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Sucralfate and the Absorption of L-Thyroxine
- John A. Campbell, MD;
- Barbara A. Schmidt, MD; and
- John P. Bantle, MD
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TO THE EDITOR:
Although an in vitro study showed binding of L-thyroxine by sucralfate [1], a later study showed that sucralfate did not interfere with in vivo absorption of replacement L-thyroxine in patients with hypothyroidism [2]. After encountering such a patient receiving replacement L-thyroxine who experienced a decrease in serum thyroxine (T4) index and a dramatic increase in serum thyrotropin after starting treatment with sucralfate, we studied the effect of sucralfate on L-thyroxine absorption.
After obtaining informed consent and baseline tests, nine patients with primary hypothyroidism were randomly assigned to treatment with sucralfate, 1 g 4 times daily or placebo, one capsule 4 times daily. The mean age was 37 years (range, 20 to 57 years), and the mean daily dose of L-thyroxine was 133 µg (range, 75 to 200 µg). Thyroid tests were obtained after 4 weeks of treatment. Therapy was discontinued for 2 weeks, and the patients then crossed over to the other study medication for 4 weeks. Both patients and investigators were masked to treatment and test results. All patients remained on their starting dose of L-thyroxine throughout the study. The results are shown in Table 1.
When compared with placebo, treatment with sucralfate produced a modest decrease in the serum T4 index (P = 0.038) and an increase in serum thyrotropin (P = 0.097) that was not statistically different. Only one patient treated with sucralfate developed an elevated serum thyrotropin level, and she also had an elevated thyrotropin value while receiving placebo, suggesting that she was not taking her medications reliably. Thus, our data suggest that sucralfate does not have a major effect on L-thyroxine absorption. However, because of the potential for a decrease in the serum T (4) index, thyroid function tests should be monitored during concomitant therapy with L-thyroxine and sucralfate.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
