Iatrogenic Thyrotoxicosis Secondary to Compounded Liothyronine
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".