title: Does hyperthyroidism increase risk of death due to the ingestion of ecstasy?
abstract: Ecstasy (3,4-methylenedioxymethamphetamine, MDMA) is a psychoactive amphetamine derivative widely used for recreational purposes. Deaths caused by acute drug intoxication with MDMA are rare but can often involve a severe hyperthermic episode. The factors underlying the increased risk of some ecstasy users to a fatal drug reaction are not known. We present a case report of a 24-year-old woman who developed fatal hyperthermia with multi-organ complications following MDMA use and was found at autopsy to have diffuse thyroid hyperplasia (Graves' disease). An antemortem blood MDMA concentration of 0.68 mg/L was measured in a sample obtained on admission to hospital. Although a cause and effect cannot be established, as the thyroid hormone is a major regulator of thermogenesis, we suggest that hyperthyroidism predisposed the subject to ecstasy-induced hyperthermia and that a pre-existing defect affecting temperature status could be one factor in explaining some ecstasy intoxication deaths.
authors.affiliation: Toxicology Section, Centre of Forensic Sciences, 25 Grosvenor Street, Toronto, ON, Canada M7A 2G8.
authors.forename: Teri L
authors.initials: TL
authors.lastname: Martin
authors.forename: David A
authors.initials: DA
authors.lastname: Chiasson
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kish
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D005334:Fever / Q000139:chemically induced*; D053593:Forensic Toxicology; D006213:Hallucinogens / Q000506:poisoning*; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications*; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000506:poisoning*
chemical_list: D006213:Hallucinogens; D018817:N-Methyl-3,4-methylenedioxyamphetamine