Ovadia Yaniv S, Paley Liza, Berkovitz Ronny, Hai Emile, Turkot Svetlana
Research Authority, Barzilai University Medical Center Ashkelon, Ashkelon, Israel.
Endocrinology Unit, Barzilai University Medical Center Ashkelon, Ashkelon, Israel.
Harefuah. 2025 Jun;164(6):358-362.
Exogenous excessive thyroid hormone intake may result in severe thyrotoxicosis and might be harmful to human health. In spite of this, a growing number of people consume over-the-counter (OTC) products that also contain Triiodothyronine (T3) and Thyroxine (T4). We report a case of Liothyronine-containing tablets consumption causing T3-induced thyrotoxicosis. A 33-year-old obese man (BMI=40 kg/m2) with no thyroid disease had typical signs of substantial thyrotoxicosis (including wide complex tachycardia and chest pain), which were confirmed by endocrine tests: both low thyrotropin (TSH) and free T4 as well as elevated free T3 (FT3). Prior to hospitalization, he had not been exposed to iodinated radiocontrast media and had not taken medications containing iodine, such as amiodarone. However, we discovered that the patient consumed tablets containing Liothyronine (135 µg/tablet) for five days prior to hospitalization following the suggestion of a non-registered individual, who introduced himself as a nutritionist. The tablets were misleadingly presented to the patient as a "weight loss" dietary supplement. The tablets were discontinued and a short term therapy that included Amiodarone (before FT3 arrived) was initiated along with Cholestyramine. After three days in the intensive care unit, the patient's heart rate stabilized and his FT3 level decreased substantially. Following investigations, the Israeli Ministry of Health (MOH) published a warning on its website advising the public to avoid these tablets. After follow-up in the community, a repeat echocardiogram revealed a borderline left ventricle dysfunction. During the four years since the patient was released from our hospital, his TSH levels have been normal.
Liothyronine consumption has been associated with substantial thyrotoxicosis and cardiac damage. The Liothyronine tablets were provided to the patient by an unauthorized party, as a weight losing nutritional supplement. However, this was done without a medical examination or indication. The increase in demand for "weight-losing" products 'over the counter', the lack of effective enforcement in the chain, the way these products are presented and the possibility of those who are not authorized to market and supply them, emphasize the need to settle the regulation of this issue as soon as possible.
外源性过量摄入甲状腺激素可能导致严重的甲状腺毒症，对人体健康有害。尽管如此，越来越多的人食用非处方（OTC）产品，这些产品也含有三碘甲状腺原氨酸（T3）和甲状腺素（T4）。我们报告一例因服用含碘塞罗宁片剂导致T3诱导的甲状腺毒症病例。一名33岁无甲状腺疾病的肥胖男子（BMI = 40 kg/m²）出现明显甲状腺毒症的典型症状（包括宽QRS波心动过速和胸痛），内分泌检查证实：促甲状腺激素（TSH）降低、游离T4降低以及游离T3（FT3）升高。住院前，他未接触过碘化造影剂，也未服用含碘药物，如胺碘酮。然而，我们发现患者在住院前五天按照一名自称营养师的非注册人员的建议，服用了含碘塞罗宁（每片135μg）的片剂。这些片剂被误导性地作为“减肥”膳食补充剂提供给患者。停用该片剂，并在FT3下降之前开始使用胺碘酮以及考来烯胺进行短期治疗。在重症监护病房治疗三天后，患者心率稳定，FT3水平大幅下降。经过调查，以色列卫生部（MOH）在其网站上发布警告，建议公众避免使用这些片剂。社区随访后，重复超声心动图显示左心室功能临界受损。自患者出院后的四年里，他的TSH水平一直正常。
服用碘塞罗宁与严重的甲状腺毒症和心脏损害有关。含碘塞罗宁片剂由未经授权的一方作为减肥营养补充剂提供给患者。然而，这是在没有医学检查或指征的情况下进行的。非处方“减肥”产品需求的增加、供应链中缺乏有效监管、这些产品的呈现方式以及未经授权销售和供应这些产品的可能性，都强调了尽快解决该问题监管的必要性。
