Reply

I read with interest the letter from Benvenga about the risk of undertreated hypothyroidism due to impaired intestinal absorption of levothyroxine caused by orally taken medications. Despite the scarcity of the available evidence to shed light on pharmacokinetic changes near the end of life, several studies have suggested that the optimal absorption of medications is often compromised as death approaches and as the number of ingested medications increases.1 In our retrospective cohort of 511,843 older adults who died between 2007 and 2013,2 we found that during the last month of life, 4.0% were exposed to levothyroxine and antacids (expected prevalence 3.8%), 1.9% were exposed to levothyroxine and calcium (expected prevalence 1.4%), and 1.3% were exposed to levothyroxine and iron (expected prevalence 1.1%).
Source: The American Journal of Medicine - Category: General Medicine Authors: Tags: Letter Source Type: research