Archives of Head and Neck Surgery
http://archivesheadnecksurgery.com/article/doi/10.4322/ahns.2018.0099
Archives of Head and Neck Surgery
Original Article Thyroid diseases and tumors

Adverse events involving levothyroxine in patients treated at the toxicological assistance center of São Paulo

Marina Romera Cavallari, Anthony Wong, Leandro Luongo Matos

Downloads: 0
Views: 38

Abstract

Introduction: Thyroxine is prescribed for patients with thyroid hormone deficiency in the event of hypothyroidism or thyroidectomy. Objective: The Toxicological Assistance Center of Sao Paulo (CEATOX-SP) aims to provide specific information to the general public and health professionals in the event of poisoning, exposure to toxic substances, accidents with venomous animals, and adverse drug reactions, assisting with diagnosis and treatment. This study assesses the epidemiology of adverse events involving levothyroxine reported at the CEATOX-SP. Materials and Methods: This is a crosssectional, retrospective study involving cases of therapeutic error, adverse reaction, individual accident with medication, and substance abuse involving levothyroxine, between 2013 and 2015. Results: During the study period, a total of 39,501 patients were treated at the CEATOX-SP, with 1% (396) of the cases involved the use of levothyroxine, and most occurrences (77.8%) were reported in the state of Sao Paulo. All occurrences were domestic; however, the CEATOX-SP was most contacted by physicians, after assistance at health services. Mean age of the patients was 24.4 ± 26.2 years, and 68.9% of them were female. The most common circumstance was “individual accident” (47.5%), the most prevalent type of exposure was “acute only” (56.3%), and the most predominant type of occurrence was “exposure” (73.5%). The main reason for seeking the service were accidents involving children, who found tablets in the house and ingested them. Conclusion: Accident prevention campaigns targeting children and medicines, and awareness of health professionals about the importance of medical prescription can reduce the number of adverse events involving levothyroxine.

Keywords

thyroxine; drug effects; prescription drug misuse; pharmacovigilance

References

1. Brasil. Ministério da Saúde. Nota Técnica N°332/2013. Brasília: Consultoria Jurídica/Advocacia Geral da União; 2013.

2. Kreisner E, Lutzky M, Gross JL. Charcoal hemoperfusion in the treatment of levothyroxine intoxication. Thyroid. 2010;20(2):209-12. http://dx.doi.org/10.1089/thy.2009.0054. PMid:20151829.

3. Papi G. Current issues in the treatment of thyrotoxicosis. Recenti Prog Med. 2005;96(11):560-5.

4. Luis DA, Abad L, Aller R, González-Sagrado M, Dueñas A. Levothyroxine poisoning: clinical manifestations and therapeutic management. An Med Interna. 2004;21(1):39-41.

5. Botella de Maglia J, Compte Torrero L, Rivas Sánchez A, Pérez Pastor JL. Triiodothyronine intoxication. A clinical and phamacokinetic study. An Med Interna. 2003;20(12):627-9.

6. Mandel SH, Magnusson AR, Burton BT, Swanson JR, LaFranchi SH. Massive levothyroxine ingestion. Conservative management. Clin Pediatr (Phila). 1989;28(8):374-6. http://dx.doi.org/10.1177/000992288902800808. PMid:2758719.

7. Mudoni A, Caccetta F, Caroppo M, Musio F, Accogli A, Zacheo MD, Burzo MD, Nuzzo V. Multi-organ failure after massive Levothyroxine ingestion: case report. G Ital Nefrol. 2015;32(1).

8. Beier C, Liebezeit B, Völkl TM, Zimdars K, Dörr HG. Attempted suicide with L-thyroxine in an adolescent girl. Klin Padiatr. 2006;218(1):34-7.

9. Matthews SJ. Acute thyroxine overdosage: two cases of parasuicide. Ulster Med J. 1993;62(2):170-3.

10. Hays HL, Jolliff HA, Casavant MJ. Thyrotoxicosis after a massive levothyroxine ingestion in a 3-year-old patient. Pediatr Emerg Care. 2013;29(11):1217-9. http://dx.doi.org/10.1097/PEC.0b013e3182aa4714. PMid:24196094.

11. Kaiserman I, Avni M, Sack J. Kinetics of the pituitary-thyroid axis and the peripheral thyroid hormones in 2 children with thyroxine intoxication. Horm Res. 1995;44(5):229-37. http://dx.doi.org/10.1159/000184631. PMid:8582716.

12. Majlesi N, Greller HA, McGuigan MA, Caraccio T, Su MK, Chan GM. Thyroid storm after pediatric levothyroxine ingestion. Pediatrics. 2010;126(2):e470-3. http://dx.doi.org/10.1542/peds.2009-2138. PMid:20643722.

13. Hartung B, Schott M, Daldrup T, Ritz-Timme S. Lethal thyroid storm after uncontrolled intake of liothyronine in order to lose weight. Int J Legal Med. 2010;124(6):637-40. http://dx.doi.org/10.1007/s00414-010-0423-y. PMid:20145940.

14. CEATOX-SP [Internet]. CEATOX-SP - O que fazemos. São Paulo: CEATOX-SP; 2006 [cited 2018 Dec 19]. Available from: http://www.ceatox.org.br/default.aspx?pagid=DKDHOQWN&menuid=9114

15. Sistema Nacional de Informações Tóxico-Farmacológicas – SINITOX. FIOCRUZ/ MS, 1996 a 2006 [cited 2018 Dec 19] Available from: https://sinitox.icict.fiocruz.br/

16. Brasil. Lei n º 9.782, de 26 de janeiro de 1999. Define o Sistema Nacional de Vigilância Sanitária, cria a Agência Nacional de Vigilância Sanitária. Diário Oficial da República Federativa do Brasil; 1999 Jan 27.

17. São Paulo. Secretaria de Estado da Saúde de São Paulo. Centro de Vigilância Sanitária [Internet]. Instruções para o Preenchimento da Ficha Individual de Notificação de Eventos Toxicológicos. São Paulo: Centro de Vigilância Sanitária; [cited 2018 Dec 19]. Available from: http://www.cvs.saude.sp.gov.br/tox_inpreficha.asp

18. Minayo MCS. O desafio do conhecimento. 11a ed. São Paulo: Hucitec; 2008.

19. Brasil. Agência Nacional de Vigilância Sanitária. Bulário eletrônico: Bula Levotiroxina Sódica. Brasília: ANVISA; 2015.

5cebdbca0e8825010aa63c0f archives Articles
Links & Downloads

Arch. Head Neck Surg.

Share this page
Page Sections