Levothyroxine toxicity - Revision history

Ostermayer: /* Hyperthermia */

2022-01-14T22:11:13Z

Hyperthermia

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	*Aspirin, should be avoided because it carries a theoretical risk of thyrotoxicity by displacing T3 and T4 from thyroxine-binding globulin.		*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.		*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==		==Disposition==

2022-01-14T22:05:13Z

Management

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	==Management==		==Management==
	*Mirrors the treatment for [[thyroid storm]]		*Mirrors the treatment for [[thyroid storm]] with the exception of antithyroid drugs which offer little potential benefit with the exception of [[propranolol]]
	===Agitation===		===Agitation===
	*Best treated with [[benzodiazepines]]		*Best treated with [[benzodiazepines]]

2022-01-09T04:03:37Z

Management

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	==Management==		==Management==
	*~~Management mirrors~~ [[~~Thyroid~~ storm]] ~~treatment and depends on the degree of clinical symptoms~~		*Mirrors the treatment for [[thyroid storm]]
	*~~Agitation - best~~ treated with [[benzodiazepines]]		===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.

	==Disposition==		==Disposition==

2022-01-09T03:50:11Z

Management

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	==Management==		==Management==
	*Management mirrors [[Thyroid storm]] treatment and depends on the degree of clinical symptoms		*Management mirrors [[Thyroid storm]] treatment and depends on the degree of clinical symptoms
			*Agitation - best treated with [[benzodiazepines]]

	==Disposition==		==Disposition==

2022-01-09T03:44:29Z

2022-01-09T03:41:51Z

Disposition

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

	==See Also==		==See Also==

2022-01-09T03:39:57Z

Evaluation

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

	~~===Diagnosis===~~

	==Management==		==Management==

2022-01-09T03:25:59Z

Background

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	*Most acute thyroxine overdoses are mild.		*Most acute thyroxine overdoses are mild.
	*Chronic ingestions are more likely to present with clinical symptoms similar to [[thyrotoxicosis]]		*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==		==Clinical Features==
	Although most thyroxine ingestions are mild, large acute or chronic ingestions can mirror moderate to severe thyrotoxicosis		Although most thyroxine ingestions are mild, large acute or chronic ingestions can mirror moderate to severe thyrotoxicosis

2022-01-09T03:00:11Z

Clinical Features

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	*Chronic ingestions are more likely to present with clinical symptoms similar to [[thyrotoxicosis]]		*Chronic ingestions are more likely to present with clinical symptoms similar to [[thyrotoxicosis]]
	==Clinical Features==		==Clinical Features==
			Although most thyroxine ingestions are mild, large acute or chronic ingestions can mirror moderate to severe thyrotoxicosis
	{{Thyrotoxicosis clinical features}}		{{Thyrotoxicosis clinical features}}

2022-01-09T02:54:39Z

Differential Diagnosis