Summary
Accidental ingestion and overdose of medications used in thyroidal illnesses may occur because of the frequency of these diagnoses. This review discusses acute overdosage of 4 groups of medicines.
Acute ingestion of thyroid replacement medications occurs very frequently. Overdosage in children is usually asymptomatic and a benign condition; after evacuation of the stomach, propranolol may be used to treat symptomatic children. Other therapeutic regimens are rarely indicated in this age group.
Ingestions of large amounts of antithyroid medications occur very rarely and limited information regarding treatment is available in the medical literature.
Acute ingestion of iodine often results in corrosive injury of the gastrointestinal tract and renal damage. Cardiopulmonary collapse secondary to circulatory failure, oedema of the epiglottis and aspiration pneumonias may cause death. Administration of starch and sodium thiosulphate, maintenance of airway and stabilisation of circulation are the major components of therapy.
Acute overdosage of β-blockers is uncommon but can be lethal. Patients may appear well initially but they can suddenly develop convulsions and profound cardiovascular collapse requiring instant aggressive therapy. Potassium and glucose concentrations should be monitored. The usage of atropine, isoprenaline (isoproterenol), glucagon and prenalteral is discussed.
Similar content being viewed by others
References
Arena JM, Drew RH. Iodine and its compounds. In Poisoning: toxicology, symptoms, treatments, 5th ed. p. 577–578, Charles C. Thomas, Springfield, 1986
Astwood EB, VanderLaan WP. Thiouracil derivatives of greater activity for the treatment of hyperthyroidism. Journal of Clinical Endocrinology 424–430, 1945
Benowitz NL. Propranolol (inderal) and beta-blocker toxicity. In Haddad LM & Winchester JF (Eds) Clinical management of poisoning and drug overdose, p. 846–852, WB Saunders Co., Philadelphia, 1983
Bhasin S, Wallace W, Lawrence JB, Lesch M. Sudden death associated with thyroid hormone abuse. American Journal of Medicine 71: 887–890, 1981
Boakes AJ, Boerie BH. Suicidal attempts with beta-adrenoceptor blocking agents. British Medical Journal 4: 675, 1973
Buiumsohn A, Eisenberg ES, Jacob H, Rosen N, Bock J, et al. Seizures and intraventricular conduction defect in propranolol poisoning: a report of two cases. Annals of Internal Medicine 91: 860–862, 1979
Cardona JC, Daly JF. Management of corrosive esophagitis: analysis of treatment, methods, and results. New York State Journal of Medicine 64: 2307–2313, 1964
Chopra IJ. Nature, source and biologic significance of thyroid hormones in blood. In Werner SC & Ingbar SH (Eds) The thyroid: a fundamental and clinical text, 4th ed, p. 100–124, Harper and Row Publishers, Hagerstown, 1978
Conolly ME, Paterson JW, Dollery CT, et al. The pharmacological and Metabolic Studies with propranolol in men. Clinical Science 38: 10p, 1970
Cooper DS. Antithyroid drugs. New England Journal of Medicine 311: 1353–1362, 1984
Cooper DS. Which anti-thyroid drug? American Journal of Medicine 80: 1165–1168, 1986
Davidson B, Soodak M, Neary JT, Strout HV, Kieffer JD, et al. The irreversible inactivation of thyroid peroxidase by methylmercaptoimidazole, thiouracil, and propylthiouracil in vitro and its relationship to in vivo findings. Endocrinology 103: 871–882, 1978
Ducret F, Zech P, Perrot D, Moskovtchenko JF, Traeger J. Deliberate self-overdose with propranolol: changes in serum levels. Nouvelle Presse Medicale 7: 27–28, 1978
Feind CR. Hyperthyroidism: surgery. In Werner SC & Ingbar SH (Eds) The thyroid: a fundamental and clinical text, 4th ed., p. 822–826, Harper and Row Publishers, Hagerstown, 1978
Frishman W, Jacob H, Eisenberg E, Ribner H. Clinical pharmacology of the new beta-adrenergic blocking drugs, Part 8: self-poisoning with beta-adrenoreceptor blocking agents; recognition and management. American Heart Journal 98: 798H, 1979
Funderburk SJ, Spaulding JS. Sodium levothyroxine (Synthroid®) intoxication in a child. Pediatrics 45: 298–301, 1970
Gault R. A death involving propranolol (inderal). Clinical Toxicology 11: 295–299, 1977
Gerard P, Malvaux P, deVisscher M. Accidental poisoning with thyroid extract treated by exchange transfusion. Archives of Disease in Childhood 47: 981–982, 1972
Golightly LK, Smolinske SC, Kulig KW, Wruk KM, Gelman CJR, et al. Clinical effects of accidental levothyroxine ingestion in children. American Journal of Diseases in Children 141: 1025–1027, 1987
Haddad HM. Rates of I131-labelled thyroxine metabolism in euthyroid children. Journal of Clinical Investigation 39: 1590–1594, 1960
Hesse B, Pedersen JT. Hypoglycemia after propranolol in children. Acta Medica Scandinavica 193: 551–552, 1973
Hollingsworth DR. Neonatal hyperthyroidism. In Delange F et al. (Eds) Pediatric thyroidology, p. 210–222, Karger, Basel, 1985
Hume L, Forfar JC. Hyperkalaemia and overdose of antihypertensive agents. Lancet 2: 1182, 1977
Ingbar SH. Thyroid storm or crisis. In Werner SC & Ingbar SH (Eds) The thyroid: a fundamental and clinical text, 4th ed., p. 800–804, Harper and Row Publishers, Hagerstown, 1978
Jackson GL, Flickinger FW, Wells LW. Massive overdosage of propylthiouracil. Annals of Internal Medicine 91: 418–419, 1979
Kirkland RT, Kirkland JL, Gregor NG, Eberle A, Marshall R. Thyroid hormone poisoning: therapy questioned. Pediatrics 74: 901, 1984
Kristinsson J. A case of fatal propranolol intoxication. Acta Pharmacologica et Toxicologica 41: 190–192, 1977
Kulig K, Golightly LK, Rumack BH. Levothyroxine overdose associated with seizures in a young child. Journal of the American Medical Association 254: 2109–2110, 1985
Kulling P, Eleborg L, Persson H. Beta-adrenoceptor blocker intoxication: epidemiological data. Prenalterol as an alternative in the treatment of cardiac dysfunction. Human Toxicology 2: 175–181, 1983
Lagerfelt J, Matell G. Attempted suicide with 5.1g of propranolol: a case report. Acta Medica Scandinavica 199: 517–518, 1976
LeBoff MS, Kaplan MM, Silva JE, Larsen PR. Bioavailability of thyroid hormones from oral replacement preparations. Metabolism 31: 900–905, 1982
Lehrner LM, Weir MR. Acute ingestions of thyroid hormones. Pediatrics 73: 313–317, 1984
Levy RP, Gilger WG. Acute thyroid poisoning: report of a new case. New England Journal of Medicine 256: 459–460, 1957
Litovitz TL, White JD. Levothyroxine ingestions in children: an analysis of 78 cases. American Journal of Emergency Medicine 3: 297–300, 1985
May ME, Mintz PD, Lowry P, Geller R, Curnow RT. Plasmapheresis in thyroxine overdose: a case report. Journal of Toxicology — Clinical Toxicology 20: 517–520, 1983
Mofenson HC, Caraccio TR, Greensher J. Iodine. In Haddad LM & Winchester JF (Eds) Clinical management of poisoning and drug overdose, p. 697–703, WB Saunders Co., Philadelphia, 1983
Morris DR, Hager LP. Mechanism of the inhibition of enzymatic halogenation by antithyroid agents. Journal of Biological Chemistry 241: 3582–3589, 1966
Nagataki S, Shizume K, Nakao K. Effect of iodide on thyroid iodine turnover in hyperthyroid subjects. Journal of Clinical Endocrinology and Metabolism 30: 469–478, 1970
Ochs HR, Carstens G, Greenblatt DG. Reduction in lidocaine clearance during continuous infusion and by coadministration of propranolol. New England Journal of Medicine 303: 373–377, 1980
Okuno A, Taguchi T, Inyaku F, Yaro K, Suzuki Y. Pharmacokinetics of propylthiouracil in children and adolescents with Graves disease after a single oral dose. Pediatric Pharmacology 3: 43–47, 1983
Petit Jr WA, Barrett EJ. Chronic thyroxine ingestion leading to thyroid storm and accelerated thyroxine turnover. Connecticut Medicine 51: 291–292, 1987
Pietsch J, Meakins JL. Complications of povidone-iodine absorption in topically treated burn patients. Lancet 1: 280–282, 1976
Salzberg MR, Gallagher EJ. Propranolol overdose. Annals of Emergency Medicine 9: 44–45, 1980
Sawin CT. Hypothyroidism. Medical Clinics of North America 69: 989–1004, 1985
Scoggin C, McClellan JR, Cary JM. Hypernatraemia and acidosis in association with topical treatment of burns. Lancet 1: 959, 1977
Stanley MM, Astwood EB. 1-methyl-2-mercaptoimidazole: an antithyroid compound highly active in man. Endocrinology 44: 588–589, 1949
Sterling K, Chodos RB. Radiothyroxine turnover studies in myxedema, thyrotoxicosis, and hypermetabolism without endocrine disease. Journal of Clinical Investigation 35: 806–813, 1956
Taurog A. The mechanism of action of the thiourylene antithyroid drugs. Endocrinology 98: 1031–1046, 1976
Taurog A. Hormone synthesis: thyroid iodine metabolism. In Werner SC & Ingbar SH (Eds) The thyroid: a fundamental and clinical text, 4th ed., p. 31–61, Harper and Row Publishers, Hagerstown, 1978
Tynan RF, Fisher MMcD, Ibels LS. Self-poisoning with propranolol. Medical Journal of Australia 1: 82–83, 1981
Van Huekdom SLH, Kinderen PJ, Vingerholds ACM. Plasmapheresis in 1-thyroxine intoxication. Veterinary and Human Toxicology 21 (Suppl.): 7, 1979
Veltri JC, Litovitz TL. 1983
Annual Report of the American Association of Poison Control Centers national data collection system. American Journal of Emergency Medicine 2: 420–443, 1984
Von Hofe SE, Young RL. Thyrotoxicosis after a single ingestion of levothyroxine. Journal of the American Medical Association 237: 1361, 1977
Wade A, Reynolds JF (Eds). Iodine. In Martindale: the extra pharmacopeia, p. 823–831, The Pharmaceutical Press, London, 1977
Wermut W, Wojcicki M. Suicidal attempt with propranolol. British Medical Journal 3: 591, 1973
White JD. Thyroid overdose. In Haddad LM & Winchester JF (Eds) Clinical management of poisoning and drug overdose, p. 950–958, WB Saunders Co., Philadelphia, 1983
White JD, Litovitz TL. Levothyroxine poisoning. Pediatrics 75: 129–130, 1985
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lin, TH., Kirkland, R.T. & Kirkland, J.L. Clinical Features and Management of Overdosage with Thyroid Drugs. Dis-Manage-Health-Outcomes 3, 264–272 (1988). https://doi.org/10.1007/BF03259939
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03259939