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[Triiodothyronine intoxication. A clinical and phamacokinetic study]
J Botella de Maglia1, L Compte Torrero, A Rivas Sánchez
1Servicios de Medicina Intensiva, Hospital La Fe, Valencia.
Anales De Medicina Interna (Madrid, Spain : 1984)
|December 31, 2003
Summary
A patient experienced severe triiodothyronine toxicity due to a 200-fold overdose, leading to significant symptoms and prolonged recovery despite charcoal hemoperfusion. This case highlights the critical importance of accurate thyroid hormone dosing.
Area of Science:
- Endocrinology
- Clinical Pharmacology
Background:
- Patient underwent thyroidectomy for papillary carcinoma and temporarily ceased levothyroxine.
- Prescribed triiodothyronine 25 mcg every 8 hours to manage symptoms during a 5-week study period.
Observation:
- Developed severe symptoms including abdominal pain, nausea, vomiting, high fever, and chest discomfort within 9 days.
- Measured serum total triiodothyronine levels reached 575.2 nmol/l, significantly exceeding normal ranges (1.1-2.9 nmol/l).
- Experienced delirium, agitation, tachycardia, hypertension, and altered bowel habits.
Findings:
- Estimated peak serum triiodothyronine concentration of 794.3 nmol/l, 397 times the mean normal value.
- Elimination half-life of triiodothyronine was determined to be 24 hours and 40 minutes.
- Charcoal hemoperfusion showed no significant effect on elimination velocity; levels normalized after 200 hours, but symptoms persisted for 3 additional days.
Implications:
- Suggests a potential 5 mg triiodothyronine capsule intake, a 200-fold overdose, as the cause of intoxication.
- Underscores the severe consequences of thyroid hormone overdose and the need for vigilant monitoring.
- Highlights the prolonged clinical manifestation of triiodothyronine toxicity beyond normalized serum levels.