Tsutaoka Ben T, Kim Susan, Santucci Stephen
California Poison Control System, San Francisco Division, University of California, 94143-1369, USA.
Pediatr Emerg Care. 2005 Dec;21(12):857-9. doi: 10.1097/01.pec.0000190240.81222.9a.
Unintentional ingestion of thyroid hormone preparations is a common occurrence reported to poison control centers. These incidents rarely result in serious outcomes. We report a case of a tonic-clonic seizure occurring in a child after ingestion of a maximum of 3.6 mg of levothyroxine.
A 3.5-year-old boy ingested up to 41 tablets of 88 microg levothyroxine, which was not discovered until the following day. On the third day after the ingestion, he had a single 5- to 10-minute tonic-clonic seizure. Laboratory results were total thyroxine greater than 24.0 microg/dL; free thyroxine, 5.5 ng/dL; and thyroid-stimulating hormone, 0.03 mU/L. On the following day, the patient had diarrhea and was hyperactive; heart rate was 144 beats per minute, and mild hyperreflexia was noted on neurological examination. Symptoms were resolved 3 days later.
This is the second case report of a seizure occurring in a child after an unintentional ingestion of levothyroxine. The maximum amount possibly ingested is much lower than that previously reported. Pediatric ingestion of less than 5 mg of levothyroxine may result in serious outcomes.
意外摄入甲状腺激素制剂是向中毒控制中心报告的常见情况。这些事件很少导致严重后果。我们报告一例儿童在摄入最多3.6毫克左甲状腺素后发生强直阵挛性癫痫发作的病例。
一名3.5岁男孩摄入了多达41片88微克的左甲状腺素，直到第二天才被发现。摄入后的第三天，他出现了一次持续5至10分钟的强直阵挛性癫痫发作。实验室检查结果为总甲状腺素大于24.0微克/分升；游离甲状腺素5.5纳克/分升；促甲状腺激素0.03毫国际单位/升。第二天，患者出现腹泻且多动；心率为每分钟144次，神经系统检查发现轻度反射亢进。症状在3天后消失。
这是第二例关于儿童意外摄入左甲状腺素后发生癫痫发作的病例报告。可能摄入的最大量远低于先前报告的量。儿童摄入少于5毫克的左甲状腺素可能会导致严重后果。
