Case Report on Inverse Presentation of Thyroid Stimulating Hormone in Thyroxine Intoxication

Abstract

Levothyroxine (T4) overdose is a rare occurrence that can occur accidentally, most frequently in children, or deliberately in people who have suicidal thoughts, especially psychiatric patients. Suicidal levothyroxine intoxication is uncommon and usually asymptomatic. A 34-year-old woman initially presented with palpitation and giddiness after an overdose of levothyroxine (3mg). Vital signs included a blood pressure of 130/90 mmHg and Pulse rate of 104 beats per minute, immediately stomach wash was given with supportive therapy of Injection Pantoprazole 40 mg (IV), Injection Optineuron 1amp in 100ml of NS and IVF 30NS\20RL\10DNS at 75ml/hour. On reference to the Psychiatry department on fifth day of mental health counselling, the patient was diagnosed with Adjustment disorder. She was prescribed with Tab. Escitalopram 10mg, Tab. Clonazepam 0.5mg. The patient was symptomatically better and was discharged on 5th day with no fresh complaints. Levothyroxine overdose should be treated according to the patient’s clinical symptoms and signs, the amount consumed and other factors. We think that the basal TSH value of our patient is clearly high and that was a truely inverse presentation from other cases.