Marked Improvement of Levothyroxine Malabsorption by Simply Changing the Timing of Thyroxine Ingestion in an Adult Woman With Hypothyroidism After Radioiodine Therapy for Graves’ Disease
Bibliographic record
Abstract
We report the case of a 37-year-old woman suffering from hypothyroidism resistant to oral levothyroxine (LT4) substitution after radioiodine therapy for Graves’ disease. She was admitted to our endocrinology clinic for persistent hypothyroidism despite administration of full-dose LT4 (175 m g/day). The patient complained of severe general fatigue, leg edema, and body weight gain. Her serum free thyroxine (FT4) and thyrotropin (TSH) levels were 0.64 ng/dL and 58.0 mIU/L, respectively. Extensive investigations excluded disease of the small bowel, liver, and pancreas, as well as drug interactions. She also had no gastrointestinal diseases (for exmple, ulcer, inflammatory colitis). We were also able to rule out failure to take LT4 and concomitant use of other drugs. One month after changing the timing of LT4 ingestion from after breakfast to before breakfast, her serum TSH level did not decrease and her serum FT4 level increased from 0.64 to 1.02 ng/dL. The symptoms of hypothyroidism remained unchanged. We then changed the timing of LT4 ingestion from morning to bedtime. One month later, her serum TSH level had normalized and signs of hypothyroidism had disappeared. This case emphasizes the clinical importance of the timing of thyroxine ingestion in not a few patients with hypothyroidism resistant to LT4, although the reason for the malabsorption in this patient remains unclear. J Endocrinol Metab. 2012;2(6):232-234 doi: https://doi.org/10.4021/jem129w
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".