Refractory Hypothyroidism : Case Report and Littérature Review

Author(s)	Dr. Sara HASSANE, Dr. Widad MOUSSAOUI, Dr. Zineb SERHANE, Prof. Dr. Mohammed Amine ESSAFI, Prof. Dr. Zineb EL AZIME, Prof. Dr. Hayat AYNAOU, Prof. Dr. Houda SALHI
Country	Morocco
Abstract	Refractory hypothyroidism is characterized by persistent clinical and biochemical hypothyroidism despite high-dose levothyroxine therapy. We report the case of a 48-year-old woman with post-thyroidectomy hypothyroidism who remained severely hypothyroid despite levothyroxine doses exceeding 2 µg/kg/day. Evaluation excluded poor adherence and common upper gastrointestinal causes of malabsorption. A levothyroxine absorption test supported impaired intestinal absorption. Switching to a capsule formulation of levothyroxine resulted in initial biochemical normalization and clinical improvement. However, hypothyroidism later recurred despite continued therapy, suggesting a complex and possibly fluctuating absorption disorder. Intravenous thyroid hormone administration was proposed both to further investigate absorption dynamics and as a potential therapeutic alternative. This case highlights the importance of structured evaluation in refractory hypothyroidism and the challenges of its management.
Keywords	Refractory hypothyroidism, Levothyroxine malabsorption; Levothyroxine capsule.
Field	Medical / Pharmacy
Published In	Volume 8, Issue 3, May-June 2026
Published On	2026-06-10
DOI	https://doi.org/10.36948/ijfmr.2026.v08i03.80992

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