Olgu Sunumu
ÇOCUKLARDA YÜKSEK DOZ LEVOTİROKSİN ALIMI: OLGU SUNUMLARI LİTERATÜRÜN GÖZDEN GEÇİRİLMESİ VE DOZ-SEMPTOM-TEDAVİ İLİŞKİSİ
Öz
LErişkinlerde az görülen levotiroksin (LT4) intoksikasyonunun çocuklarda görülme sıklığı oldukça fazladır. Bu çalışmada LT4 fazla alımı ile acil servise başvuran dört olguyu sunduk. Sadece bir vakada baş ağrısı, tremor ve konvülziyon gibi belirgin klinik semptomlar görüldü. Tüm vakalar 10 gün boyunca izlendi ve herhangi bir komplikasyon gelişmedi. Akut LT4 intoksikasyonu sonrası 10 gün boyunca tiroid hormon düzeylerinin ölçümü önerilmektedir. Toksik doz net değildir. Adölesanlarda minimal doz aşımı sonrası semptom görülebilirken, bir çok vakada yüksek dozlarda semptom görülmeyebilir. Semptomlar ilaç alımından günler hatta aylar sonra ortaya çıkabilir. Klavuzların önerileri oral alınan LT4 dozuna dayanmaktadır. LT4 intoksikasyonu için tedavi protokollerinin oluşturulması bir gereklidir.
Anahtar Kelimeler
Destekleyen Kurum
DESTEKLEYEN KURUM VE KURULUŞ YOKTUR
Kaynakça
- Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev.2014; 13:391-7.
- Léger J, Olivieri A, Donaldson M, Torresani T, Krude H, van Vliet G, et al. European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism. J Clin Endocrinol Metab. 2014;99 (2):363-84.
- Ogilvy-Stuart AL. Neonatal thyroid disorders. Arch Dis Child Fetal Neonatal Ed. 2002;87:165-71. Bakker B, Kempers MJ, De Vijlder JJ, et al. Dynamics of the plasma concentrations of TSH, FT4 and T3 following thyroxine supplementation in congenital hypothyroidism. Clinical Endocrinology 2002; 57: 529-37.
- Hartman S, Noordam K, Maseland M, van Setten P. Benign course after acute high dose levothyroxine intoxication in a 3-year-old boy. Clin Pediatr Endocrinol. 2017;26(3):171-5.
- de LuisDA,DuenasA,MartinJ,AbadL,CuellarL,AllerR.Light symptoms following a high-dose intentional L-thyroxine ingestion treated with cholestyramine. Hormone Research 2002;57:61–3.
- Savran Y, Mengi T,Keskinkilic M. A severe case of levothyroxine intoxication successfully treated in intensive care unit. J Acute Dis 2018; 7(4): 175-7.
- Tunget CL, Clark RF, Turchen SG, Manoguerra AS. Raising the decontamination level for thyroid hormone ingestions. Am J Emerg Med. 1995;13(1):9-13.
- Güngör A, Bilen H, Akba EM, ve ark. Levotiroksin sodyum intoksikasyonu: Olgu Sunumu. Abant Med J 2013; 2(3): 227-8.
- Xue J, Zhang L, Qin Z, Li R, Wang Y, Zhu K, Li X, Gao X, Zhang J. No obvious sympathetic excitation after massive levothyroxine overdose: A case report. Medicine. 2018; 97 (23).
- Hasan K, Yıldız Ö, Büküm İ, Çetkin A, Karadağ R. Levotiroksin İntoksikasyonu. Fırat Tıp Dergisi 2010;15(4): 213-4.
- Kılınç F, Aydın BB, Pekkolay Z, ve ark. Levotiroksin intoksikasyonu: Olgu sunumu. Dicle Med J 2015; 42: 265-7.
- Baysal ŞG , Bulur N. Levotiroksin Sodyum İntoksikasyonu: Olgu Sunumu Aegean J Med Sci 2018;2:71-2.
- Nygaard B, Saedder EA, Dalhoff K, Wikkelsoe M, Jürgens G. Levothyroxine Poisoning - Symptoms and Clinical Outcome. Basic Clin Pharmacol Toxicol. 2015; 117: 280-5.
- Tenenbein M, Dean HJ. Benign course after massive levothyroxine ingestion. Pediatr Emerg Care. 1986 ;2(1):15-7.
- Ergul AB, Altuner Torun Y, Serbetci MC, Ozcan A, Bas VN. Clinical Toxicity of Acute Overdoses With L-Thyroxin in Children. Pediatr Emerg Care. 2017; 18:787-90.
- Medeiros-Neto G. Thyroxine poisoning. In: de Groot LJ, Beck-Peccoz P, Chrousos G, et al, eds. Endotext [Internet]. South Dartmouth, MA: MDText.com, Inc; 2000.
- Mudoni A, Caccetta F, Caroppo M, et al. Multi-organ failure after massive levothyroxine ingestion: case report [in Italian]. G Ital Nefrol. 2015;32.
- Medeiros-Neto G. Thyroxine poisoning. In: de Groot LJ, Beck-Peccoz P, Chrousos G, et al., eds. Endotext [Internet]. South Dartmouth, MA: MDText.com, Inc; 2000.
- Golightly LK, Smolinske SC, Kulig KW, Wruk KM, Gelman CJ, Rumack BH, Linden CH. Clinical effects of accidental levothyroxine ingestion in children. Am J Dis Child. 1987; 141: 1025-7.
- Seizure in a child after an acute ingestion of levothyroxine. Pediatr Emerg Care. 2005;21(12):857-9.
HIGH-DOSE LEVOTYROXIN RECEPTION IN CHILDREN: CASE REPORTS REVIEW OF THE LITERATURE AND DOSE-SYMPTOM-TREATMENT RELATION
Öz
Levothyroxine (LT4) intoxication, which is rare in adults, is more common in children. In this study, we presented four cases who presented to the emergency department with excess LT4 intake. Only one case had prominent clinical symptoms such as headache, tremor, and convulsions. All the cases followed up ten days and cases did not develop any complication during this period. It is recommended to measure thyroid hormone levels for 10 days after acute LT4 intoxication. The cut-off of toxic dose is unclear. While symptoms may be seen after minimal overdose in adolescents, symptoms may not be seen at high doses in many cases. Symptoms may appear days or even months after taking the medication. The recommendations of guidelines depend on the quantity of LT4 that has been ingested. It is necessary to establish treatment protocols for LT4 intoxication.
Anahtar Kelimeler
Kaynakça
- Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev.2014; 13:391-7.
- Léger J, Olivieri A, Donaldson M, Torresani T, Krude H, van Vliet G, et al. European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism. J Clin Endocrinol Metab. 2014;99 (2):363-84.
- Ogilvy-Stuart AL. Neonatal thyroid disorders. Arch Dis Child Fetal Neonatal Ed. 2002;87:165-71. Bakker B, Kempers MJ, De Vijlder JJ, et al. Dynamics of the plasma concentrations of TSH, FT4 and T3 following thyroxine supplementation in congenital hypothyroidism. Clinical Endocrinology 2002; 57: 529-37.
- Hartman S, Noordam K, Maseland M, van Setten P. Benign course after acute high dose levothyroxine intoxication in a 3-year-old boy. Clin Pediatr Endocrinol. 2017;26(3):171-5.
- de LuisDA,DuenasA,MartinJ,AbadL,CuellarL,AllerR.Light symptoms following a high-dose intentional L-thyroxine ingestion treated with cholestyramine. Hormone Research 2002;57:61–3.
- Savran Y, Mengi T,Keskinkilic M. A severe case of levothyroxine intoxication successfully treated in intensive care unit. J Acute Dis 2018; 7(4): 175-7.
- Tunget CL, Clark RF, Turchen SG, Manoguerra AS. Raising the decontamination level for thyroid hormone ingestions. Am J Emerg Med. 1995;13(1):9-13.
- Güngör A, Bilen H, Akba EM, ve ark. Levotiroksin sodyum intoksikasyonu: Olgu Sunumu. Abant Med J 2013; 2(3): 227-8.
- Xue J, Zhang L, Qin Z, Li R, Wang Y, Zhu K, Li X, Gao X, Zhang J. No obvious sympathetic excitation after massive levothyroxine overdose: A case report. Medicine. 2018; 97 (23).
- Hasan K, Yıldız Ö, Büküm İ, Çetkin A, Karadağ R. Levotiroksin İntoksikasyonu. Fırat Tıp Dergisi 2010;15(4): 213-4.
- Kılınç F, Aydın BB, Pekkolay Z, ve ark. Levotiroksin intoksikasyonu: Olgu sunumu. Dicle Med J 2015; 42: 265-7.
- Baysal ŞG , Bulur N. Levotiroksin Sodyum İntoksikasyonu: Olgu Sunumu Aegean J Med Sci 2018;2:71-2.
- Nygaard B, Saedder EA, Dalhoff K, Wikkelsoe M, Jürgens G. Levothyroxine Poisoning - Symptoms and Clinical Outcome. Basic Clin Pharmacol Toxicol. 2015; 117: 280-5.
- Tenenbein M, Dean HJ. Benign course after massive levothyroxine ingestion. Pediatr Emerg Care. 1986 ;2(1):15-7.
- Ergul AB, Altuner Torun Y, Serbetci MC, Ozcan A, Bas VN. Clinical Toxicity of Acute Overdoses With L-Thyroxin in Children. Pediatr Emerg Care. 2017; 18:787-90.
- Medeiros-Neto G. Thyroxine poisoning. In: de Groot LJ, Beck-Peccoz P, Chrousos G, et al, eds. Endotext [Internet]. South Dartmouth, MA: MDText.com, Inc; 2000.
- Mudoni A, Caccetta F, Caroppo M, et al. Multi-organ failure after massive levothyroxine ingestion: case report [in Italian]. G Ital Nefrol. 2015;32.
- Medeiros-Neto G. Thyroxine poisoning. In: de Groot LJ, Beck-Peccoz P, Chrousos G, et al., eds. Endotext [Internet]. South Dartmouth, MA: MDText.com, Inc; 2000.
- Golightly LK, Smolinske SC, Kulig KW, Wruk KM, Gelman CJ, Rumack BH, Linden CH. Clinical effects of accidental levothyroxine ingestion in children. Am J Dis Child. 1987; 141: 1025-7.
- Seizure in a child after an acute ingestion of levothyroxine. Pediatr Emerg Care. 2005;21(12):857-9.
Toplam 20 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 3 Temmuz 2021 |
| Gönderilme Tarihi | 21 Aralık 2020 |
| Kabul Tarihi | 10 Şubat 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 2 Sayı: 1 |
