Accidental levothyroxine ingestion in children: Review of four cases

Abstract

Incidence of accidental levothyroxine ingestion in children has been increasing in recent times, mainly because of increasing prescriptions. We present four such cases, who presented to the pediatrics department in the past year. Four children aged 2–14 years presented to the emergency department with accidental consumption of levothyroxine tablets, total strength ranging from 1000 to 3000 μg. All were reported within half an hour to 8 h of consumption. Three of them were asymptomatic at presentation and one had one episode of vomiting. Gastric lavage was done and activated charcoal was given to all. Vitals were normal, except one had tachycardia for which the child received propranolol tablet for 1-week duration to control heart rate. Baseline free T4 was high and thyroid-stimulating hormone was normal in all. They were admitted for observation for 2–6 days and later followed on an outpatient basis. Ingestion of large doses of levothyroxine in children typically follows a benign course. Patients may be asymptomatic or have thyrotoxic symptoms and rarely significant complications, including seizures and arrhythmias. The severity of symptoms does not correlate with plasma levels of T4, and the onset of symptoms can be delayed for up to 6–11 days. Asymptomatic children can be monitored at home following gastrointestinal decontamination. In cases with severe symptoms, children should be monitored in the hospital for cardiac or neurological instability. Propranolol is used in the presence of features of toxicity. Levothyroxine is colorful and palatable that can be attractive to young children. Gastric lavage and activated charcoal is the mainstay of treatment in accidental levothyroxine ingestion in children.