Massive thyroxine intoxication: evaluation of plasma extraction

Binimelis, J.; Bassas, Lluís; Marruecos, Laura; Rodríguez, Josep Maria Trigo i; Domingo, Manel Puig; Madoz, P; Armengol, S.; Mangues, M. A.; Leiva, Alberto de

doi:10.1007/bf00263555

Cited by 70 publications

(69 citation statements)

References 19 publications

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“…While this is effective in the short-term, its effect is transient and so TPE cannot be used as definitive therapy. In an emergency or in the absence of response to other treatments, it is necessary, therefore, to resort to consolidation therapies such as thyroidectomy [3,22,23]. The therapy goal is not only to achieve a reduction in biochemical markers, however, but also to reduce the incidence of clinical outcomes such as thyroid storm and associated mortality.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Plasmapheresis in Patients with Thyrotoxicosis. Report of Two Cases

Guillermo¹,

R²,

Arango³

2015

Rheumatology (Sunnyvale)

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Section: Discussionmentioning

confidence: 99%

Therapeutic Plasmapheresis in Patients with Thyrotoxicosis. Report of Two Cases

Guillermo¹,

R²,

Arango³

2015

Rheumatology (Sunnyvale)

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“…12,15 In contrast, adults with massive levothyroxine ingestion typically have more severe symptoms, including cardiac arrhythmias, coma, and malignant hyperthermia. 16,17 Some case reports suggest that adults with underlying comorbidity, including chronic renal failure and cardiac pathology, are more predisposed to develop severe arrhythmias and decreased level of consciousness following levothyroxine ingestion. 16 However, it is uncertain whether prediction of who is at risk of severe complications among patients who were previously well is possible.…”

Section: Discussionmentioning

confidence: 99%

Massive levothyroxine ingestion in a pediatric patient: case report and discussion

Jackson

Johnson

2011

CJEM

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We describe the course of a toddler who ingested a massive amount of levothyroxine and review treatment options for such overdoses. A 2K-year-old boy presented shortly after an ingestion of up to 7.6 mg of levothyroxine (potentially as much as 700 mg/kg). He was initially asymptomatic, treated with oral charcoal 1 g/kg, and discharged home from the emergency department after a few hours. He returned approximately 24 hours later with a temperature of 38.5uC, heart rate of 163 beats per minute, respiratory rate of 30 breaths per minute, and blood pressure of 136/70 mm Hg. He had a slightly decreased appetite and no signs or symptoms of infection. He was admitted to hospital and treated with oral acetaminophen. The initial free thyroxine (T 4 ) was . 100 pmol/L and free triiodothyronine (T 3 ) was 35.3 pmol/L. The patient had desquamation of the palms and soles, hair loss, and irritability during the month following the ingestion. Resolution of the elevated free T 4 occurred by 12 days post-ingestion and normalization of the thyroid-stimulating hormone by 7 weeks post-ingestion. There were no longterm sequelae. Levothyroxine overdose can result in significant complications, including seizures and arrhythmias, both of which should be monitored for. However, as our case illustrates, massive ingestion of levothyroxine in children typically follows a benign course.

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“…27 Hemoperfusion and plasmapheresis have been reported to be successful in removing levothyroxine from the serum. 28 These methods are not likely to be necessary for most cases of levothyroxine overdose but could be considered in critically ill patients. However, data on the use of these therapies are limited, and not all groups have reported plasmapheresis to be efficacious in this setting.…”

Section: Symptomatic Treatmentmentioning

confidence: 99%

Case report: clues to the diagnosis of an unsuspected massive levothyroxine overdose

Allen

Crawford

Conaglen

et al. 2015

CJEM

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There is currently little literature pertaining to levothyroxine overdose apart from minor or accidental overdoses in the pediatric population. In particular, there is little information available on how to confidently differentiate levothyroxine overdose from endogenous causes of thyrotoxicosis when there is no history available at the time of assessment.We report a levothyroxine (15,800 mcg) and citalopram (2,460 mg) overdose in a 55-year-old woman presenting with seizure and tachycardia in which the diagnosis was not initially suspected. Clinical data, including a long history of treated hypothyroidism and lack of a goiter; and biochemical findings, such as an incompletely suppressed thyroid-stimulating hormone (TSH) level, despite a markedly elevated free thyroxine level (FT 4 ), a normal sex hormone-binding globulin level at baseline, and an undetectable thyroglobulin, supported the diagnosis of thyrotoxicosis due to a massive exogenous thyroid hormone overdose. Treatment was given to decrease free triiodothyronine (FT 3 ) conversion and increase thyroid hormone clearance with dexamethasone and cholestyramine. The patient made a full recovery.Levothyroxine overdose can result in subtle symptoms and signs clinically, even when in massive quantities. This can make diagnosis challenging. Biochemical features, such as the pattern of thyroid hormone elevation and thyroglobulin levels, help differentiate exogenous thyroid hormone overdose from endogenous causes of thyrotoxicosis. RÉSUMÉLa documentation sur le surdosage de lévothyroxine est peu abondante, exception faite des surdosages mineurs ou accidentels chez les enfants; plus particulièrement, il manque d'information sur la manière de faire la distinction, en toute confiance, entre le surdosage de lévothyroxine et la thyrotoxicose d'origine endogène, dans les cas d'absence d'antécédents évocateurs au moment de l'évaluation.Sera exposé ici un cas de surdosage de lévothyroxine (15 800 μg) et de citalopram (2460 mg) chez une femme de 55 ans, prise de convulsions et de tachycardie, chez qui rien, au point de départ, ne laissait soupçonner le diagnostic. Toutefois, des données d'ordre clinique, notamment des antécédents d'hypothyroïdie traitée de longue date et l'absence de goitre; des résultats d'analyses biochimiques, par exemple la présence de thyréostimuline (TSH) partiellement supprimée malgré un taux nettement élevé de thyroxine libre (T 4 libre); un taux normal, au départ, de globuline de liaison aux hormones sexuelles et un taux indétectable de thyroglobuline, ont étayé le diagnostic de thyrotoxicose attribuable à un surdosage massif d'hormone thyroïdienne d'origine exogène. Le traitement, par la dexaméthasone et la cholestyramine, visait à abaisser la conversion de la triiodothyronine libre (T 3 libre) et à accroître la clairance de l'hormone thyroïdienne. La patiente s'est complètement rétablie.Le surdosage de lévothyroxine, même massif, peut se manifester par des signes et des symptômes cliniques peu prononcés, d'où la difficulté de poser le dia...

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Massive thyroxine intoxication: evaluation of plasma extraction

Cited by 70 publications

References 19 publications

Therapeutic Plasmapheresis in Patients with Thyrotoxicosis. Report of Two Cases

Therapeutic Plasmapheresis in Patients with Thyrotoxicosis. Report of Two Cases

Massive levothyroxine ingestion in a pediatric patient: case report and discussion

Case report: clues to the diagnosis of an unsuspected massive levothyroxine overdose

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