pretty much constant. That is another reason for not changing your dose. Because the eltroxin last so long in your system small changes in dose don't translate into better drug levels.
In summary
1. Slightly elevated TSH is OK
2. no dose changes needed
3. Absorption is affected by disease but long excretion times will not change drug levels.
4. Repeat TSH in 4-6 weeks
5. Taking your medication while fasting will improve drug absorption FYI
I hope I answered your question. Please contact HCM again with your health care concerns or questions.
No increase
Detailed Answer:
Thanks for contacting HCM with your health care concerns
You have a history of hypothyroidism and have been placed on eltroxin. Your most recent blood work shows your Ft4 to be within normal limits and that your TSH is just ever so slightly elevated at 4.65. You are concerned that the TSH is high and that you may need a slight raise in your dose to compensate for the high TSH. I have to agree with your doctor that no change is needed. The TSH is a really sensitive test for hypothyroid but the actual interpretation varies. The normal range is up to 4.2 and then there is a large gap between 4.2 and 6.2 that we don't usually diagnose with hypothyroidism. In my practice I will not start a person on thyroid medication unless the TSH is elevated above 6 and only after 2 blood draws are above 6. This is because the body is changing the levels every single day and one days test does not show the true level of thyroid function. I recommend that you have your TSH recheck again in 4-6 weeks and if TSH is still elevated then maybe consider a dose change.
You are also concerned about the absorption of eltroxin. A dose of eltroxin is absorbed in the small intestines and then even in normal people will be about 40-80% absorbed. Since Crohn's disease can affect the small intestine there maybe a small difference in you absorption rates. But what off sets the absorption is the long excretion phase. It takes 7-10 days to completely eliminate the medication. So despite varying amount of absorption your body keeps it so long in the body that your overall levels stay pretty much constant. That is another reason for not changing your dose. Because the eltroxin last so long in your system small changes in dose don't translate into better drug levels.
In summary
1. Slightly elevated TSH is OK
2. no dose changes needed
3. Absorption is affected by disease but long excretion times will not change drug levels.
4. Repeat TSH in 4-6 weeks
5. Taking your medication while fasting will improve drug absorption FYI
I hope I answered your question. Please contact HCM again with your health care concerns or questions.
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Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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