Clinical Pediatrics

 

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Clinical Pediatrics, Vol. 28, No. 8, 374-376 (1989)
DOI: 10.1177/000992288902800808

Massive Levothyroxine Ingestion

Conservative Management

Scott H. Mandel, MD

Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97201

A. Roy Magnusson, MD

Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97201

Brent T. Burton, MD

Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97201

J. Robert Swanson, MD

Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97201

Stephen H. LaFranchi, MD

Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97201

The clinical course of a 29-month-old girl who was referred for evaluation after ingesting ninety 0.2-mg tablets of levothyroxine is reported. Despite an initial thyroxine (T4) level of 282 µg/dl and a triiodothyronine (T3) level of 1,837 ng/dl at 48 hours postingestion, her symptoms were mild and included irritability, vomiting, tremor, and tachycardia. Treatment was limited to activated charcoal and propranolol. Thyroid hormone levels fell to normal by 13 days postingestion. The child's clinical course was benign.

Even after massive acute ingestions of levothyroxine, children's symptoms are usually mild and may be controlled with propranolol. This conservative approach should be considered before expensive and potentially dangerous therapies are undertaken.


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