Endocrinology Unit, Hospital Materno-Infantil Presidente Vargas, Porto Alegre, Brazil.
Thyroid. 2010 Feb;20(2):209-12. doi: 10.1089/thy.2009.0054.
Levothyroxine (l-thyroxine) intoxication may arise from intentional or accidental ingestion of excessive doses of the hormone and may cause symptoms equivalent to thyroid storm. We report a case of massive accidental l-thyroxine intoxication resulting from an error in the preparation of capsules to treat goiter.
A 61-year-old woman was admitted showing high levels of thyroid hormones, with serum-free l-thyroxine level of 955.90 nmol/L (74.1 ng/mL) (normal values: 11.61-27.09 nmol/L or 0.9-2.1 ng/mL). It was discovered that she had ingested 50 mg instead of 50 microg/day of l-thyroxine during 9 days. Following charcoal hemoperfusion, the levels of total thyroxine, serum-free l-thyroxine, and triiodothyronine declined dramatically, with a reproducible pattern of reduction in hormone levels observed after each of the three sessions. The patient recovered from her stuporous mental state, atrial fibrillation, and acute respiratory failure.
The use of hemoperfusion with a charcoal filter appears to be a very important therapeutic tool for the treatment of acute and severe forms of thyrotoxicosis due to l-thyroxine intoxication.
左甲状腺素（L-甲状腺素）中毒可能是由于故意或意外摄入过量激素引起的，并可能导致与甲状腺危象相当的症状。我们报告了一例因治疗甲状腺肿的胶囊制备错误而导致的大量意外左甲状腺素中毒。
一名 61 岁女性因甲状腺激素水平升高而入院，血清游离 L-甲状腺素水平为 955.90nmol/L（74.1ng/mL）（正常值：11.61-27.09nmol/L 或 0.9-2.1ng/mL）。发现她在 9 天内摄入了 50mg 而不是 50μg/天的 L-甲状腺素。进行炭素血液灌流后，总甲状腺素、血清游离 L-甲状腺素和三碘甲状腺原氨酸水平显著下降，每三次治疗后激素水平均呈可重复的下降模式。患者从昏迷状态、心房颤动和急性呼吸衰竭中恢复。
使用带炭素过滤器的血液灌流似乎是治疗由于 L-甲状腺素中毒引起的急性和重度甲状腺毒症的非常重要的治疗工具。
