Charcoal Hemoperfusion in the Treatment of Levothyroxine Intoxication

Abstract

The use of hemoperfusion with a charcoal filter appears to be a very important therapeutic tool for the treatment of acute and severe forms of thyrotoxicosis due to l-thyroxine intoxication.

2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis

“…Severe thyrotoxicosis and rarely, thyroid storm, have been reported following thyroid hormone overdose or poisoning. Treatment with cholestyramine (671) and charcoal hemoperfusion (672) have been used in this circumstance.…”

Review: Endocrine and metabolic emergencies: thyroid storm

“…However, plasmapharesis needs to be repeated several times as only about 20% of the T4 pool and even less of the T3 pool can be removed each session. Charcoal haemoperfusion has also been demonstrated to be useful in thyrotoxic states [Kreisner et al 2010]. There is great interest in the role of biological agents in treatment of immune-mediated thyrotoxic states.…”

Antidotes to coumarins, isoniazid, methotrexate and thyroxine, toxins that work via metabolic processes

“…Activated charcoal and cholestyramine are potential therapies to reduce thyroxine absorption, but there are no controlled data in overdose. Other specific therapies such as extracorporeal removal may be required rarely for very large overdoses with severe toxicity .…”