SAT-519 Armour Thyroid and Liothyronine Combination Potentiated Thrombosis

Abstract

Objective To describe a case presentation of multiple sinus thrombosis while on combination therapy of liothyronine and Armour Thyroid for Hashimoto’s thyroiditis with other risk factors of thrombosis. Methods A case report with medical history, diagnostic and treatment course is presented with discussion. Results A 47-year-old female with a history of Hashimoto’s thyroiditis on liothyronine and Armour Thyroid, on oral contraceptive use and cigarette smoking presented to Emergency Room with complaints of severe headache, neck pain and dizziness later developing confusion, word-finding difficulty and various left-sided neurological deficit. She was found to have superior sagittal sinus and right transverse sinus thrombosis, both with partial to complete occlusion and involved hematoma. Patient went through endovascular intervention for successful thrombectomy with recanalization, and neurosurgical intervention for decompressive evacuation of hematoma. Patient was found to have undetectably low thyroid stimulating hormone level, and her base-line level from one year ago was 0.147 milli-international units per liter while having been on liothyronine and Armour Thyroid for years. Patient was started on daily oral levothyroxine and recovered eventually from neurological deficits. Repeated thyroid function test showed improving results. Evaluation for other causes of thrombosis included positive results for prothrombin gene mutation, confirming her inherited thrombophilia condition that has been undiagnosed until this event. Discussion Primary hypothyroidism is one of the most prevalent endocrine disorders, occurring in up to 5% of the population. While synthetic thyroxine has been standard therapy for the primary hypothyroidism for many years, many alternative thyroid therapies have resurfaced recently. For instance, there has been increasing trend of using liothyronine in addition to levothyroxine with symptomatic benefit despite insufficient evidence. Armour Thyroid, which is a natural porcine derivative thyroid supplement often used as a weight loss supplement without proper monitor by physician, has repeatedly been controversial. Many studies have raised concerns for cardiovascular disease including arrhythmia with high thyroid hormone level. Also a number of case reports have shown association with hyperthyroidism and pro-thrombotic state. Although there are scarce publications associating liothyronine or Armour Thyroid and hypercoagulable thrombotic event, significant drug interactions may exist with patient who are more vulnerable with inherited condition or other risk factors.