Weekly Intramuscular Injection of Levothyroxine following Myxoedema: A Practical Solution to an Old Crisis
An 82-year-old female with known hypothyroidism was admitted to hospital after being found on the floor. On examination, she was unkempt, confused, bradycardic, hypothermic, and barely arousable. Initial biochemistry revealed a thyroid stimulating hormone (TSH) of >100 mU/L and free thyroxine (FT...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2015/169194 |
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| author | Peter N. Taylor Arshiya Tabasum Gina Sanki David Burberry Brian P. Tennant James White Onyebuchi Okosieme Andrew Aldridge Gautam Das |
| author_facet | Peter N. Taylor Arshiya Tabasum Gina Sanki David Burberry Brian P. Tennant James White Onyebuchi Okosieme Andrew Aldridge Gautam Das |
| author_sort | Peter N. Taylor |
| collection | DOAJ |
| description | An 82-year-old female with known hypothyroidism was admitted to hospital after being found on the floor. On examination, she was unkempt, confused, bradycardic, hypothermic, and barely arousable. Initial biochemistry revealed a thyroid stimulating hormone (TSH) of >100 mU/L and free thyroxine (FT4) level of 1.5 pmol/L which supported a diagnosis of myxoedema coma. She was resuscitated and commenced on liothyronine, levothyroxine, and hydrocortisone and some improvement was made. It became apparent that she was hiding and spitting out her oral levothyroxine including levothyroxine elixir. Given the need for prompt alternative control, we sought advice from international experts where intramuscular levothyroxine was recommended. She was managed from day 50 onwards with intramuscular levothyroxine 200 mcg once a week, which was subsequently increased to 500 mcg. Thyroid function normalized and she made continual cognitive and physical progress and was discharged to a rehabilitation hospital. Her intramuscular levothyroxine was stopped and she was subsequently restarted on oral levothyroxine, with a plan for on-going close monitoring of her thyroid function. This report highlights the potential to use intramuscular levothyroxine in individuals with severe hypothyroidism arising from poor compliance with levothyroxine treatment or other potential causes such as impaired absorption. |
| format | Article |
| id | doaj-art-59045bb84003428587d8b929eebee25f |
| institution | OA Journals |
| issn | 2090-6501 2090-651X |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-59045bb84003428587d8b929eebee25f2025-08-20T02:05:20ZengWileyCase Reports in Endocrinology2090-65012090-651X2015-01-01201510.1155/2015/169194169194Weekly Intramuscular Injection of Levothyroxine following Myxoedema: A Practical Solution to an Old CrisisPeter N. Taylor0Arshiya Tabasum1Gina Sanki2David Burberry3Brian P. Tennant4James White5Onyebuchi Okosieme6Andrew Aldridge7Gautam Das8Endocrinology and Diabetes Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil CF47 9DT, UKEndocrinology and Diabetes Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil CF47 9DT, UKBiochemistry Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil CF47 9DT, UKEndocrinology and Diabetes Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil CF47 9DT, UKBiochemistry Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil CF47 9DT, UKDepartment of Medicine of the Elderly, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil CF47 9DT, UKEndocrinology and Diabetes Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil CF47 9DT, UKPharmacy, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil CF47 9DT, UKEndocrinology and Diabetes Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil CF47 9DT, UKAn 82-year-old female with known hypothyroidism was admitted to hospital after being found on the floor. On examination, she was unkempt, confused, bradycardic, hypothermic, and barely arousable. Initial biochemistry revealed a thyroid stimulating hormone (TSH) of >100 mU/L and free thyroxine (FT4) level of 1.5 pmol/L which supported a diagnosis of myxoedema coma. She was resuscitated and commenced on liothyronine, levothyroxine, and hydrocortisone and some improvement was made. It became apparent that she was hiding and spitting out her oral levothyroxine including levothyroxine elixir. Given the need for prompt alternative control, we sought advice from international experts where intramuscular levothyroxine was recommended. She was managed from day 50 onwards with intramuscular levothyroxine 200 mcg once a week, which was subsequently increased to 500 mcg. Thyroid function normalized and she made continual cognitive and physical progress and was discharged to a rehabilitation hospital. Her intramuscular levothyroxine was stopped and she was subsequently restarted on oral levothyroxine, with a plan for on-going close monitoring of her thyroid function. This report highlights the potential to use intramuscular levothyroxine in individuals with severe hypothyroidism arising from poor compliance with levothyroxine treatment or other potential causes such as impaired absorption.http://dx.doi.org/10.1155/2015/169194 |
| spellingShingle | Peter N. Taylor Arshiya Tabasum Gina Sanki David Burberry Brian P. Tennant James White Onyebuchi Okosieme Andrew Aldridge Gautam Das Weekly Intramuscular Injection of Levothyroxine following Myxoedema: A Practical Solution to an Old Crisis Case Reports in Endocrinology |
| title | Weekly Intramuscular Injection of Levothyroxine following Myxoedema: A Practical Solution to an Old Crisis |
| title_full | Weekly Intramuscular Injection of Levothyroxine following Myxoedema: A Practical Solution to an Old Crisis |
| title_fullStr | Weekly Intramuscular Injection of Levothyroxine following Myxoedema: A Practical Solution to an Old Crisis |
| title_full_unstemmed | Weekly Intramuscular Injection of Levothyroxine following Myxoedema: A Practical Solution to an Old Crisis |
| title_short | Weekly Intramuscular Injection of Levothyroxine following Myxoedema: A Practical Solution to an Old Crisis |
| title_sort | weekly intramuscular injection of levothyroxine following myxoedema a practical solution to an old crisis |
| url | http://dx.doi.org/10.1155/2015/169194 |
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