Treatment of thyrotoxicosis resistant to carbimazole with corticosteroids

Jude, Edward B.; Dale, Jessica; Kumar, Satyam; Dodson, P. M.

doi:10.1136/pgmj.72.850.489

Cited by 18 publications

(24 citation statements)

References 6 publications

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“…22,23 A number of chemical compounds such as levamisole and other imidazoles have also been used in the regulation of thyroid metabolism. [24][25][26] On the other hand, antithyroid substances cause weight gains in animals. In the past, methimazole had been used specifically for this purpose, but now the use of antithyroid agents for fattening food animals is prohibited by law.…”

Section: Discussionmentioning

confidence: 99%

Effects of therapeutic and toxic doses of levamisole on thyroid hormones and some biochemical parameters in sheep

Ateşşahín

Karahan

Pirinçci

2004

Cell Biochemistry & Function

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This study was carried out to establish the effects of therapeutic and toxic doses of levamisole on thyroid hormone levels and some biochemical parameters in sheep. Twelve Akkaraman ewes were used. Levamisole was given orally at doses of 7.5 mg kg(-1) (group 1) and 40 mg kg(-1) (group 2) to the animals. Blood samples were taken from the jugular vein at 2, 4, 8, 24, 48, 96 and 144 h after the administrations. Serum thyroid hormones and some biochemical parameters were determined on these samples. When compared with the control levels, no significant changes were observed in triiodothyronine (T3) and thyroxin (T4) levels in group 1. Although levamisole was found to increase the levels of total T3, it decreased the levels of total T4 in group 2. On the other hand, free T3 and free T4 levels were not changed in either group. While serum alkaline phosphatase (ALP) activities were decreased, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and creatinine kinase (CK) activities were increased significantly by levamisole. However, it increased the serum albumin and cholesterol levels, but decreased the inorganic phosphate levels in groups 1 and 2. On the other hand, when compared with the control levels, no significant changes were detected in serum sodium, potassium and calcium levels. In conclusion, therapeutic and toxic doses of levamisole were determined to affect thyroid metabolism and some biochemical parameters in sheep.

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Section: Discussionmentioning

confidence: 99%

Effects of therapeutic and toxic doses of levamisole on thyroid hormones and some biochemical parameters in sheep

Ateşşahín

Karahan

Pirinçci

2004

Cell Biochemistry & Function

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“…Lithium, used for bipolar affective disorder, increases retention of radioactive iodine in the thyroid gland and has been successfully used as an adjunct to radioactive iodine in such cases [ 6 ]. Corticosteroids are generally used in thyroid storm [ 7 ]. Sporadically, they have been used preoperatively or before administration of radioiodine to achieve a euthyroid state in patients with resistant thyrotoxicosis [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Since a remarkable improvement in thyroid function was observed within a few days of starting corticosteroids, with FT4 levels reaching 29.3 pmol/L (normal range: 12-22), corticosteroid administration was kept along with CBZ [ 6 , 7 ]. A 30 mg daily dose of prednisolone led to normalisation of FT4 levels within one week (FT4: 15.9 pmol/L) (Figure 1 ).…”

Section: Case Presentationmentioning

confidence: 99%

Resistant Thyrotoxicosis due to Graves' Disease in Pregnancy: Case Report and Review of the Literature

Linardi¹,

Michou²,

Ilias³

et al. 2018

Cureus

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The effective management of Graves' disease (GD) during pregnancy is crucial for maternal and neonatal well-being. Conventional treatment of GD during pregnancy includes antithyroid drugs (ATDs) and surgery, ideally during the second trimester. We report a 27-year-old woman with GD and we present the course of GD during her three consecutive pregnancies. During the first pregnancy, thyrotoxicosis was successfully treated with low doses of antithyroid drugs; in the second pregnancy, thyrotoxicosis was only controlled at the third trimester; while in the third pregnancy, our patient presented with treatment-resistant thyrotoxicosis, which was finally managed with corticosteroids in adjunction with ATDs. Although hyperthyroid, the patient maintained her fertility. Resistance to ATD is a rare condition and in our case was adequately controlled with corticosteroids.

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“…19 Use of benzodiazepines can be considered if the patient is severely agitated. 19 Blockade of peripheral conversion and increasing thyroid hormone clearance Dexamethasone can be useful in severe thyrotoxicosis 22 because it reduces peripheral FT 4 to FT 3 conversion. Dexamethasone was given, in this case, as the amount of levothyroxine taken was initially unknown, the FT 3 was over three times the upper limit of normal, and it was thought that the FT 3 level could further increase with the potential for cardiac instability.…”

Section: Symptomatic Treatmentmentioning

confidence: 99%

Case report: clues to the diagnosis of an unsuspected massive levothyroxine overdose

Allen

Crawford

Conaglen

et al. 2015

CJEM

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There is currently little literature pertaining to levothyroxine overdose apart from minor or accidental overdoses in the pediatric population. In particular, there is little information available on how to confidently differentiate levothyroxine overdose from endogenous causes of thyrotoxicosis when there is no history available at the time of assessment.We report a levothyroxine (15,800 mcg) and citalopram (2,460 mg) overdose in a 55-year-old woman presenting with seizure and tachycardia in which the diagnosis was not initially suspected. Clinical data, including a long history of treated hypothyroidism and lack of a goiter; and biochemical findings, such as an incompletely suppressed thyroid-stimulating hormone (TSH) level, despite a markedly elevated free thyroxine level (FT 4 ), a normal sex hormone-binding globulin level at baseline, and an undetectable thyroglobulin, supported the diagnosis of thyrotoxicosis due to a massive exogenous thyroid hormone overdose. Treatment was given to decrease free triiodothyronine (FT 3 ) conversion and increase thyroid hormone clearance with dexamethasone and cholestyramine. The patient made a full recovery.Levothyroxine overdose can result in subtle symptoms and signs clinically, even when in massive quantities. This can make diagnosis challenging. Biochemical features, such as the pattern of thyroid hormone elevation and thyroglobulin levels, help differentiate exogenous thyroid hormone overdose from endogenous causes of thyrotoxicosis. RÉSUMÉLa documentation sur le surdosage de lévothyroxine est peu abondante, exception faite des surdosages mineurs ou accidentels chez les enfants; plus particulièrement, il manque d'information sur la manière de faire la distinction, en toute confiance, entre le surdosage de lévothyroxine et la thyrotoxicose d'origine endogène, dans les cas d'absence d'antécédents évocateurs au moment de l'évaluation.Sera exposé ici un cas de surdosage de lévothyroxine (15 800 μg) et de citalopram (2460 mg) chez une femme de 55 ans, prise de convulsions et de tachycardie, chez qui rien, au point de départ, ne laissait soupçonner le diagnostic. Toutefois, des données d'ordre clinique, notamment des antécédents d'hypothyroïdie traitée de longue date et l'absence de goitre; des résultats d'analyses biochimiques, par exemple la présence de thyréostimuline (TSH) partiellement supprimée malgré un taux nettement élevé de thyroxine libre (T 4 libre); un taux normal, au départ, de globuline de liaison aux hormones sexuelles et un taux indétectable de thyroglobuline, ont étayé le diagnostic de thyrotoxicose attribuable à un surdosage massif d'hormone thyroïdienne d'origine exogène. Le traitement, par la dexaméthasone et la cholestyramine, visait à abaisser la conversion de la triiodothyronine libre (T 3 libre) et à accroître la clairance de l'hormone thyroïdienne. La patiente s'est complètement rétablie.Le surdosage de lévothyroxine, même massif, peut se manifester par des signes et des symptômes cliniques peu prononcés, d'où la difficulté de poser le dia...

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Treatment of thyrotoxicosis resistant to carbimazole with corticosteroids

Cited by 18 publications

References 6 publications

Effects of therapeutic and toxic doses of levamisole on thyroid hormones and some biochemical parameters in sheep

Effects of therapeutic and toxic doses of levamisole on thyroid hormones and some biochemical parameters in sheep

Resistant Thyrotoxicosis due to Graves' Disease in Pregnancy: Case Report and Review of the Literature

Case report: clues to the diagnosis of an unsuspected massive levothyroxine overdose

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