ACUTE LEVOTHYROXINE INGESTION IN CHILDREN

The paper presents two cases of acute levothyroxine ingestion: the first is an accidental ingestion in a child and the second is a voluntary ingestion in an adolescent. Ingestion of levothyroxine in children usually follows a benign course. Patients may be asymptomatic or may develop mild symptoms including hyperthermia, tachycardia, hypertension, and irritability. Severe toxicity, which presents with seizures and arrhythmias, is rare. No fatal cases have been reported in acute intoxication so far, in contrast to chronic abuse. Therapy is based on activated charcoal, gastric lavage and symptomatic drugs. Beta-blockers are used in case of moderate-serious symptoms. The onset of symptoms may be delayed up to 6-11 days and does not correlate with plasma levels of thyroid hormones, which can help only in verifying the diagnosis. Cardiovascular monitoring (even at home) for several days after ingestion is therefore necessary, until normalization of thyroid hormones (usually in 1-2 weeks).