ESPE Abstracts

Objective: The objective of this study was to investigate the clinical presentations, laboratory findings, treatment modalities, follow-up strategies employed for children with levothyroxine (LT4) poisoning.

Materials-Methods: The study encompassed patients admitted to the respective centers between 2010-2023, who fulfilled the predefined study criteria. Findings were presented as percentages (%), median values with interquartile ranges (25th-75th percentile).

Results: A total of 45 patients were enrolled in the study, with 62.2% (n = 28) being female. The median age was 3.83 (2.2-6.1) years. The ingestion of LT4 was accidental in 80% (n = 36) of cases, suicidal in 20% (n = 9). The median ages for accidental and suicidal ingestion were 3.0 (2.0-4.2) and 15.0 (13.7-16.9) years, respectively (P <0.001). Nine patients (20%) were concurrently taking multiple medications. Of those who ingested LT4 for suicidal purposes, 66.7% (n = 6) were taking multiple drugs compared to 8.3% (n = 3) of those with accidental ingestion (P <0.01). The median LT4 dose ingested was 500 (212.5-1112.5) mcg/day, 27 (10.55-53.25) mcg/kg/day. Symptoms were reported in 31.1% (n = 14) of patients, with tachycardia being the most common (31.1%, n = 14), followed by hypertension (8.9%, n = 4), agitation (6.7%, n = 3), restlessness (2.2%, n = 1), headache (2.2%, n = 1), confusion (2.2%, n = 1). The median LT4 dose among symptomatic patients was 1112.5 (431.2-2312.5) mcg/day, significantly higher than the median dose of 325 (200-750) mcg/day among asymptomatic patients (P = 0.003). Symptoms were more prevalent in patients taking multiple medications (66.7%, n = 6) compared to those not taking multiple medications (22.2%, n = 8) (P = 0.017). Thyroid function tests (TFTs) were abnormal in 48.9% (n = 22) of patients, normal in 51.1% (n = 23). The median LT4 dose among those with abnormal TFTs was 875 (456.2-1875) mcg/day, higher than the median dose of 300 (150-600) mcg/day among those with normal TFTs (P <0.001). Abnormal TFTs were observed in 64.3% (n = 9) of symptomatic patients and 41.9% (n = 13) of asymptomatic patients (P = 0.165). Treatment was initiated in 53.3% (n = 24) of patients, with gastric lavage administered to 26.6% (n = 12), activated charcoal given to 51.1% (n = 23). Additionally, one patient with severe symptoms received propranolol, methimazole, steroids, while two patients with tachycardia received propranolol, one patient received steroids. The median hospital stay was 24 (12-48) hours, with an outpatient follow-up duration of 3 (0-14) days.

Conclusion: Adolescents who present with LT4 poisoning tend to have ingested multiple drugs primarily for suicidal intent and to be more symptomatic. Although mild symptomps may be evident in such cases many patients experience recovery with supportive treatment and/or follow-up care.