Clinical insights into levothyroxine overdose: A systematic review

Table 4 Summary of clinical characteristics, treatment strategies, and outcomes in larger-scale studies of levothyroxine toxicity

Ref.	n	Age group	Key presentations	Reason for ingestion	LTX dose ingested	Treatment and complications
Litovitz et al[35]	78	0-12 years (0-5: 75; 5-12: 3)	74 Asymptomatic (94.9%), 3 fever, 1 vomiting, 1 diarrhea	Not specified	0.5 mg or less: 35 patients; 0.6-3.0 mg: 27 patients; > 3.0 mg: 6 patients	75 (96.1%) managed at home; 26 (33.3%) received no treatment; 38 (48.7%) received ipecac; 3 patients were hospitalized, 1 required propranolol treatment (2.5 mg every 6 hours)
Binimelis et al[4]	6	46-74 years	6 fever, tremors, heat intolerance, tachycardia	Unintentional	70-1200 mg ingested over 2-12 days	All patients received propranolol (120-140 mg/day) and hydrocortisone (400 mg/day). Patients 4-6 received propylthiouracil (400-1200 mg/day) and plasmapheresis. All patients developed neurological complications (e.g., coma, hemiparesis, aphasia). Patients 1-2 had left ventricular failure; others had rhythm disturbances. 1 patient died
Seidel et al[40]	54	< 28 days	42 Asymptomatic (77.8%). 1 tachypnea, 1 weight loss, 3 diarrhea, 6 restlessness	Not specified	< 30 µg/kg: 36 patients (87% asymptomatic); 30-50 µg/kg: 14 patients (79% asymptomatic); 50-60 µg/kg: 4 patients (75% asymptomatic)	Gastric lavage, Beta-blockers
Kandasamy et al[26]	5	Not specified	3 asymptomatic (60%). 2 hypertension with transient ECG changes	Unintentional	Maximum dose: 500 μg	No active treatment
Nygaard et al[41]	181	1-14 years	153 asymptomatic (84.5%)	Suicide: 44 (24.3%); unintentional: 134 (74.0%)	300-18000 μg	Not available
Roth et al[39]	11189	0-5 years: 6668 (59.6%); > 5 years: 4521 (40.4%)	112 vomiting (1.0%), 78 restlessness (0.7%), 123 tachycardia (1.1%)	10742 (96.0%) unintentional	Not specified	Activated charcoal in 392 patients (3.5%); gastric decontamination: Ipecac-induced emesis followed by activated charcoal administration in 134 patients (1.2%)

LTX: Levothyroxine; ECG: Electrocardiogram.