| Thyroid storm after pediatric levothyroxine ingestion. | |
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MedLine Citation:
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PMID: 20643722 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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A 2-year-old girl was found with an empty bottle of levothyroxine and blue coloring around her mouth. Forty tablets of 150-microg levothyroxine tablets were missing. Her 6-hour postingestion total thyroxine (T4) level was 68.1 microg/dL (normal range: 5-12 microg/dL), and her total triiodothyronine (T3) level was 472 ng/dL (normal range: 40-130 ng/dL). Serum levels of thyrotropin, T3, and T4 were then checked on days 3, 5, 7, and 10. On postingestion day 5, the child presented for follow-up with hyperthermia, vomiting, irritability, and increased lethargy. She was referred to the emergency department, where a heart rate of 220 beats per minute, a blood pressure of 130/80 mm Hg, and a temperature of 101 degrees F were recorded. She also had multiple episodes of diarrhea. The patient was treated with oral propranolol (0.8 mg/kg) every 6 hours, intravenous normal saline, and ibuprofen; all her vital signs improved. Serial T3, T4, and thyrotropin serum levels were measured. Her total T3 levels were >800, 798, 445, 446, and 98 ng/dL on days 3, 5, 6, 9, and 13, respectively. Total T4 measurement was repeated on day 13, and the concentration was found to be 11.9 microg/dL. Her thyrotropin levels remained undetectable throughout the course of treatment. The patient was discharged from the hospital after a 4-day PICU stay, in good condition, on oral propranolol 0.8 mg/kg every 8 hours. Propranolol administration was discontinued 8 days after initiation with no further tachycardia, hypertension, or hyperthermia. The child tolerated the recommended regimen. |
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Authors:
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Nima Majlesi; Howard A Greller; Michael A McGuigan; Tom Caraccio; Mark K Su; Gar M Chan |
Publication Detail:
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Type: Case Reports; Journal Article Date: 2010-07-19 |
Journal Detail:
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Title: Pediatrics Volume: 126 ISSN: 1098-4275 ISO Abbreviation: Pediatrics Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-08-03 Completed Date: 2010-09-02 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376422 Medline TA: Pediatrics Country: United States |
Other Details:
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Languages: eng Pagination: e470-3 Citation Subset: AIM; IM |
Affiliation:
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Emergency Department, Staten Island University Hospital, Staten Island, NY 10305, USA. nima.majlesi@gmail.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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therapeutic use* Child, Preschool Female Humans Overdose Propranolol / therapeutic use* Thyrotoxicosis / chemically induced*, drug therapy* Thyroxine / pharmacokinetics*, poisoning* |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 525-66-6/Propranolol; 7488-70-2/Thyroxine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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