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

Show simple item record Allen, KM en Crawford, VB en Conaglen, John en Elston, Marianne en 2016-08-26T01:27:34Z en 2015-11 en
dc.identifier.citation Canadian Journal of Emergency Medicine, 2015, 17 (6), pp. 692 - 698 en
dc.identifier.uri en
dc.description.abstract 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 (FT4), 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 (FT3) 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. en
dc.description.uri en
dc.publisher Cambridge University Press (CUP) en
dc.relation.ispartofseries Canadian Journal of Emergency Medicine en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. Details obtained from en
dc.rights.uri en
dc.title Case report: clues to the diagnosis of an unsuspected massive levothyroxine overdose en
dc.type Journal Article en
dc.identifier.doi 10.1017/cem.2014.75 en
pubs.issue 6 en
pubs.begin-page 692 en
pubs.volume 17 en
dc.description.version AM - Accepted Manuscript en
dc.identifier.pmid 25824846 en en
pubs.end-page 698 en
pubs.publication-status Published en
dc.rights.accessrights en
pubs.subtype Article en
pubs.elements-id 479696 en Medical and Health Sciences en School of Medicine en Medicine Department en
dc.identifier.eissn 1481-8043 en
pubs.record-created-at-source-date 2016-08-26 en
pubs.dimensions-id 25824846 en

Files in this item

Find Full text

This item appears in the following Collection(s)

Show simple item record


Search ResearchSpace