Management of a child with acute thyroxine ingestion

Roesch, Charles; Becker, Patricia; Sklar, Stephen J.

doi:10.1016/s0196-0644(85)80935-5

Cited by 11 publications

(4 citation statements)

References 7 publications

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“…Patients may be asymptomatic or have symptoms including mild fever, tachycardia, hypertension, and irritability. [4][5][6]8,13,14 Some cases involving seizures have been reported. 12,15 In contrast, adults with massive levothyroxine ingestion typically have more severe symptoms, including cardiac arrhythmias, coma, and malignant hyperthermia.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…3 Significant levothyroxine ingestions in children have been reported previously. [4][5][6][7][8][9][10][11][12] We report a case of a toddler with a particularly large levothyroxine ingestion and very few clinical findings. Written consent was obtained from the patient's family for publication of this case.…”

Section: Ré Sumémentioning

confidence: 99%

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

Jackson

Johnson

2011

CJEM

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“…Management of symptoms is the same as for thyrotoxicosis, with non‐selective β‐adrenoceptor antagonists such as propranolol being the mainstay of management (Table ). Doses of propranolol should be titrated to clinical response, and in patients with asthma, more careful monitoring is required.…”

Section: Thyroxinementioning

confidence: 99%

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

Bateman

Page

2015

Brit J Clinical Pharma

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Some toxins cause their effects by affecting physiological processes that are fundamental to cell function or cause systemic effects as a result of cellular interaction. This review focuses on four examples, coumarin anticoagulants, isoniazid, methotrexate and thyroxine from the context of management of overdose as seen in acute general hospitals. The current basic clinical pharmacology of the toxin, the clinical features in overdose and evidence base for specific antidotes are discussed. The treatment for this group is based on an understanding of the toxic mechanism, but studies to determine the optimum dose of antidote are still required in all these toxins except thyroxine, where treatment dose is based on symptoms resulting from the overdose.

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“…Se dispone de limitada información acerca de la sobredosis de hormonas tiroideas en el ser humano. Se han publicado casos de sobredosis de tiroxina (1)(2)(3)(4)(5)(6)(7)(8)(9), pero hay poca información sobre la sobredosis de triyodotironina. El interés del caso que presentamos a continuación reside en que se trata, con mucho, de la mayor sobredosis de triyodotironina en el ser humano notificada en la literatura científica hasta la fecha y en que su estudio nos ha permitido: a) conocer la cinética de eliminación de la triyodotironina en los casos de sobredosis masiva; b) evaluar el efecto que sobre ella ha tenido un procedimiento terapéutico (la hemoperfusión con cartucho de carbón activado), y c) proponer un posible mecanismo causal.…”

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