Abstract
Six patients were admitted after erroneous massive intake of levothyroxine (70–1200mg over an interval of 2–12 days). All patients developed classical symptoms of thyrotoxicosis within 3 days of the first dose; five patients presented grade II–III coma and one became stuporous (days 7–10). Two patients developed left ventricular failure and three had arrhythmias (days 8–11). Total thyroid hormone levels in serum on admission ranged 935–7728 nmol/l for T4 (TT4) and 23–399 nmol/l for T3 (TT3). All patients received treatment with hydrocortisone and Propranolol. Propylthiouracil was also given in 3 cases. Extractive techniques (charcoal haemoperfusion and/or plasmapheresis) were initiated 8–14 days after the first dose of L-T4. The plasma disappearance rate (K) of TT4 with plasmapheresis was 30 times higher, on average, than under standard medical treatment (M). Also, K of TT4 under haemoperfusion was about five times higher than K under M. K changes for TT3 were higher under haemoperfusion than under plasmapheresis. Furthermore, extractive procedures shortened the average half life of TT4, (from 106.5±44.6 to 59.7±20.2 h, p<0.05).
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References
Bhasin S, Wallace W, Lawrence JB, Lesch M (1981) Sudden death associated with thyroid hormone abuse. Am J Med 71:887
Braverman LE (1983) Thyroid storm. In: Krieger DT, Bardin CW (eds) Current therapy in endocrinology 1983–1984. Deeker, Philadelphia, p 68
Burman KD, Yaeger HC, Briggs WA, Earll JM, Wartofsky L (1976) Resin haemoperfusion: a method of removing circulating thyroid hormones. J Clin Endocrinol Metab 42:70
Chopra IJ (1977) A study of extrathyroidal conversion of thyroxine (T4) to triiodothyronine (T3) in vitro. Endocrinology 101:453
Chopra JI, Williams DE, Orgiazzi J, Solomon DH (1975) Oposite effects of dexamethasone on serum concentrations of 3,3′5′-triodothyromine (reverse T3) and to 3,5,3-triidothyronine (T3) in humans. J Clin Endocrinol Metab 41:911
Evered D, Young ET, Ormston BJ, Menzies R, Smith PA, Hall R (1973) Treatment of hypothyroidism; a reappraisal of thyroxine therapy. Br Med J 3:131
Forfar JC, Muir AL, Sawers SA, Toft AD (1982) Abnormal left ventricular function in hyperthyroidism: evidence of a possible reversible cardiomyopathy. N Engl J Med 307:1165
Goulon M, Combes A (1977) Crise thyrotoxique médicamenteuse. Des dangers d'une préparation prétendue homéopathique. Presse Med 6:3729
Haire W, Newcomer J, Hartman C (1981) Plasmapheresis in the management of thyroid storm, Plasma Ther 2:3
Hamblin PS, Mohr VS, Stockigt JR, Topliss DJ (1985) Iopanoic acid is of minimal benefit in the treatment of severe hypothyroidism: conclusions from a case study. Clin Endocrinol (Oxf) 22:503
Herrmann J, Rudorff KH, Gockjenan G, Koningshausen T, Grabensel B, Kruskemper ML (1977) Charcoal haemoperfusion in thyroid storm. Lancet 1:248
Lehrner LM, Weir MR (1984) Acute ingestions of thyroid hormones. Pediatrics 73:313
Malvaux PG, de Vischer M (1972) Accidental poisoning with thyroid extract treated by exchange transfusion. Arch Dis Child 47:980
May ME, Mintz PD, Lowry P, Geller R, Curnow RT (1983) Plasmapheresis in thyroxine overdose: a case report. J Toxicol Clin Toxicol 20:517
Miralles-Garcia JM, Garcia-Iglesias C, De Pablo-Dávila F, Lanao JM, Castro del Pozo S (1981) Thyroxine and triiodothyronine kinetics and extrathyroidal conversion rate of thyroxine of triiodothyronine in healthy elderly humans. Horm Metab Res 13:626
Nyström E, Lindstaedt G, Lundberg PA (1980) Minor signs and symptoms of toxicity in a young woman in spite of massive thyroxine ingestion. Acta Med Scand 207:135
Refetoff S (1979) Thyroid hormone transport. In: De Groot LJ et al. (eds) Endocrinology. Grune and Stratton, New York, p 347
Resnikow L, Falikov RE (1977) Thyrotoxicosis and lactate producing angina pectoris with normal coronary arteries. Br Heart J 39:1051
Rodriguez Espinosa J, Ordoñez Llanos J, Concustell Bas E (1978) Effects of a single dose of dexamethasone on the serum concentrations of thyroxine (it); 3,5,3′-Triiodothyronine (T3); 3,3′5′-Triiodothyronine (rT3); and TSH in healthy euthyroid individuals. Endocrinologia 25:50
Schlienger JL, Drui S, de Laharpe F, Reville P, Stephan F (1977) Traitement de la crise thyrotoxique aiguée par exsanguinotransfusion. Presse Med 6:2996
Schlienger JL, Faradji A, Demangeat C, Sapin R, Chabrier G, Simon C, Imler M (1983) Evolution quantitative de la soustraction hormonale réalisee par échange plasmatique continu chez des sujets euthyroidiens. Presse Med 12:499
Schlienger JL, Faradji A, Blickle JF, Chabrier G, Simon C, Imler M (1985) Traitement de l'hyperthyroidie grave par échange plasmatique. Efficacité clinique et biologique. Huit observations. Presse Med 14:1271
Schottstaedt ES, Smoller M (1966) “Thyroid storm” produced by acute thyroid hormone poisoning. Ann Int Med 64:847
Shaldon S, Chandussi L, Higgs B (1961) Hemodialysis by percutaneous catheterization of the femoral artery and vein with regional heparinization. Lancet 2:857
Siegenbeek LH, Kinderen PJ, Vingerhoeds ACM (1980) Plasmapheresis in L-Thyroxine intoxication. Plasma Ther 1:33
Tajiri J, Katsuya H, Kiyokawa T, Urata K, Okamoto K, Shimada T (1984) Successful treatment of thyrotoxic crisis with plasma exchange. Crit Care Med 12:536
Wartofsky L, Burman KD (1982) Alterations in thyroid function in patients with systemic illness: the “Euthyroid sick syndrome”. Endocrine Rev 3:164
White JD (1983) Thyroid overdose. In: Haddad LM, Winchester JM (eds) Clinical management of poisoning and drug overdose. Saunders, Philadelphia, p 950
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Binimelis, J., Bassas, L., Marruecos, L. et al. Massive thyroxine intoxication: evaluation of plasma extraction. Intensive Care Med 13, 33–38 (1987). https://doi.org/10.1007/BF00263555
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DOI: https://doi.org/10.1007/BF00263555