Light symptoms following a high-dose intentional L-thyroxine ingestion treated with cholestyramine.
Adult exposure to L-thyroxine has a wide range of presentations: most adults either do not develop symptoms or only become minimally symptomatic. Appropriate treatments after exposure to L-thyroxine have yet to be established. A 26-year-old woman with a suicidal intention was witnessed to ingest approximately 50 L-thyroxine tablets, each containing 0.1 mg L-thyroxine (total dose 5 mg). Cholestyramine was administered (4 g every 8 h p.o.). Vital signs were monitored every 6 h and the hormone levels (L-thyroxine and thyroid-stimulating hormone) every 24 h. The thyroxine levels increased, and the thyroid-stimulating hormone levels decreased, with a normalization of the L-thyroxine level on postingestion day 6. Hypertension, dysrhythmias, and delusions did not appear in our patient. Only distal tremor and diaphoresis appeared on day 1 after ingestion. Cholestyramine has been used in cases of iatrogenic hyperthyroidism, in patients with Graves' disease, and in patients with digoxin intoxications, with good responses in all cases and a low incidence of side effects. This case illustrates the potential utility of cholestyramine to treat L-thyroxine intoxications.
de Luis
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DA
Institute of Endocrinology and Nutrition, Medical School, Hospital Rio Hortega, University of Valladolid, Spain. dadluis@yahoo.es
Dueñas
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A
Martin
J
J
Abad
L
L
Cuellar
L
L
Aller
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R
D000328:Adult; D000837:Anion Exchange Resins / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002792:Cholestyramine Resin / Q000627:therapeutic use*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D011041:Poisoning / Q000188:drug therapy* / Q000503:physiopathology; D013406:Suicide, Attempted; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000506:poisoning*; D014284:Triiodothyronine / Q000097:blood
D000837:Anion Exchange Resins; D014284:Triiodothyronine; D002792:Cholestyramine Resin; D013972:Thyrotropin; D013974:Thyroxine