title: Massive thyroxine intoxication: evaluation of plasma extraction.
abstract: Six patients were admitted after erroneous massive intake of levothyroxine (70-1200 mg 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 less than 0.05).
mesh_terms: D000368:Aged; D003128:Coma / Q000139:chemically induced; D005260:Female; D006207:Half-Life; D006464:Hemoperfusion; D006801:Humans; D008297:Male; D008508:Medication Errors; D008875:Middle Aged; D010956:Plasmapheresis; D013971:Thyrotoxicosis / Q000139:chemically induced / Q000628:therapy; D013974:Thyroxine / Q000097:blood / Q000506:poisoning*; D014284:Triiodothyronine / Q000097:blood
chemical_list: D014284:Triiodothyronine; D013974:Thyroxine