Ver el código de «Levothyroxine toxicity»

==Background==
*Most acute thyroxine overdoses are mild.
*Chronic ingestions are more likely to present with clinical symptoms similar to [[thyrotoxicosis]]
*Diet pills such as Singaporean Slim 10<ref>Hedberg CW: An outbreak of thyrotoxicosis caused by the consumption of bovine thyroid gland in ground beef. N Engl J Med. 1987;316:993–998.</ref> and athletic stimulant compounds can contain large amounts of T3/T4
*Thyrotoxicosis factitia - also known as thyroxine addict or metabolic malingerer where large doses of thyroid supplementation is taaking for weight loss or stimulation

==Clinical Features==
Although most thyroxine ingestions are mild, large acute or chronic ingestions can mirror moderate to severe thyrotoxicosis
{{Thyrotoxicosis clinical features}}

==Differential Diagnosis==
{{Widened Pulse Pressure DDX}}

==Evaluation==
*Workup and diagnosis will follow that for [[thyrotoxicosis]]

==Management==
*Mirrors the treatment for [[thyroid storm]] with the exception of antithyroid drugs which offer little potential benefit with the exception of [[propranolol]]
===Agitation===
*Best treated with [[benzodiazepines]]
===Catecholamine Excess===
*[[Propranolol]] 1 to 2 mg IV every 10 to 15 minutes are recommended
===Hyperthermia===
*Aspirin, should be avoided because it carries a theoretical risk of thyrotoxicity by displacing T3 and T4 from thyroxine-binding globulin.
*External cooling is the best means to treat severe hyperthermia in addition consideration of intubation with sedation and continued paralysis.
===Drug Removal===
*[[Plasma exchange]] or [[plasmapheresis]] can be used in the most severe of poisonings<re>Van Huekelom S, et al Plasmapheresis in L-thyroxine intoxication. Vet Hum Toxicol.1979;s21:7</ref>

==Disposition==
*Symptomatic patients should be admitted for observation

==See Also==
*[[Thyroid disease]]
*[[Thyroid storm]]

==External Links==


==References==
<references/>

[[Category: Toxicology]]