Levothyroxine toxicity
Background
- Most acute thyroxine overdoses are mild.
- Chronic ingestions are more likely to present with clinical symptoms similar to thyrotoxicosis
Clinical Features
Classic Triad
- Hyperthermia
- Often marked (40 - 41C)[1]
- Tachycardia
- Often out of proportion to fever [2]
- Altered mental status (agitation, confusion, delirium stupor, coma, seizure)
May also have:
- Goiter
- Thyrotoxic stare, lid retraction
- Hyperhidrosis
- Thermoregulatory dysfunction
- Central nervous system dysfunction
- Gastrointestinal-hepatic dysfunction
- Diarrhea, nausea and vomiting, abdominal pain
- Unexplained jaundice, hepatomegaly
- Cardiovascular dysfunction
- Tachycardia, palpitations
- Congestive heart failure, dyspnea
- Pedal edema
- A. fib
- Widened pulse pressure
Differential Diagnosis
- Sympathomimetic ingestion
- Atherosclerosis
- Aortic regurgitation
- Thyrotoxicosis
- Fever
- Anemia
- Pregnancy
- Anxiety
- Patent ductus arteriosus
- Heart block
- Aortic dissection
- Endocarditis
- Increased ICP
- Vasodilating drugs
- Beriberi
- Pheochromocytoma
Evaluation
Workup
Diagnosis
Management
- Management mirrors Thyroid storm treatment and depends on the degree of clinical symptoms
Disposition
See Also
External Links
References
- ↑ Thiessen, M. (2018). Thyroid and Adrenal Disorders in Rosen's emergency medicine: Concepts and clinical practice (9th ed.). Philadelphia, PA: Elsevier/Saunders.
- ↑ Thiessen, M. (2018). Thyroid and Adrenal Disorders in Rosen's emergency medicine: Concepts and clinical practice (9th ed.). Philadelphia, PA: Elsevier/Saunders.