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Massive levothyroxine ingestion in a pediatric patient: case report and discussion

Published online by Cambridge University Press:  11 May 2015

Josephine Ho ,
Renee Jackson  and
David Johnson
Josephine Ho*
Affiliation:
Faculty of Medicine, University of Calgary, Calgary, AB
Renee Jackson
Affiliation:
Division of Pediatrics, Alberta Children's Hospital, Calgary, AB
David Johnson
Affiliation:
Faculty of Medicine, University of Calgary, Calgary, AB
*
Division of Pediatric Endocrinology, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8; josephine.ho@albertahealthservices.ca.

Abstract

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We describe the course of a toddler who ingested a massive amount of levothyroxine and review treatment options for such overdoses. A 2½-year-old boy presented shortly after an ingestion of up to 7.6 mg of levothyroxine (potentially as much as 700 µg/kg). He was initially asymptomatic, treated with oral charcoal 1 g/kg, and discharged home from the emergency department after a few hours. He returned approximately 24 hours later with a temperature of 38.5°C, heart rate of 163 beats per minute, respiratory rate of 30 breaths per minute, and blood pressure of 136/70 mm Hg. He had a slightly decreased appetite and no signs or symptoms of infection. He was admitted to hospital and treated with oral acetaminophen. The initial free thyroxine (T4) was > 100 pmol/L and free triiodothyronine (T3) was 35.3 pmol/L. The patient had desquamation of the palms and soles, hair loss, and irritability during the month following the ingestion. Resolution of the elevated free T4 occurred by 12 days post-ingestion and normalization of the thyroid-stimulating hormone by 7 weeks post-ingestion. There were no longterm sequelae. Levothyroxine overdose can result in significant complications, including seizures and arrhythmias, both of which should be monitored for. However, as our case illustrates, massive ingestion of levothyroxine in children typically follows a benign course.

Keywords

childrenemergency departmentlevothyroxineoverdosepediatricthyroid hormonetreatment
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 3 , May 2011 , pp. 165 - 168
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

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