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Sudden death associated with thyroid hormone abuse

S Bhasin, W Wallace, J B Lawrence

    The American Journal of Medicine
    |November 1, 1981
    PubMed
    Summary
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    Factitious hyperthyroidism from excessive L-thyroxine intake can cause sudden death, potentially from drug-induced myocarditis. This risk exists even without coronary artery disease, highlighting the dangers of L-thyroxine abuse.

    Area of Science:

    • Cardiology
    • Endocrinology
    • Toxicology

    Background:

    • Deliberate L-thyroxine overdose can lead to severe hyperthyroidism.
    • Hyperthyroidism may present atypically, delaying diagnosis.
    • Sudden cardiac death is a potential complication.

    Observation:

    • Three cases of sudden death in patients with factitious hyperthyroidism due to L-thyroxine abuse are presented.
    • Two patients had atypical presentations, with hyperthyroidism unrecognized on admission.
    • Autopsy findings in two patients revealed myocarditis and, in one, myocardial infarction with coronary thrombosis.

    Findings:

    • Factitious hyperthyroidism can cause instantaneous death, presumed to be from ventricular fibrillation.
    • Sudden death may occur in the absence of coronary artery disease.

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  • Drug-induced myocarditis is a potential mechanism linking L-thyroxine abuse to sudden cardiac events.
  • Implications:

    • Physicians should consider factitious hyperthyroidism in unexplained sudden cardiac death.
    • Early recognition of atypical hyperthyroidism presentations is crucial.
    • L-thyroxine abuse poses significant cardiovascular risks beyond typical hyperthyroid symptoms.