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Propranolol-induced hyperthyroxinemia.

A Mooradian, J E Morley, G Simon

Archives of Internal Medicine

|November 1, 1983

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High-dose propranolol may cause euthyroid hyperthyroxinemia, leading to diagnostic confusion. Protirelin testing is crucial for patients on high-dose propranolol to differentiate from true hyperthyroidism.

Area of Science:

Endocrinology
Pharmacology

Background:

Propranolol hydrochloride is a beta-blocker commonly prescribed for hypertension.
Elevated thyroid hormone levels can indicate hyperthyroidism, a condition requiring specific treatment.

Observation:

A patient on high-dose propranolol (400 mg/day) presented with elevated thyroxine (T4) and free T4, despite a normal thyrotropin response to protirelin.
This observation prompted an investigation into similar cases.

Findings:

Four out of 14 hypertensive patients on high-dose propranolol (≥320 mg/day) exhibited elevated serum T4 levels.
Patients on high-dose propranolol therapy showed significantly higher serum T4, free T4 indices, and triiodothyronine levels compared to healthy controls.

Implications:

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High-dosage propranolol use may be associated with euthyroid hyperthyroxinemia, mimicking true hyperthyroidism.
This condition can lead to diagnostic challenges in clinical practice.
Protirelin testing is recommended for patients on high-dose propranolol to accurately assess thyroid status and avoid misdiagnosis of hyperthyroidism.