{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:01:02Z","timestamp":1792080062435,"version":"4.4.0"},"reference-count":25,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["SAGE Open Medical Case Reports"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:p> Tablets of levothyroxine (LT4) are the most used form for the treatment of hypothyroidism. Some patients may present with refractory hypothyroidism despite a high daily LT4 dose. We report the case of a 49-year-old woman who was admitted to our department for refractory hypothyroidism. She was treated with 300 \u03bcg oral LT4 tablets daily (3.9 \u03bcg\/kg\/day). Despite good compliance and regular intake of high doses of LT4, she had persistent symptoms of hypothyroidism and a thyroid-stimulating hormone level of 92.4 mIU\/L. LT4 absorption test was consistent with the diagnosis of malabsorption. Etiological investigations revealed Helicobacter pylori gastritis. Helicobacter infection was adequately treated, but symptoms of hypothyroidism and elevated thyroid-stimulating hormone persisted. Increased LT4 doses (400 \u03bcg) failed to normalize thyroid-stimulating hormone levels. Thus, she was put on LT4 liquid form at a dose of 80 drops\/day per day (400 \u00b5g). Two weeks later, she presented with clinical and biological improvement with a normal free thyroxine level of 1.14 ng\/dL. Patients with gastrointestinal disorders may present with refractory hypothyroidism despite increasing doses of LT4. Switching to liquid formulation may resolve this problem. <\/jats:p>","DOI":"10.1177\/2050313x231209229","type":"journal-article","created":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T07:02:42Z","timestamp":1698908562000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Levothyroxine liquid oral substitution as an alternative treatment for refractory hypothyroidism due to gastrointestinal malabsorption: A case report"],"prefix":"10.1177","volume":"11","author":[{"given":"Faten","family":"Cherchir","sequence":"first","affiliation":[{"name":"Faculty of Medicine of Tunis, Department of Endocrinology, La Rabta University Hospital, University of Tunis El Manar, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4278-9447","authenticated-orcid":false,"given":"Ibtissem","family":"Oueslati","sequence":"additional","affiliation":[{"name":"Faculty 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