FARUK KILINÇ, Berrin AYDIN BALIK, ZAFER PEKKOLAY, Melike Elif ÇELİK, Alpaslan Kemal TUZCU

Levotiroksin intoksikasyonu: Olgu sunumu

Yüksek doz levotiroksin maruziyetine bağlı levotiroksin intoksikasyonu geniş ve ağır semptomlarla ortaya çıkmaktadır. Levotiroksin, tiroid hormon replasman tedavisinde çok kullanılan bir ilaçtır. İntoksikasyon gelişen hastalarda klinik tablo hastanın aldığı ilaç dozuna, yandaş hastalıklarına, birlikte aldığı diğer ilaçlara göre değişiklik göstermektedir. Düşük dozda alınan vakaların çoğu asemptomatik seyretmektedir. Uygun tedavi protokolleri hala kesinleşmemiştir. Bu sunumda 18 yaşında, suisid amaçlı 6 mg dozunda levotiroksin alan ve intoksikasyon nedeniyle dahili yoğun bakım ünitesinde takip edilen bir olgu sunuldu. Olgu ileri düzeyde tirotoksikoz tablosu ile yatırıldı. Olguya gastrik lavaj, aktif kömür, propiltiourasil, propranolol, prednizolon ve tekrarlayan plazmaferez tedavisi uygulandı. Hastamız şifa ile taburcu edildi.

Levothyroxine intoxication: Case report

Levothyroxine intoxication has a large and severe scale of symptoms in patients which expose to high dose. Levothyroxine is a common drug which is used in thyroid replacement therapy. Patients with intoxication clinical table varies depending on drug dose, concomitant diseases, other drugs taken together. Most of the patients exposed low dose drug remains asymptomatic. There havent been any established trade protocols. In this case, we report a 18 year old swallow 6 mg levothyroxin and required intensive care treatment levothyroxine intoxication patient. Patient had severe thyrotoxicosis symptoms. Patient had gastrointestinal lavage, activated charcoal, propylthiouracil, propranolol, prednisolone therapy and recurrent plasmapheresis. Patient discharged with healing.

PDF

___

1. Beier C, Liebezeit B, Völkl TM, et al. Attempted suicide with L-thyroxine in an adolescent girl. Klin Padiatr 2006; 218: 34-37.
2. Ellenhorn MJ, Schonwald S, Ordod G, Wasserberger J. Section II. Drugs. Part D. Systems Toxicology. In: Ellenhorn MJ, Schonwald S, Ordod G, Wasserberger J (Eds): Ellenhorns Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. Pennsylvania: Williams& Wilkins 1997;242-244.
3. Luis D.A, Duenas A, Martin J, et al. Light symptoms following a high-dose intentional L thyroxine ingestion treated with cholestyramine. Horm Res 2002;57:61-63.
4. Lehrner LM, Weir MR. Acute ingestions of thyroid hormones. Pediatrics 1984;73:313-317.
5. Shilo L, Kovatz S, Hadari R, et al. Massive thyroid hormone overdose: kinetics, clinical manifestations and management. Isr Med Assoc J 2002;4:298-299.
6. Litovitz TL, White JD. Levothyroxine ingestions in children: an analysis of 78 cases. Am J Emerg Med 1985;3:297-300.
7. Tenenbein M, Dean HJ. Benign course after massive levothyroxine ingestion. Pediatr Emerg Care 1986;2:15-17.
8. Tunget CL, Clark RF, Turchen SG, et al. Raising the decontamination level for thyroid hormone ingestions.Am J Emerg Med 1995;13:9-13.
9. Chyka PA, Seger D, Krenzelok EP, et al. Position paper: single-dose activated charcoal. Clin Toxicol (Phila) 2005;43:61-87.
10. Vale JA, Kulig K. Position paper: gastric lavage. J Toxicol Clin Toxicol 2004;42:933-943.
11. Lehrner LM, Weir MR. Acute ingestions of thyroid hormones. Pediatrics 1984;73:313-317.
12. Shilo L, Kovatz S, Hadari R, et al. Massive thyroid hormone overdose: kinetics, clinical manifestations and management. Isr Med Assoc J 2002;4:298-299.
13. Berkner PD, Starkman H, Person N. Acute L-thyroxine overdose; therapy with sodium ipodate: evaluation of clinical and physiologic parameters. J Emerg Med 1991;9:129- 131.
14. Kreisner E, Lutzky M, Gross JL. Charcoal hemoperfusion in the treatment of levothyroxine intoxication. Thyroid 2010;20:209-212.
15. Binimelis J, Bassas L, Marruecos L, et al. Massive thyroxine intoxication: evaluation of plasma extraction. Intensive Care Med 1987;13:33-38.