Gastroparesis: A Novel Cause of Persistent Thyroid Stimulating Hormone Elevation in Hypothyroidism

The document reported a case of a 77-year-old man with hypothyroidism who required unusually high doses of levothyroxine due to persistent thyroid stimulating hormone (TSH) elevation, despite being compliant with medication and having no interfering conditions like celiac disease or Helicobacter pylori infection. The patient had a complex medical history, including diabetes and cardiovascular disease, and was on multiple medications. A gastric emptying study confirmed gastroparesis, which was identified as a novel cause of thyroxine malabsorption. This case suggested that gastroparesis should be considered in patients with persistent TSH elevation despite standard thyroxine treatment.