Iatrogenic Thyrotoxicosis Secondary to Compounded Liothyronine
Notice bibliographique
Résumé
A 71-year-old woman presented with ST segment elevation myocardial infarction (STEMI) associated with hypotension (100/70 mm Hg) and dizziness. Her husband stated that she appeared confused and was experiencing visual hallucinations. Her medical history was significant for hypertension, pulmonary embolism, hypothyroidism, and gastroesophageal reflux disease. Preadmission medications were reported as amlodipine 2.5 mg daily and pantoprazole 40 mg daily. She denied any recreational drug use or history of mental illness (including hallucinations). She was living independently at home with her husband. The patient’s atypical cardiac symptoms prompted referral to the neurology service. However, neurogenic causes such as Hashimoto encephalitis and cerebrovascular accident were ruled out by negative results on thyroid antibody testing and computed tomography of the head. Incidentally, the laboratory panel for Hashimoto encephalitis included measurement of thyroid hormones, which showed that the level of free tri-iodothyronine was greater than 50 pmol/L (normal range 3–6.8 pmol/L). Thyroidstimulating hormone was 0.03 mIU/L (normal range 0.34–5.6 mIU/L) and free thyroxine was 15 pmol/L (normal range 10–23 pmol/L). The thyroid was not examined, and Grave disease was ruled out on the basis of the normal thyroxine level. In light of the laboratory results, a more detailed investigation for an exogenous iatrogenic cause was initiated. The only discrepancy between the patient’s in-hospital medications and her preadmission medications was a compounded product that she had been taking before the admission, specifically compounded liothyronine capsules (25 μg of liothyronine in hydroxypropyl methylcellulose [hypromellose] for once-daily dosing). The diagnosis was iatrogenic thyrotoxicosis secondary to a compounding error involving liothyronine. The patient’s symptoms, her history related to the current illness, and the supratherapeutic level of tri-iodothyronine were consistent with acute toxicity. She was given supportive care until her mental status and hemo dynamics returned to normal and was then discharged to home. The consequences of the poisoning included STEMI, acute renal injury secondary to hypotension (with serum creatinine twice her baseline value), and a 13-day hospital stay for delirium. Hospital staff contacted the patient’s outpatient pharmacy and alerted them to these findings.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».