title: L-carnitine treatment in a seriously ill cancer patient with severe hyperthyroidism.
abstract: OBJECTIVE
  To report a case of vaccine-induced Graves' disease successfully managed with L-carnitine and propranolol and without antithyroid drugs (ATDs). ATDs sometimes need to be used at low doses or can be contraindicated/refused. One of the ancillary compounds available is L-carnitine. L-carnitine is a naturally occurring quaternary amine, which acts by impairing thyroid hormone access to the cell nucleus.
  
  
  METHODS
  A 32-year-old Chinese woman with a synovial sarcoma received radiotherapy, chemotherapy and experimental immunotherapy. Two months after the start of immunotherapy, she developed autoimmune hyperthyroidism [thyroid-stimulating immunoglobulins (TSI)=152%, normal values <140]. Left untreated, hyperthyroidism worsened (TSI=248%), so that for 3 months she took L-carnitine (1-4 g/d) and propranolol (20-80 mg/d). Though the hyperthyroidism worsened biochemically (FT4>50 pg/ml, FT3>20 pg/ml, TSI=501%), it was tolerated very well clinically. Fearing a life-threatening thyroid storm, she agreed to have, while still hyperthyroid, total thyroidectomy. The operation was uneventful.
  
  
  CONCLUSIONS
  This case expands previous observations involving two more patients who survived thyroid storms while being treated with L-carnitine (combined with low doses of ATD). Taking also into account that tissue concentrations of L-carnitine decrease in hyperthyroidism, there is room for wide therapeutic use of L-carnitine in several hyperthyroidism settings.
authors: Department of Developmental Biology, Stanford University, School of Medicine, CA, USA.
authors: Rene
authors: R
authors: Chee
authors: Internal Medicine, Palo Alto Medical Foundation, Mountain View; CA, USA.
authors: Ravin
authors: R
authors: Agah
authors: Section of Endocrinology, Department of Clinical & Experimental Medicine, University of Messina, Messina, Italy.
authors: Roberto
authors: R
authors: Vita
authors: Section of Endocrinology, Department of Clinical & Experimental Medicine, University of Messina, Messina, Interdepartmental Program of Molecular & Clinical Endocrinology and Women's Endocrine Health, A.O.U. Policlinico G. Martino, Italy.
authors: Salvatore
authors: S
authors: Benvenga
mesh_terms: D000328:Adult; D019496:Cancer Vaccines / Q000009:adverse effects*; D002331:Carnitine / Q000627:therapeutic use*; D005260:Female; D006111:Graves Disease / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D013584:Sarcoma, Synovial / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D012720:Severity of Illness Index; D012888:Skull Neoplasms / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D013965:Thyroidectomy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019496:Cancer Vaccines; D002331:Carnitine