The importance of reverse triiodothyronine in hypothyroid children on replacement treatment.

Desai, Meena; Irani, Aspi; Patil, K; Pandya, C S

doi:10.1136/adc.59.1.30

Cited by 11 publications

(5 citation statements)

References 14 publications

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“…at follow up. Previous outpatient measurements of T4 or protein bound iodine had been below the normal range in only four children but had been above normal on at least one previous occasion in 62%.TreatmentFigure 3shows the thyroxine dosage expressed as [tg/kg body weight together with the recommended doses at different ages' (MRC Register of Children with Congenital Hypothyroidism, Institute of Child Health,30 Guilford Street, London WCIN 1EH). The mean total dose was 172-Thyroxine treatment doses/kg body weight in hypothyroid children.…”

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confidence: 99%

Management of patients with congenital hypothyroidism.

Frost¹,

Parkin²

1985

BMJ

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The biochemical state and treatment of 73 children and 44 adults up to the age of 40 with proved congenital hypothyroidism were assessed in a regional study in the north of England. The findings showed that a substantial proportion of the patients were having inappropriate treatment or were not taking their treatment regularly and that in some of these there were clinical effects. IntroductionThe development of children with congenital hypothyroidism has been considerably improved as a result of early detection by neonatal screening.' Nevertheless, satisfactory long term results also require optimal treatment. We have assessed the adequacy of treatment of patients with congenital hypothyroidism below the age of 40 in the north of England.

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confidence: 99%

Management of patients with congenital hypothyroidism.

Frost¹,

Parkin²

1985

BMJ

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“…When serum T4 increases, serum rT3 level elevates and rT3/T4 ratio increases or does not change. 27,28 Nevertheless, our patient exhibited higher rT3/fT4 ratio during BZ treatment compared to the period of fT4 elevation after BZ suspension.…”

Section: Discussionmentioning

confidence: 48%

Bezafibrate induces hypothyroidism in a patient with resistance to thyroid hormone β due to a G347R variant

Yamauchi

Yamashita

Sugawa

et al. 2021

Clinical Endocrinology

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Objective: A unique clinical course was observed in a patient with resistance to thyroid hormone β (RTHβ) caused by a variant of the THRB gene leading to the replacement of glycine with arginine in codon 347 (p.G347R). He presented with the syndrome of inappropriate secretion of thyrotropin (TSH) (free T4 [fT4]: 32.43 pmol/L, TSH: 4.67 mIU/L), but slowly developed progressive hypothyroidism (fT4: 8.37 pmol/L, TSH: 100.90 mIU/L) that resolved after suspending bezafibrate (BZ) treatment (fT4: 32.18 pmol/L, TSH: 7.14 mIU/L). This study clinically and experimentally evaluated this interesting phenomenon. Methods: A retrospective cohort analysis of non-RTHβ patients was performed at Kyoto University Hospital. Data before BZ treatment were compared to the first data after treatment. Using reporter assays of iodothyronine deiodinases (DIO1, DIO2, DIO3) in HEK293T cells, we performed functional analyses of mutant thyroid hormone receptor β with p.G347R (G347R TRβ). Mice with G347R TRβ were generated by hydrodynamic gene delivery. Results: In non-RTHβ patients (n = 7), BZ treatment did not change serum free T3 and TSH but significantly increased fT4 (p = .008). BZ administration increased DIO3 reporter activity in the context of G347R TRβ, whereas did not change DIO1 and DIO2 reporter activity. In the livers of mice with G347R TRβ, BZ administration increased reverse T3 content, which corresponded to an increase in Dio3 messenger RNA. Conclusions: While hypothyroidism associated with BZ treatment did not occur in non-RTHβ patients, it was observed in a patient with RTHβ due to the p.G347R variant. Liver DIO3 upregulation might involve this hypothyroidism.

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“…It binds to the thyroid hormone receptors and thereby blocks the action of T3. ( 5 ) The Rennie Deflatine ® might have protected our patient unintentionally by binding levothyroxine to cations and thereby decreasing absorption ( 6 ).…”

Section: Discussionmentioning

confidence: 99%

Benign course after acute high dose levothyroxine intoxication in a 3-year-old boy

Hartman

Noordam

Maseland

et al. 2017

Clin Pediatr Endocrinol

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Abstract.Acute ingestion of thyroid hormone preparations is a common intoxication, with 181 cases in children <12 yr in 2009 in the Netherlands, but generally has a mild course. However, some reports show that even low dosages may cause serious events such as seizures, thyroid storm and coma. We report a 3 yr old boy case with an acute intoxication with high dose levothyroxine (0.5 mg/kg). We describe the proper management of levothyroxine intoxication in children. A 3-year-old boy with no notable medical history ingested sixty tablets of levothyroxine 150 µg. His vital-signs were normal and the only symptom during admission was a tachycardia the following day. Laboratory data showed elevated T3, fT3 and fT4 levels; and decrease TSH levels. He was treated prophylactically and therapeutically with activated charcoal and propranolol. Despite very high levels, his clinical symptoms were relatively mild. After clinical follow-up for 3 d he was discharged. We propose that children with thyroid hormone intoxication with either a levothyroxine dose >0.1 g/kg, a short interval since ingestion, symptomatic presentation, and/or a fT4 >100 pmol/l should be monitored in the hospital during at least 48–72 h post-ingestion and on an outpatient basis for 14 d.

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The importance of reverse triiodothyronine in hypothyroid children on replacement treatment.

Cited by 11 publications

References 14 publications

Management of patients with congenital hypothyroidism.

Management of patients with congenital hypothyroidism.

Bezafibrate induces hypothyroidism in a patient with resistance to thyroid hormone β due to a G347R variant

Benign course after acute high dose levothyroxine intoxication in a 3-year-old boy

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