Accidental Levothyroxine Ingestion in a Child

Hypothyroidism is one of the most common endocrine disorders, and many levothyroxine prescriptions are written to replace the hormone deficit. Herewith we report a thyroid hormone overdose in a 6 year old boy. 6 year old Beckwith-Wiedeman syndrome boy with developmental delay presented with accidental ingestion of 2.5 mg of levothyroxine 6 hours prior to admission. He has been receiving levothyroxine for hypothyroidism since neonatal period and currently (weight=17 kgs) he was on 100 μg of levothyroxine once a day. There were no tremors, irritability, convulsions or diarrhea. On examination his temperature was 98.6oF, pulse rate 100/min, RR 20/min and BP was 100/60 mm Hg. Other systems examination was unremarkable. His Thyroid profile is shown in Table 1. Gastric lavage and gastrointestinal decontamination was done. His complete blood count, blood sugar, blood urea, serum creatinine, Aspartate transaminase (SGOT), lactate dehydrogenase (LDH), creatine kinase MB (CK-MB) and electrocardiography were within normal limits. He was monitored for overdose features. After 24 hours he was tachycardic (PR 120/min), febrile (99.60F) with blood pressure 112/80mm Hg (>95th centile) along with sweating of palms and soles. In view of tachycardia, sweating and hypertension, Propranolol and Dexamethasone was started. After 76 hours features of thyroid toxicity subsided and drugs were tapered. Child was restarted on thyroxine and discharged on 8thday. Child was followed up at 3 and 6 months, there was no feature of hypothyroidism. Levothyroxine overdose in children typically follows a benign course[1]. Children may be asymptomatic or have clinical features like fever, tachycardia, hypertension, tremor, insomnia, irritability and convulsions[1-3]. Our patient had typical clinical features like tachycardia, sweating