Isr Med Assoc J. 2002 Apr;4(4 298-9. PMID : To err is human If you disagree with the recommended answers or have other suggestions please leave a comment below!Symptom onset is typically within 1-2 hours. the absence of significant sedation, ataxia, or dysarthria at 6 hours post-ingestion suggests that these symptoms are unlikely to occur to any clinically significant extent.
The ATA also notes that hyperthyroidism has no cure, but patients may manage and treat the affliction to control it. Learn more about Drug Interactions.Thanks so much! I really appreciate how helpful you've been and would recommend your company to anyone who asks.
The patient claims to have taken 60 x 200 mcg of thyroxine and 10 x 10 mg of temazepam. The ingestion was not witnessed by anyone else. The patient currently has normal vital signs (GCS of 15) and is feeling tired but is otherwise asymptomatic.Clinical manifestations of thyroxine overdose are largely sympathomimetic in nature and result from adrenergic stimulation they include: agitation, sweating, tachycardia, hypertension, headache, diarrhoea and vomiting. Temazepam 100mg most benzodiazepines, in the absence of other sedative coingestants, only cause mild sedation.
I'm glad to say that I can recommend you with total confidence. Thanks. Mohammed Farooq This is to inform you that I have received my package yesterday. I want to thank you and other staff members of canadian pharmacy for your continous coordination and support for customers.Aka Toxicology Conundrum 019 You receive a call from a concerned doctor at midnight. The doctor asks you for advice about the management of the following case: A 34 year-old female with a past medical history of Hashimotos thyroiditis (currently taking thyroxine 200 mcg daily) who took an overdose 6 hours ago.
Daniel Haroldsen I received the package a few days ank you so very much! Everything was perfect. I do appreciate your great service and will most definitely order again from you.Symptoms of thyroid excess do not occur so soon after thyroxine ingestion. Risk assessment as described in Q2. Investigations screening tests only ECG, paracetamol level, BSL. Decontamination, Enhanced elimnation and Antidot es nil Disposition psychiatric assessment for deliberate self-poisoning advise patient they may develop delayed symptoms of thyroid excess arrange appropriate outpatient follow-up for assessment.
I really appreciate the services of your pharmacy. Best Regards. Tristan Corring Hi! I am pleased to inform you that I have received my package today. Best regards. Jenny K. Schuster.If beta-blockers are contra-indicated, an alternative is diltiazem 60-180 mg q8h po. Q6. Describe your overall management plan. Show Answer Resuscitation, supportive care and monitoring no resuscitation issues. The patient does not require cardiac monitoring.
Dont discharge the patient at midnight! She should be admitted overnight for supportive care. Prolonged hospital admission is unnecessary. If you cant remember how thyroid hormones exert their effects at the cellular level, check out the clunky video: References Hack JB, Leviss JA, Nelson LS, Hoffman RS.Q5. How would you treat a patient who is symptomatic following thyroxine overdose? Show Answer Patients with the sympathomimetic features described in Q2 may be treated with propanolol 10-40mg q6h po for symptomatic relief.
Full Answer The American Thyroid Association notes several symptoms often associated with hyperthyroidism, including a slowdown of the body's normal processes. When this occurs, the body becomes tired easily but unable to sleep, it becomes cold and the skin feels drier.The doctor wants to know the best way of managing this patients impending thyrotoxic storm. Questions Q1. What advice would you give the doctor regarding her concern about an impending thyrotoxic storm?
Q4. Discuss the utility of thyroid function tests in this patient. Show Answer Thyroid function tests are not routinely indicated following thyroxine overdose. Although elevated thyroxine levels are expected, they have little clinical correlation and do not alter management.Other symptoms include depression, nervousness, shakiness, trouble exercising, shortness of breath, greater appetite and feelings of forgetfulness. However, these symptoms may vary and many people miss them because they associate these symptoms with other ailments.
Q3. Would you decontaminate this patient? Show Answer. No the patient has presented too late. In the setting of a thyroxine overdose activated charcoal may be given if: the patient is cooperative 10mg thyroxine was ingested (i.e.Q2. What is your risk assessment? Show Answer The patient will not develop significant life-threatening toxicity from this co-ingestion. Delayed symptoms from thyroxine excess may occur. Thyroxine 12mg most patients remain asymptomatic following thyroxine overdose symptoms may occur if 10mg thyroxine is ingested if symptoms do develop they usually do not arise until after 48.
Severe symptoms following a massive intentional L-thyroxine ingestion. Vet Hum Toxicol. 1999 Oct;41(5 323-6. PMID : Lewander WJ, Lacouture PG, Silva JE, Lovejoy FH. Acute thyroxine ingestion in pediatric patients. Pediatrics.1989 Aug;84(2 262-5. PMID : 2748253 Litovitz TL, White JD. Levothyroxine ingestions in children: an analysis of 78 cases. Am J Emerg Med. 1985 Jul;3(4 297-300. PMID : 2860910 Murray L, Daly FFS, Little M, and Cadogan M.
Show Answer The doctor can relax. A thyrotoxic storm is never an early feature of acute thyroxine ingestion, even if the dose is massive. This ingestion is not life-threatening. Chronic thyroxine excess is more likely to cause clinically important thyrotoxicosis, and is particularly concerning in the elderly and those with cardio-respiratory comorbidities.Chapter 3.67 Thyroxine; in Toxicology Handbook, Elsevier Australia, 2007. Google Books Preview Shilo L, Kovatz S, Hadari R, Weiss E, Nabriski D, Shenkman L. Massive thyroid hormone overdose: kinetics, clinical manifestations and management.