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Levothyroxine overdose in a hypothyroid patient with adjustment disorder: A case report.

ABSTRACT: Introduction:Levothyroxine (T4) overdose is not frequently encountered and for the clinical signs to materialize, the ingested dose, the rate of conversion of T4 to T3 and chronicity of overdose can be held accountable. Case report:A 29-year-old female, a known case of hypothyroidism and adjustment disorder, under levothyroxine, propranolol and sertraline, intentionally ingested 2.5 mg of levothyroxine but remained asymptomatic with sudden surge in T4 in initial hours of ingestion which gradually started declining along with reciprocal change in TSH. However, the change in T3 was almost negligible. Discussion:T3, the active thyroid hormone, when in excess accounts for toxic effects. The duration during physiological process of deiodination and half life of hormone correlates with onset and duration of symptoms. Propranolol which blocks peripheral conversion of T4 to T3 and sertraline which is also reported to reduce the efficacy of levothyroxine, which is evident from low T3 in thyroid profile, must have led to patient being asymptomatic despite lack of early gastric decontamination. Conclusion:Levothyroxine overdose up to 4mg/day may be asymptomatic but in patients with concomitant neurotic or psychiatric illness, who intentionally take it, are also put on drugs like sertraline and propranolol, the effects of which on thyroid hormones must be contemplated for possible explanation of being asymptomatic.

SUBMITTER: Kiran Kumar KC

PROVIDER: S-EPMC7566947 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Levothyroxine overdose in a hypothyroid patient with adjustment disorder: A case report.

Kiran Kumar K C KC Ghimire Nirmal N Limbu Trishant T Khapung Robin R

Annals of medicine and surgery (2012) 20201009

<h4>Introduction</h4>Levothyroxine (T4) overdose is not frequently encountered and for the clinical signs to materialize, the ingested dose, the rate of conversion of T4 to T3 and chronicity of overdose can be held accountable.<h4>Case report</h4>A 29-year-old female, a known case of hypothyroidism and adjustment disorder, under levothyroxine, propranolol and sertraline, intentionally ingested 2.5 mg of levothyroxine but remained asymptomatic with sudden surge in T4 in initial hours of ingestion ...[more]

PMID: 33088498

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Project description:BackgroundLevels of thyroid-stimulating hormone (TSH) are believed to reflect degree of disease in patients with hypothyroidism, and normalization of levels is the treatment goal. However, despite adequate levels of TSH after starting levothyroxine (LT4) therapy, 5-10% of hypothyroid patients complain of persisting symptoms with a significant negative impact on quality of life. This indicates that TSH is not an optimal indicator of intracellular thyroid hormone effects in all patients. Our aim was to investigate different effects of LT3 and LT4 monotherapy on other biomarkers of the thyroid signaling pathway, in addition to adverse effects, in patients with residual hypothyroid symptoms.MethodsFifty-nine female hypothyroid patients, with residual symptoms on LT4 monotherapy or LT4/liothyronine (LT3) combination therapy, were randomly assigned in a non-blinded crossover study and received LT4 or LT3 monotherapy for 12 weeks each. Measurements, including serum analysis of a number of biochemical and hormonal parameters, were obtained at the baseline visit and after both treatment periods.ResultsFree thyroxine (FT4) was higher in the LT4 group, while free triiodothyronine (FT3) was higher in the LT3 group. The levels of reverse triiodothyronine (rT3) decreased after LT3 treatment compared with LT4 treatment. Both low-density lipoprotein (LDL) and total cholesterol levels were reduced, while sex hormone-binding globulin (SHBG) increased after LT3 treatment compared with LT4 treatment. The median TSH levels for both treatment groups were within the reference range, however, lower in the LT4 group than in the LT3 group. We did not find any differences in pro-B-type natriuretic peptide (NT pro-BNP), handgrip strength, bone turnover markers, or adverse events between the two treatment groups.ConclusionWe have demonstrated that FT4, FT3, rT3, cholesterol, and SHBG show significantly different values on LT4 treatment compared with LT3 treatment in women with hypothyroidism and residual symptoms despite normal TSH levels. No differences in general or bone-specific adverse effects were demonstrated. This trial is registered with NCT03627611 in May 2018.

Dataset Information

Levothyroxine overdose in a hypothyroid patient with adjustment disorder: A case report.

Publications

Levothyroxine overdose in a hypothyroid patient with adjustment disorder: A case report.

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