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This is why some men don’t absorb food well
Matt Cook here, and ulcerative colitis is an increasingly common inflammatory bowel disease.
It is at the extreme end of a range of gastrointestinal problems that perhaps the majority of people suffer from these days.
Gut problems like this affect absorption of foods, treatments, and supplements.
Let’s take a look at a number of papers investigating the role of ulcerative colitis in the absorption of thyroid hormones…
Something which is relevant to those with hypothyroidism and gut issues.
The first paper is a human study that was carried out at the Sapienza University of Rome and was published in Frontiers in Endocrinology.
This study looks at the absorption of thyroxine, also called Synthroid or T4.
“Thyroxine absorption takes place at the small intestine level, and several disorders affecting this intestinal tract lead to thyroxine malabsorption.”
The researchers studied more than a dozen people with confirmed ulcerative colitis and hypothyroidism – clinically low levels of thyroid hormones.
The participants were all in the remission phase of ulcerative colitis when they were studied.
“Thirteen of them were hypothyroid, bearing UC during the remission phase and in need of thyroxine treatment, thus representing the study group.”
The researchers compared the participants against similar thyroid patients who did not have any gastrointestinal problems.
“The dose of T4 required by UC patients was compared to that of 51 similarly treated age- and weight-matched patients, compliant with treatment and clearly devoid of any gastrointestinal disorder.”
The researchers defined the optimal dose of T4 as that which would bring the TSH into a certain optimal range.
Almost all patients with ulcerative colitis, even though they were in remission, needed more T4.
“In almost all hypothyroid (92%) patients with UC, the therapeutic dose of thyroxine is increased.”
Ulcerative colitis is just one of many conditions that can affect the absorption of foods, medicines, and supplements.
“Therefore, ulcerative colitis, even during clinical remission, should be included among the gastrointestinal causes of an increased need for oral thyroxine.”
The second paper is a case report of one woman who required extraordinary doses of thyroid hormones, which was published in Endocrine Abstracts.
The woman had hypothyroidism and active ulcerative colitis, as well as another gastrointestinal condition – celiac disease.
“A 49 yrs old lady was referred to us as her primary hypothyroidism deteriorated after exacerbation of her ulcerative colitis (UC). She also has coeliac disease.”
The woman was being treated with 175 mcg of T4. This is above the average of between 100 to 150 mcg per day.
But still, her TSH was way above where the doctors wanted it to be.
At that high dose, her TSH was at 40 – they wanted it below 5.
Her T4 levels were also low, even though she was on a relatively high dose.
“Although on oral T4 175 mcg, her TSH remained above 40, and T4 was low.”
The researchers gradually increased her daily dose up to a staggering 900 mcg per day!
But that didn’t help either.
“A stepwise increase of oral T4 to 900 mcg proved no benefit.”
The researchers gave her a liquid solution of T4, thinking it might help with absorption.
They also gave her a little oral T3 – the active thyroid hormone, too.
This did not help either.
“Changing to oral T4 tablets to syrup and addition of a low dose of oral T3 20 mcg also made no difference.”
Injections of the active thyroid hormone (T3) helped with some of her hypothyroid symptoms – but her TSH remained high.
“A trial low dose (20 mcg) of intravenous T3 injection showed improvement clinically while her TSH level remained elevated.”
Eventually, the researchers found that a very high dose of oral T4 and a relatively high dose of T3 was effective at reducing symptoms and TSH levels.
“Hence, a combination therapy of oral T4 (700 mcg) and a high dose of oral T3 (60 mcgs) was attempted.”
Some people with gut issues need otherwise extraordinary doses of thyroid hormones just to keep them healthy.
“She made remarkable improvement symptomatically, and her TSH was reduced to 6.6 and T4 increased to 8.5.”
Later, the doctors were able to lower her dose. Obviously, her ability to absorb their treatments had increased.
But later still, things got worse again, and she required very high levels of thyroid hormones again.
“She later had a flare-up of her UC during which her TSH increased to 40 while her FT4 decreased to <5.5.”
These doses of thyroid hormones could be harmful to many people – even those with hypothyroidism.
But in the case of people with gastrointestinal problems, they may be essential at certain times.
“High dose of oral T3 (40 mcg) therapy may be an effective treatment in patients suffering from inflammatory bowel disease (IBD) and/or coeliac disease if they do not respond to a high dose of oral T4.”
The dosing of thyroid hormones should always be guided by thyroid hormone labs and TSH levels…
…not by expectations or how someone responded at some point in the past.
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