Loss of antinociceptive effectiveness of morphine and oxycodone following titration of levothyroxine: Case reports and a brief review of published literature

Theresa A. Matoushek, PharmD; Tina C. Kearney, MD; Tammy J. Lindsay, MD, FAAFP; Christopher M. Herndon, PharmD, BCPS, CPE, FASHP

doi:10.5055/jom.2012.0115

Authors

Theresa A. Matoushek, PharmD
Tina C. Kearney, MD
Tammy J. Lindsay, MD, FAAFP
Christopher M. Herndon, PharmD, BCPS, CPE, FASHP

DOI:

https://doi.org/10.5055/jom.2012.0115

Keywords:

morphine, oxycodone, levothyroxine, thyroid, hypothyroid, opioid

Abstract

Chronic pain management is a complex process involving numerous facets of care. Although pharmacotherapy is a part of the treatment plan for these patients, it often represents the most complex of the modalities to manage. Two chronic pain patients with loss of pain control following dosage increase in levothyroxine supplementation are presented. The authors sought to identify relationships among thyroid status, opioid pharmacokinetics, and nociceptive processing. In conclusion, well-designed human studies using pain models and controlling for thyroid status are warranted to better understand the impact this system has on pain control.

Author Biographies

Theresa A. Matoushek, PharmD

Southern Illinois University Edwardsville, Edwardsville, Illinois

Tina C. Kearney, MD

Faculty Physician, Southern Illinois Healthcare Foundation, Illinois; Assistant Clinical Professor, Department of Family and Community Medicine, St. Louis University School of Medicine, Belleville, Illinois

Tammy J. Lindsay, MD, FAAFP

Clinical Associate Professor, St. Louis University Family Medicine Residency, St. Louis, Missouri; Military Program Director, United States Air Force

Christopher M. Herndon, PharmD, BCPS, CPE, FASHP

Associate Professor, School of Pharmacy, Southern Illinois University Edwardsville, Edwardsville, Illinois; Clinical Assistant Professor, St. Louis University School of Medicine, Edwardsville, Illinois

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