Delayed diagnosis of T3 supplementation in a bodybuilder presenting with tachycardia and features of sepsis

Warner, Bronwen E; Woodrow, Charles J.; Pal, Aparna

doi:10.1136/bcr-2019-232867

Cited by 4 publications

(1 citation statement)

References 14 publications

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“…After studying the effect of sport on thyroid hormones for years, Luksch and Collins 67 warned that athletes who present signs and symptoms of TH excess without previous history or physical examination findings that corroborate a true thyroid disorder could lead to the misinterpretation of a fictitious hyperthyroidism. One case of this type of clinical case misinterpretation was reported for a bodybuilder who was consuming T3 as part of dietary supplementation 96 …”

Section: Physiology Of Thyroid Hormones: Implications In Sportmentioning

confidence: 99%

Thyroid metabolism and supplementation: A review framed in sports environment

Brito

Botrè

Romanelli

et al. 2022

Drug Testing and Analysis

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Objectives: This paper aimed to consider those features that may suggest a link between thyroid hormones pharmacology and athletes' health based on current consumption trends in a population of athletes.Methods: Methods used were observation, description, and synthesis, mainly. Among the documents reviewed were books, scientific articles, and review articles peerreviewed. The review covered sources published in the period 1961 to 2021. Only references with a traceable origin were accepted (DOI numbering, ISSN, and ISBN, as well as peer-reviewed journals). The data on the consumption of thyroid hormones derivatives were extracted from the Doping Control Forms of athlete samples received at Laboratorio Antidoping FMSI of Rome from 2017 to 2021.Results: An overview of the biosynthesis, pharmacology, and metabolism of thyroid hormones, including thyronamines and thyronacetic acids, was presented. Likewise, a summary is presented on the relationship between thyroid hormones and ethnic and gender differences, their physiology in sport, and the reasons why their use could be considered attractive for athletes. Conclusion:Today, thyroid hormones are not listed as a prohibited substance by the World Anti-Doping Agency. However, several requests to include levothyroxine on the prohibited list are documented. The observation that the number of athletes taking thyroid hormones is growing, particularly in sports such as cycling, triathlons, and skating, should prompt an update on this topic.

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Section: Physiology Of Thyroid Hormones: Implications In Sportmentioning

confidence: 99%

Thyroid metabolism and supplementation: A review framed in sports environment

Brito

Botrè

Romanelli

et al. 2022

Drug Testing and Analysis

View full text Add to dashboard Cite

show abstract

Liothyronine abuse

2020

Reactions Weekly

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A 25-year-old man developed thyrotoxicosis due to abuse of liothyronine as part of recreational bodybuilding activities. The man presented to the emergency room due to headache, sweating and feeling generally unwell. Vital signs were as follows: body temperature 37.2°C, BP 148/73, RR 25, HR 123 and oxygen saturations 97% on room air. An insect bite on his arm was noted during an examination. The differential diagnosis of systemic inflammatory response syndrome following infected insect bite was considered.The man was treated with unspecified antibacterials and IV fluids in the ambulatory unit. He was referred to the acute medical team due to persistent malaise and tachycardia. ECG revealed sinus tachycardia. Initial laboratory tests revealed low levels of TSH and free thyroxine while elevate levels of urea, WBC count and neutrophil count. Haemoglobin, electrolytes, liver function tests and clotting screen were normal or closed to normal range. Subsequent endocrine investigations showed elevated levels of testosterone, prolactin and free T3 with borderline positive TSH receptor antibody while low levels of follicle stimulating hormone. Based on the laboratory findings, the differential diagnoses of systemic inflammatory response syndrome, sepsis, phaeochromocytoma and secondary hypothyroidism were excluded, and liothyronine-induced thyrotoxicosis was considered. He started receiving propylthiouracil and propranolol for thyrotoxicosis. Further endocrine screening was completed after a discharge on the same day from the ambulatory unit. At follow-up visit (2 weeks later), examination showed increased muscle bulk and well virilisation with normal secondary sexual characteristics. He had no evidence of thyroid eye disease or thyroid goitre. During anamnesis, he confessed that he had been self-administering injections of testosterone 375mg every week for 14 weeks in cycles and tablets containing liothyronine [triiodothyronine] 25µg daily for 4 weeks for recreational bodybuilding activities. He was advised about the potential harms of supplementation containing liothyronine and testosterone and recommended to stopped all the supplements containing exogenous hormone. Propylthiouracil was discontinued as intrinsic thyroid disease was excluded. At follow-up visit 8 months later, he felt well with normal thyroid functions.

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Comment on: “Premature Death in Bodybuilders: What Do We Know?”

Hsieh,

Lin

2024

Sports Med

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Delayed diagnosis of T3 supplementation in a bodybuilder presenting with tachycardia and features of sepsis

Cited by 4 publications

References 14 publications

Thyroid metabolism and supplementation: A review framed in sports environment

Thyroid metabolism and supplementation: A review framed in sports environment

Liothyronine abuse

Comment on: “Premature Death in Bodybuilders: What Do We Know?”

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