Thyrotoxicosis after a massive levothyroxine ingestion: A case report

Abstract

BACKGROUND The literature on thyrotoxicosis caused by excessive ingestion of exogenous thyroid hormone is limited, and most cases reported have involved pediatric clinical studies. CASE SUMMARY A 21-year-old woman initially presented with palpitation and chest tightness after an overdose of levothyroxine (10 mg). The patient transiently lost consciousness and developed atrial fibrillation during hospitalization. We used propylthiouracil to decrease the peripheral conversion of T4 to T3 and inhibit the synthesis of endogenous thyroxine, propranolol to control heart rate, hydrocortisone to correct severe thyrotoxicosis, and hemoperfusion to increase levothyroxine clearance. The patient recovered and was discharged. CONCLUSION For patients with thyrotoxicosis after taking excess levothyroxine, it is critical to monitor vital signs and initiate effective treatment.

Test

“…However, our patient only received Gastric lavage and received the above-mentioned supportive therapy. However, a case report done by Fang Du et al, [24] patient had palpitation and a heart rate of > 100 beats/min, so propranolol was given to control the heart rate. Fortunately, our patient did not develop any other complications.…”

Data Analysis and Systematic Scoping Review on the Pathogenesis and Modalities of Treatment of Thyroid Storm Complicated with Myocardial Involvement and Shock

“…Patients administered propranolol or atenolol tend to require extensive resuscitation [52]. Evidently, in conditions with signs of heart failure and low ejection fraction during thyrotoxic crisis, other agents are recommended [10,20,46,47]. Such agents are cardioselective BBs with shorting-acting properties, such as landiolol and esmolol, because titration and cessation are attainable [10,26,51,52].…”