Lewander W J, Lacouture P G, Silva J E, Lovejoy F H
Department of Pediatrics, Rhode Island Hospital Brown University Medical School, Providence 02902.
Pediatrics. 1989 Aug;84(2):262-5.
During a 1-year period, 15 cases of acute thyroxine (T4) overdose with documented serum T4 concentrations were studied. All patients were less than 5 years of age and 80% were boys. All were examined within 1 to 6 hours of ingestion and all were asymptomatic. Estimated dose ingested in 10 patients ranged from 1.5 to 8.8 mg (0.1 to 0.73 mg/kg). Three patients with initial T4 serum concentrations greater than 75 micrograms/dL manifested signs of toxicity within 12 to 48 hours (fever, tachycardia, hypertension, and/or agitation) that resolved within 24 to 60 hours. The mean elimination half-life of T4 in 7 patients with multiple serum concentrations was 2.8 +/- 0.4 days, whereas the mean elimination half-life of triiodothyronine was 6 +/- 1.7 days. It was concluded that (1) the majority of acute pediatric T4 overdoses are not severe and may be managed on an outpatient basis, (2) the absence of early clinical manifestations does not preclude delayed onset of toxicity that may be better predicted by initial T4 concentrations, and (3) the elimination half-life of T4 is shorter and the elimination half-life of tri-iodothyronine is longer than with therapeutic doses.
在1年期间，对15例有记录血清甲状腺素（T4）浓度的急性T4过量病例进行了研究。所有患者年龄均小于5岁，80%为男孩。所有患者均在摄入后1至6小时内接受检查，且均无症状。10例患者摄入的估计剂量为1.5至8.8毫克（0.1至0.73毫克/千克）。3例初始T4血清浓度大于75微克/分升的患者在12至48小时内出现中毒迹象（发热、心动过速、高血压和/或躁动），并在24至60小时内缓解。7例有多个血清浓度的患者中，T4的平均消除半衰期为2.8±0.4天，而三碘甲状腺原氨酸的平均消除半衰期为6±1.7天。得出的结论是：（1）大多数急性儿童T4过量并不严重，可在门诊处理；（2）早期无临床表现并不排除毒性延迟发作，初始T4浓度可能更好地预测毒性延迟发作；（3）与治疗剂量相比，T4的消除半衰期较短，三碘甲状腺原氨酸的消除半衰期较长。
