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Weekly intramuscular injection of Levothyroxine following Myxoedema: a practical solution to an old crisis

Taylor, Peter, Tabasum, Arshiya, Sanki, Gina, Burberry, David, Tennant, Brian P., White, James, Okosieme, Onyebuchi, Aldridge, Andrew and Das, Gautam 2015. Weekly intramuscular injection of Levothyroxine following Myxoedema: a practical solution to an old crisis. Case Reports in Endocrinology 2015 , 169194. 10.1155/2015/169194

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Abstract

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 >100mU/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 500mcg. Thyroid function normalized and she made continual cognitive and physical progress and was discharged to a rehabilitation hospital.Her intramuscular levothyroxinewas stopped and shewas subsequently restarted on oral levothyroxine, with a plan for on-going closemonitoring 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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Publisher: Hindawi Publishing Corporation
ISSN: 2090-6501
Date of First Compliant Deposit: 13 September 2017
Date of Acceptance: 20 October 2015
Last Modified: 26 Jun 2019 21:31
URI: http://orca.cf.ac.uk/id/eprint/104619

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