Use of liothyronine without levothyroxine in the treatment of mild consumptive hypothyroidism caused by hepatic hemangiomas

Multifocal Infantile Hepatic Hemangiomas Complicated by Consumptive Hypothyroidism: The Benefits of Early Diagnosis and Treatment

“…Regular screening of thyroid function tests during follow-up is of paramount importance because thyroid hormone levels are excellent biomarkers of tumor response to treatment. 7,14 Regarding treatment with propranolol, it seems to act on IHH by 3 distinct molecular mechanisms (vasoconstriction, induced endothelial apoptosis, and inhibited angiogenesis), which seem to be responsible for its higher efficacy in tumor regression and faster clinical improvement, in most cases within the first week of treatment. 11,15 The optimal dose and the duration of treatment with oral propranolol in IHH is not completely established and it is mainly based on international guidelines for infantile hemangiomas.…”

“…As IHH undergo involution, the hypothyroidism tends to correct. Regular screening of thyroid function tests during follow-up is of paramount importance because thyroid hormone levels are excellent biomarkers of tumor response to treatment 7,14…”

Combination therapy of propranolol, levothyroxine, and liothyronine was effective in a case of severe consumptive hypothyroidism associated with infantile hepatic hemangioma

“…However, when serum fT 4 is normal and fT 3 is reduced, we may use liothyronine supplementation alone, as reported by Higuchi et al . (7). Based on these data, we suggest that treatment strategies should be individualized based on thyroid function, and that the combination of propranolol for anti-tumor treatment and levothyroxine and liothyronine for thyroid supplementation is an effective treatment option, particularly in cases of severe consumptive hypothyroidism due to multiple IHHs and probable high activity type 3 iodothyronine deiodinase activity.…”

How we approach hemangiomas in infants

“…They can be associated with high-output cardiac failure, abdominal compartment syndrome, liver failure, acquired hypothyroidism, and failure to thrive. 8,44,45 This patient had secondary hypothyroidism from Interpretation of serum AFP values in infants can be difficult due to this tumor marker's wide RR (6-146,500 ng/ml). AFP elevation is associated with hepatoblastoma, germ cell tumors, biliary atresia, hepatitis, teratomas, and hemangiomas.…”

“…IH of the liver present as solitary, multifocal, and diffuse tumors. They can be associated with high‐output cardiac failure, abdominal compartment syndrome, liver failure, acquired hypothyroidism, and failure to thrive 8,44,45 . This patient had secondary hypothyroidism from a hemangioma‐associated Type III deiodinase that blocks conversion of inactive T4 to biologically active triiodothyronine (T3).…”