Levothyroxine poisoning in children – should we really be afraid?

Abstract

Aim: L-thyroxine intoxication is rarely seen in children; however, it can be worrying for clinicians and parents. This study aimed to present the clinical and laboratory findings of children admitted to the pediatric emergency department with l-thyroxine intoxication. Methods: Patients admitted to the pediatric emergency department with l-thyroxine intake between January 2015 and June 2022 were included in this retrospective study. The patient’s clinical characteristics, laboratory findings, treatment, and hospital costs were recorded and analyzed. Results: This study included 33 pediatric patients with thyroxine intoxication. The median age was 35 months (The interquartile range (IQR) 25-47.5) and 19 of them were girls (57,5%). No patient had a clinical symptom at the admittance. One patient had massive l-thyroxine intake and two patients had tachycardia. Gastric lavage and activated charcoal were used in 18 patients. Four patients were followed in the pediatric intensive care unit and one of them was treated with propranolol. The median time of hospital stay was 24 hours (IQR 13,5-84). The median cost of the treatment was $73 (IQR56.2-116.75). Conclusion: L-thyroxine intoxication usually occurs with low drug doses in children and has a benign prognosis. Routine hospitalization of these patients, particularly with low drug dose intake, should be questioned considering the treatment cost.