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Title: | Prolonged coma resulting from massive levothyroxine overdose and the utility of N-terminal prohormone brain natriuretic peptide (NT-proBNP). | Authors: | Wong O.;Graudins A. ;Greene S.;Wong A. | Institution: | (Wong, Graudins) Monash Clinical Toxicology Unit, Emergency Medicine Service, Monash Health, Melbourne, VIC, Australia (Wong, Graudins) Department of Medicine, School of Clinical Sciences, Monash Emergency Research Collaborative, Monash University, Monash Health, Melbourne, VIC, Australia (Wong, Greene) Austin Toxicology Service, Austin Health, VIC, Australia (Wong, Greene, Graudins) Victorian Poisons Information Centre, Austin Health, Heidelberg, VIC, Australia (Greene) Department of Medicine at Austin Health, University of Melbourne, Melbourne, VIC, Australia | Issue Date: | 21-May-2019 | Copyright year: | 2019 | Publisher: | Taylor and Francis Ltd | Place of publication: | United States | Publication information: | Clinical Toxicology. 57 (6) (pp 415-417), 2019. Date of Publication: 03 Jun 2019. | Journal: | Clinical Toxicology | Abstract: | Introduction: Levothyroxine overdose rarely results in systemic toxicity. We report a case of intentional levothyroxine overdose with a delayed onset coma and delirium lasting two weeks. Case Summary: A 72-year-old female ingested 12 mg levothyroxine. Initially, she was drowsy but quickly recovered and was well for the following two days. On day-3 post-overdose her mental state gradually deteriorated. She presented to the hospital with agitation, confusion and dyspnoea. Initial vital signs: P128 bpm, BP132/67 mmHg, temperature 38 degreeC and SpO2 97%RA. Features suggesting thyroid storm were present: fever >38 degreeC, tachycardia and persistent coma. Serum T4 and T3 were >150 pmol/L (normal: 8-16) and >30.8 pmol/L (normal: 3.2-6.1), respectively. These remained elevated for 11 days. She was treated with propranolol, propylthiouracil and cholestyramine. She remained intubated for two weeks without sedation. Her conscious state improved on day-13, coinciding with normalisation of serum T4. Normal cognition was regained four days later. N-terminal pro-brain natriuretic peptide (NT ProBNP) concentration was increased during coma and peaked 2 days prior to Glasgow Coma Score improving. Discussion(s): Our case demonstrates features of thyrotoxicosis and thyroid storm with coma after massive levothyroxine overdose. Coma was associated with an increase in NT-proBNP concentration. This may be a potential marker for brain injury and recovery.Copyright © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1080/15563650.2018.1533639 | PubMed URL: | 30484711 [http://www.ncbi.nlm.nih.gov/pubmed/?term=30484711] | ISSN: | 1556-3650 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/35675 | Type: | Article | Subjects: | liothyronine blood level mental deterioration nuclear magnetic resonance imaging protein blood level restlessness retrospective study sinus tachycardia/dt [Drug Therapy] *thyroid crisis/di [Diagnosis] *thyroid crisis/et [Etiology] *thyrotoxicosis/di [Diagnosis] *thyrotoxicosis/et [Etiology] thyroxine blood level vital sign *amino terminal pro brain natriuretic peptide/ec [Endogenous Compound] colestyramine/dt [Drug Therapy] colestyramine/pv [Special Situation for Pharmacovigilance] diazepam/pv [Special Situation for Pharmacovigilance] eletriptan/pv [Special Situation for Pharmacovigilance] hydrocortisone/iv [Intravenous Drug Administration] hydrocortisone/pv [Special Situation for Pharmacovigilance] *levothyroxine/do [Drug Dose] *levothyroxine/pv [Special Situation for Pharmacovigilance] liothyronine/ec [Endogenous Compound] propranolol/dt [Drug Therapy] propranolol/po [Oral Drug Administration] propranolol/pv [Special Situation for Pharmacovigilance] propylthiouracil/dt [Drug Therapy] propylthiouracil/pv [Special Situation for Pharmacovigilance] thyrotropin/ec [Endogenous Compound] thyroxine/ec [Endogenous Compound] laboratory device Stratus CS Acute Care drug overdose aged article body temperature case report clinical article cognition *coma/et [Etiology] confusion drowsiness *drug intoxication/dt [Drug Therapy] dyspnea female fever Glasgow coma scale human intubation Article female fever Glasgow coma scale human intubation liothyronine blood level mental deterioration nuclear magnetic resonance imaging protein blood level restlessness retrospective study sinus tachycardia / drug therapy *thyroid crisis / *diagnosis / *etiology *thyrotoxicosis / *diagnosis / *etiology thyroxine blood level vital sign aged dyspnea body temperature case report clinical article cognition *coma / *etiology confusion drowsiness *drug intoxication / *drug therapy drug overdose |
Type of Clinical Study or Trial: | Case series or case report |
Appears in Collections: | Articles |
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