{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:26:32Z","timestamp":1783445192766,"version":"3.54.6"},"reference-count":28,"publisher":"Bioscientifica","issue":"2","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":3917,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2015,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Nephrotic syndrome increases &amp;lt;smlcap&amp;gt;L&amp;lt;\/smlcap&amp;gt;-thyroxine requirements because of urinary loss of free and protein-bound thyroid hormones. We report 2 hypothyroid patients referred to us because of high serum TSH, even though the &amp;lt;smlcap&amp;gt;L&amp;lt;\/smlcap&amp;gt;-thyroxine daily dose was maintained at appropriate levels or was increased. The cause of nephrotic syndrome was multiple myeloma in one patient and diabetic glomerulosclerosis in the other patient. As part of the periodic controls for diabetes, urinalysis was requested only in the second patient so that proteinuria could be detected. However, as in the first patient, facial puffiness and body weight increase were initially attributed to hypothyroidism, which was poorly compensated by &amp;lt;smlcap&amp;gt;L&amp;lt;\/smlcap&amp;gt;-thyroxine therapy. In the first patient, the pitting nature of the pedal edema was missed at the initial examination. An endocrinologist consulted over the phone by the practitioner hypothesized some causes of intestinal malabsorption of &amp;lt;smlcap&amp;gt;L&amp;lt;\/smlcap&amp;gt;-thyroxine. This diagnosis would have been accepted had the patient continued taking a known sequestrant of &amp;lt;smlcap&amp;gt;L&amp;lt;\/smlcap&amp;gt;-thyroxine, i.e. calcium carbonate. The diagnostic workup of patients with increasing requirements of &amp;lt;smlcap&amp;gt;L&amp;lt;\/smlcap&amp;gt;-thyroxine replacement therapy should not be concentrated on the digestive system alone. Careful history taking and physical examination need to be thorough. Endocrinologists should not forget nephrotic syndrome that, in turn, can be secondary to serious diseases.<\/jats:p>","DOI":"10.1159\/000381310","type":"journal-article","created":{"date-parts":[[2015,5,28]],"date-time":"2015-05-28T07:31:36Z","timestamp":1432798296000},"page":"138-142","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-17","source":"Crossref","is-referenced-by-count":31,"title":["Do Not Forget Nephrotic Syndrome as a Cause of Increased Requirement of Levothyroxine Replacement Therapy"],"prefix":"10.1530","volume":"4","author":[{"given":"Salvatore","family":"Benvenga","sequence":"first","affiliation":[{"name":"1Department of Clinical and Experimental Medicine, Italy"},{"name":"2Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina School of Medicine, Italy"},{"name":"3Interdepartmental Program of Molecular and Clinical Endocrinology, and Women's Endocrine Health, University Hospital Policlinico G. Martino, Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Vita","sequence":"additional","affiliation":[{"name":"1Department of Clinical and Experimental Medicine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Di Bari","sequence":"additional","affiliation":[{"name":"1Department of Clinical and Experimental Medicine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poupak","family":"Fallahi","sequence":"additional","affiliation":[{"name":"4Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Antonelli","sequence":"additional","affiliation":[{"name":"4Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2015,5,28]]},"reference":[{"key":"2026070712453372100_ref1","doi-asserted-by":"crossref","unstructured":"Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, Pessah-Pollack R, Singer PA, Woeber KA; American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults: Clinical practice guidelines for hypothyroidism for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012;22:1200-1235.10.1089\/thy.2012.020522954017","DOI":"10.1089\/thy.2012.0205"},{"key":"2026070712453372100_ref2","unstructured":"Jonklaas J: Treatment of hypothyroidism; in Braverman LE, Cooper DS (eds): Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text, ed 10. Philadelphia, Wolters Kluwer, Lippincott Williams and Wilkins 2013, pp 611-628."},{"key":"2026070712453372100_ref3","doi-asserted-by":"crossref","unstructured":"Morris JC: How do you approach the problem of TSH elevation in a patient on high-dose thyroid hormone replacement? Clin Endocrinol 2009;70:671-673.10.1111\/j.1365-2265.2009.03536.x19226259","DOI":"10.1111\/j.1365-2265.2009.03536.x"},{"key":"2026070712453372100_ref4","doi-asserted-by":"crossref","unstructured":"Benvenga S: When thyroid hormone replacement is ineffective? 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