{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:01:00Z","timestamp":1792080060338,"version":"4.4.0"},"reference-count":21,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>We assessed the effectiveness of administering subcutaneous levothyroxine in a medically complex patient, a 51-year-old male who previously underwent total thyroidectomy for papillary thyroid carcinoma. His thyrotropin (TSH) worsened to &gt;100 mIU\/L, caused by encapsulating sclerosing peritonitis that led to thyroxine malabsorption and enteral loss of protein-bound thyroxine. Several routes of levothyroxine were evaluated prior to subcutaneous levothyroxine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Subcutaneous levothyroxine was initiated at a low dose of 100 mcg thrice a week. A pharmacokinetic absorption study was performed to assess the bioavailability of subcutaneous levothyroxine against oral levothyroxine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A 103% increase in free thyroxine at 6 hours post-subcutaneous levothyroxine 100 mcg confirmed effective absorption. Area-under-curve analysis showed that the relative bioavailability of subcutaneous levothyroxine was 8.75 times of oral levothyroxine for our patient. Hence, subcutaneous levothyroxine was initiated, with TSH normalizing 20 days later.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Subcutaneous levothyroxine may be an alternative in patients with oral malabsorption.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10507256251409071","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T11:33:07Z","timestamp":1767094387000},"page":"108-112","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Subcutaneous Levothyroxine Administration in Treatment of Refractory Primary Hypothyroidism: A Case Report"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0838-6721","authenticated-orcid":false,"given":"Lawrence Siu-Chun","family":"Law","sequence":"first","affiliation":[{"name":"Endocrinology Division, Department of Medicine, National University Hospital, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9217-1455","authenticated-orcid":false,"given":"Nicholas Wei Xiang","family":"Kuu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, National University Hospital, Singapore."},{"name":"Duke-NUS Graduate Medical School, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1897-5762","authenticated-orcid":false,"given":"Melissa Hui Ting","family":"Leong","sequence":"additional","affiliation":[{"name":"Endocrinology Division, Department of Medicine, National University Hospital, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0763-2639","authenticated-orcid":false,"given":"Siang Fei","family":"Yeoh","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, National University Hospital, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha Peiling","family":"Yang","sequence":"additional","affiliation":[{"name":"Endocrinology Division, Department of Medicine, National University Hospital, Singapore."},{"name":"Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-017-0706-y"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.12659\/AJCR.883788"},{"issue":"5","key":"e_1_3_3_4_2","first-page":"664","article-title":"Subcutaneous administration of levothyroxine: A novel approach to refractory hypothyroidism\u2014A review and a case report","volume":"65","author":"Topf A","year":"2021","unstructured":"Topf A, , Pleininger T, , Motloch LJ, et al. Subcutaneous administration of levothyroxine: A novel approach to refractory hypothyroidism\u2014A review and a case report. Arch Endocrinol Metab, 2021; 65(5):664\u2013668.","journal-title":"Arch Endocrinol Metab"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000029690"},{"issue":"6","key":"e_1_3_3_6_2","first-page":"487","article-title":"A rare case of malabsorption of thyroid hormones","volume":"17","author":"Nobre EL","year":"2004","unstructured":"Nobre EL, , Jorge Z, , Anselmo J, et al. A rare case of malabsorption of thyroid hormones. Acta M\u00e9dica Portuguesa, 2004; 17(6):487\u2013491.","journal-title":"Acta M\u00e9dica Portuguesa"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-200194080-00017"},{"key":"e_1_3_3_8_2","first-page":"169194","article-title":"Weekly intramuscular injection of levothyroxine following Myxoedema: A practical solution to an old crisis","volume":"2015","author":"Taylor PN","year":"2015","unstructured":"Taylor PN, , Tabasum A, , Sanki G, et al. Weekly intramuscular injection of levothyroxine following Myxoedema: A practical solution to an old crisis. Case Rep Endocrinol, 2015; 2015:169194.","journal-title":"Case Rep Endocrinol"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jnma.2017.05.007"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1159\/000503324"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.15761\/CRT.1000291"},{"issue":"2012","key":"e_1_3_3_12_2","first-page":"P359","article-title":"Hypothyroidism treated with intramuscular thyroxine injections","volume":"28","author":"Kalathil D","year":"2012","unstructured":"Kalathil D, , Rajeev S, , Chattington P. Hypothyroidism treated with intramuscular thyroxine injections. Endocrine Abstracts, 2012; 28(SFEBES2012):P359.","journal-title":"Endocrine Abstracts"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1530\/ETJ-25-0012"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0020"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/10507256251363120"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdz400"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad132"},{"key":"e_1_3_3_18_2","unstructured":"Fresenius Kabi Canada. Product monograph: Levothyroxine sodium for injection. 2024. Available from: https:\/\/www.fresenius-kabi.com\/content\/dam\/fresenius-kabi\/ca\/products\/product-documents\/iv-drugs\/levothyroxine-sodium-for-injection_\/Product%20Monograph.pdf.coredownload.inline.pdf"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2885.2004.00604.x"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2301594"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1210\/endrev\/bnac030"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/cts.70244"}],"container-title":["Thyroid\u00ae"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10507256251409071","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10507256251409071","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10507256251409071","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:10:36Z","timestamp":1787065836000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10507256251409071"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,30]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,1]]}},"alternative-id":["10.1177\/10507256251409071"],"URL":"https:\/\/doi.org\/10.1177\/10507256251409071","relation":{},"ISSN":["1050-7256","1557-9077"],"issn-type":[{"value":"1050-7256","type":"print"},{"value":"1557-9077","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,30]]}}}