ESPE Abstracts (2015) 84 P-3-1204

ESPE2015 Poster Category 3 Thyroid (64 abstracts)

Use of Liothyronine in a Case of Consumptive Hypothyroidism Caused by Hepatic Hemangiomas

Shinji Higuchi , Masaki Takagi , Masahiro Goto & Yukihiro Hasegawa


Tokyo Metropolitan Chidren’s Medical Center, Tokyo, Japan


Background: Diffuse or multifocal infantile hepatic hemangiomas cause consumptive hypothyroidism due to overexpression of type 3 deiodinase in the endothelium of vascular tumor. Because type 3 deiodinase converts of T4 to reverse T3 and of T3 toT2, a use of levothyroxine alone may not maintain normal levels both fT3 and fT4. T3 therapy in this order has scarcely been reported. We here present a Japanese case with multifocal infantile hemangiomas, whose fT3 and fT4 levels were low and normal respectively. The low level of fT3 improved with liothyronine alone.

Case report: He was referred to our hospital because of jaundice at the age of 2 months. He showed no signs of hypothyroidism except jaundice. On physical examination, the liver was palpable 3 cm below the right costal margin. Abdominal ultrasonography showed multifocal hemangiomas in both lobes of the liver. Blood tests at this time were as follows: serum total bilirubin 6.4 mg/dl, serum direct bilirubin 0.2 mg/dl, TSH 17.7 μU/ml, fT3 1.96 pg/dl, fT4 1.48 ng/dl. We diagnosed him as having hypothyroidism due to hepatic hemangiomas. Propranolol (2 mg/kg per day) and liothyronine (0.1 μg/kg per day) were started. We used liothyronine alone for hypothyroidism because only fT3 was decreased. The thyroid hormone requirement was gradually reduced and the treatment was discontinued at the age of 5 months. At the age of 8 months, His growth and neurological development were normal for age and he was euthyroid.

Conclusion: A use of liothyronine alone can be useful in some patients with hypothyroidism caused by infantile hepatic hemangiomas, especially when their fT3 level is low, compared to fT4 level.

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