Betül ÖZTÜRK, İlknur BODUR, Aysun TEKELİ, Ali GÜNGÖR, Raziye Merve YARADILMIŞ, Muhammed Mustafa GÜNEYLİOĞLU, Aytaç GÖKTUĞ, Nilden TUYGUN, Can Demir KARACAN

Çocukluk çağında levotiroksin zehirlenmesi – gerçekten korkmalı mıyız?

Amaç: L-tiroksin zehirlenmesi çocukluk çağında az görülmesine rağmen, aileler ve klinisyenler açısından endişe verici bir durumdur. Bu çalışmada l-tiroksin zehirlenmesi ile acil servise başvuran çocukların klinik ve laboratuvar bulgularının sunulması amaçlanmıştır. Yöntemler: L-tiroksin alımıyla Ocak 2015 – Haziran 2022 arası çocuk acil servisine başvuran hastalar geriye dönük olarak çalışmaya dahil edildi. Hastaların klinik özellikleri, laboratuvar bulguları, tedavi ve hastane masrafları kayıt ve analiz edildi. Bulgular: Bu çalışmada tiroksin intoksikasyonu olan 33 hasta vardı. Hastaların medyan yaşı 35 ay (Interquartil Range (IQR): 25-47.5) ve hastaların 19’u kızdı (57,5%). Başvuru sırasında hiçbir hastada klinik semptom yoktu. Bir hastada masif l-tiroksin alımı varken iki hastada taşikardi mevcuttu. 18 hastada gastrik lavaj ve aktif kömür kullanıldı. 4 hasta çocuk yoğun bakımda takip edildi ve bir tanesi için propranolol tedavisi uygulandı. Ortanca hastanede kalış süresi 24 (IQR 13,5-84) saatti. Ortanca tedavi masrafı ise $73’dı (IQR56.2-116.75). Sonuç: L-tiroksin zehirlenmesi çocuklarda sıklıkla düşük dozlarda olur ve iyi seyirlidir. Bu hastaların özellikle düşük doz alımı olanların rutin olarak hastaneye yatışı tedavi masrafları göz önüne alındığında yeniden sorgulanmalıdır.

Anahtar Kelimeler:

Çocukluk, intoksikasyon, l-tiroksin, toksisite, zehirlenme

Levothyroxine poisoning in children – should we really be afraid?

Aim: L-thyroxine intoxication is rarely seen in children; however, it can be worrying for clinicians and parents. This study aimed to present the clinical and laboratory findings of children admitted to the pediatric emergency department with l-thyroxine intoxication. Methods: Patients admitted to the pediatric emergency department with l-thyroxine intake between January 2015 and June 2022 were included in this retrospective study. The patient’s clinical characteristics, laboratory findings, treatment, and hospital costs were recorded and analyzed. Results: This study included 33 pediatric patients with thyroxine intoxication. The median age was 35 months (The interquartile range (IQR) 25-47.5) and 19 of them were girls (57,5%). No patient had a clinical symptom at the admittance. One patient had massive l-thyroxine intake and two patients had tachycardia. Gastric lavage and activated charcoal were used in 18 patients. Four patients were followed in the pediatric intensive care unit and one of them was treated with propranolol. The median time of hospital stay was 24 hours (IQR 13,5-84). The median cost of the treatment was $73 (IQR56.2-116.75). Conclusion: L-thyroxine intoxication usually occurs with low drug doses in children and has a benign prognosis. Routine hospitalization of these patients, particularly with low drug dose intake, should be questioned considering the treatment cost.

Keywords:

Children, intoxication, l-thyroxin, poisoning, toxicity,

PDF

___

Savran Y, Mengi T, Keskinkilic M. A severe case of levothyroxine intoxication successfully treated in intensive care unit. J Acute Dis 2018;7:175-7.
Medeiros-Neto G. Thyroxine poisoning. In: de Groot LJ, Beck-Peccoz P, Chrousos G, et al, eds. Endotext [Internet]. South Dartmouth, MA: MDText.com, Inc; 2000.
Nygaard B, Saedder EA, Dalhoff K, et al. Levothyroxine poisoning—symptoms and clinical outcome. Basic Clin Pharmacol Toxicol. 2015;117:280–5.
Tenenbein M, Dean HJ. Benign course after massive levothyroxine ingestion. Pediatr Emerg Care. 1986;2:15–17.
Ergul AB, Altuner Torun Y, Serbetci MC, Ozcan A, Bas VN. Clinical Toxicity of Acute Overdoses With L-Thyroxin in Children. Pediatr Emerg Care. 2019;35(11):787-90.
Litovitz TL, White JD. Levothyroxine ingestions in children: an analysis of 78 cases. Am J Emerg Med. 1985;3:297–300.
Mowry JB, Spyker DA, Brooks DE, Zimmerman A, Schauben JL. 2015 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 33rd Annual Report. Clin Toxicol (Phila). 2016;54(10):924-1109.
Ulusal Zehir Danışma Merkezi (UZEM) Raporları 2014-2020 Yılları. https://hsgm.saglik.gov.tr/depo/kurumsal/yayinlarimiz/Raporlar/Uzem/uzem_raporlari_2014-2020.pdf Accessed December 2020
Golightly LK, Smolinske SC, Kulig KW, et al. Clinical effects of accidental levothyroxine ingestion in children. Am J Dis Child. 1987;141:1025–7.
Gittoes NJ, Franklyn JA. Drug-induced thyroid disorders. Drug Saf. 1995;13:46–55.
Von Hofe SE, Young RL. Thyrotoxicosis After a Single Ingestion of Levothyroxine. JAMA. 1977;237(13):1361.
Kreisner E, Lutzky M, Gross JL. Charcoal hemoperfusion in the treatment of levothyroxine intoxication. Thyroid. 2010;20(2):209-12.
Lewander WJ, Lacouture PG, Silva JE, Lovejoy FH. Acute thyroxine ingestion in pediatric patients. Pediatrics. 1989;84(2):262-5.
Lehrner LM, Weir MR. Acute ingestions of thyroid hormones. Pediatrics. 1984;73:313–7.
Shilo L, Kovatz S, Hadari R, Weiss E, Nabriski D, Shenkman L. Massive thyroid hormone overdose: kinetics, clinical manifestations and management. Isr Med Assoc J. 2002;4(4):298-9.
Brooks MH, Waldstein SS, Bronsky D, Sterling K. Serum triiodothyronine concentration in thyroid storm. J Clin Endocrinol Metab. 1975;40(2):339-41.
Vale JA, Kulig K. Position paper: gastric lavage. J Toxicol Clin Toxicol 2004;42:933-43.
Geffner DL, Hershman JM. Beta-adrenergic blockade for the treatment of hyperthyroidism. Am J Med. 1992;93:61–8.
Kubota S, Tamai H, Ohye H, Fukata S, Kuma K, Miyauchi A. Transient hyperthyroidism after withdrawal of antithyroid drugs in patients with Graves’ disease. Endocr J. 2004;51(2):213-7.
Singh GK, Winterborn MH. Massive overdose with thyroxine—toxicity and treatment. Eur J Pediatr. 1991;150:217.
Majlesi N, Greller HA, McGuigan MA, Caraccio T, Su MK, Chan GM. Thyroid storm after pediatric levothyroxine ingestion. Pediatrics. 2010;126(2):e470-3.