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Goiter Patients with Gastritis May Require More Thyroxine

Higher doses recommended for patients with H. pylori–related gastritis, atrophic gastritis, or both\r\n\r\n

WEDNESDAY, April 26 (HealthDay News) -- Patients with euthyroid multinodular goiter and H. pylori-related gastritis or atrophic gastritis may require increased doses of thyroxine, according to a study published in the April 27 issue of the New England Journal of Medicine.

Marco Centanni, M.D., of the University La Sapienza in Rome, Italy, and colleagues studied 248 patients with multinodular goiter, including 53 with Helicobacter pylori-related gastritis, 60 with atrophic gastritis and 135 with no gastric disorders.

Compared with the reference group, the researchers found that thyroxine requirements were 22 percent to 34 percent higher in patients with H. pylori-related gastritis, atrophic gastritis, or both conditions. They stated that their findings support the hypothesis that gastric acid secretion is necessary for the effective absorption of oral thyroxine.

"Although the clinical importance of these findings is fairly clear, the mechanism by which intestinal absorption of thyroxine is impaired in patients with hypochlorhydria is unknown," the authors state. "We may only speculate that oral thyroxine is administered as sodium salt that is less lipophilic than the native hormone, which enters target cells both through passive diffusion and in a carrier-mediated, inhibitable way."

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