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Raising the decontamination level for thyroid hormone ingestions
C L Tunget1, R F Clark, S G Turchen
1San Diego Regional Poison Center, University of California, San Diego Medical Center 92103-8925.
Insights
Acute pediatric thyroid hormone ingestions of 5 mg levothyroxine (T4) equivalent or less are unlikely to cause significant toxicity. Most young children experienced mild symptoms, with no clear link between ingestion amount and observed effects.
Area of Science:
- Pediatric Toxicology
- Endocrinology
- Emergency Medicine
Background:
- Acute thyroid hormone ingestions in children require careful evaluation for potential toxicity.
- Levothyroxine (T4) is a common thyroid hormone replacement medication.
- Understanding dose-response relationships is crucial for managing pediatric ingestions.
Purpose of the Study:
- To determine if acute ingestions of ≤5 mg levothyroxine (T4) equivalent cause significant toxicity in pediatric patients.
- To identify the highest tolerated milligram-per-kilogram dose of thyroid hormone in children.
- To analyze factors influencing toxicity in pediatric thyroid hormone ingestions.
Main Methods:
- Retrospective review of 92 pediatric cases (< or = 6 years) of acute thyroid hormone ingestions reported to a poison control center.
- Evaluation of patient weight, ingested dose, drug preparation, treatment, outcome, and management site.
- Literature review to identify additional cases of pediatric thyroid hormone toxicity.
Main Results:
- Eight patients (9%) experienced mild symptoms without specific medical intervention.
- No correlation was found between the amount of thyroid hormone ingested and observed symptoms.
- The maximum T4 dose ingested without gastrointestinal decontamination was 0.13 mg/kg (2 mg).
- Literature review identified only one case of moderate toxicity with <5 mg T4 equivalent.
Conclusions:
- Significant toxicity is not expected in pediatric patients with acute ingestions of ≤5 mg levothyroxine (T4) equivalent.
- Most pediatric levothyroxine ingestions result in mild or no symptoms.
- The data suggest a wide margin of safety for low-dose levothyroxine ingestions in young children.
Abstract:
Ninety-two pediatric cases (age < or = 6 years) of acute thyroid hormone ingestions that were reported over a 20-month period to one American Association of Poison Control Centers (AAPCC)-certified regional poison center were reviewed to determine whether significant toxicity in pediatric patients is associated with acute ingestions of < or = 5 mg levothyroxine (T4) equivalent of thyroid hormone and the highest-tolerated milligram-per-kilogram dose. Parameters evaluated included patient weight, amount ingested, drug preparation, treatment type, outcome, management site, and relevant comments. Eight patients had mild symptoms requiring no specific medical intervention and there was no correlation between the amount ingested and symptoms observed. The maximum T4 dose ingested without gastrointestinal decontamination was 0.13 mg/kg (2 mg). A literature review was also conducted. Only one case of moderate toxicity with a dose of less than 5 mg T4 equivalent was found in the literature review. Significant toxicity is not expected with ingestions of less than or equal to 5 mg T4 equivalent of thyroid hormone.