0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Reports |

The Use of Bile Acid Sequestrants to Lower Serum Thyroid Hormones in Iatrogenic Hyperthyroidism

K. M. Mohamed Shakir, MD; Rodney D. Michaels, MD; James H. Hays, MD; and Bonnie B. Potter, MD
[+] Article and Author Information

From the National Naval Medical Center and the Uniformed Services University of the Health Sciences, Bethesda, Maryland. Requests for Reprints: CAPT K. M. M. Shakir, MC, USN, Division of Endocrinology and Metabolism, National Naval Medical Center, Bethesda, MD 20889-5000. Acknowledgment: The authors thank Ms. Pat Rattal for editorial assistance.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1993;118(2):112-113. doi:10.7326/0003-4819-118-2-199301150-00006
Text Size: A A A

Hyperthyroidism occasionally must be rapidly restored to euthyroidism, especially if it is associated with an emergent condition such as myocardial infarction. Several modalities are available to render endogenous hyperthyroid patients to a euthyroid state rapidly. Few therapeutic options, however, are available to rapidly treat hyperthyroidism caused by ingestion of excess thyroid hormones, except perhaps the use of β-blockers. We observed hypothyroidism develop in two patients taking stable doses of levothyroxine after cholestyramine was added to their drug regimen. This finding led us to treat two patients with iatrogenic hyperthyroidism with cholestyramine. A euthyroid state was achieved in 72 to 96 hours whereas in three similar patients without cholestyramine treatment it had taken almost 8 days for serum thyroid hormone levels to fall into normal range. Our preliminary results suggest that bile acid sequestrants may be useful in treating exogenous thyroid-hormone-induced hyperthyroidism in emergent situations.

Figures

Grahic Jump Location
Figure 1.
Changes in serum thyroid hormones over time.443open circlesn44343

The alterations in serum total T , free T , total T , and thyroid stimulating hormone (TSH) levels in Patient 1 ( ), Patient 2 (open triangles), and control patients (solid boxes) ( = 3, values = mean ± SE) are shown. The normal serum values are as follows: total T , 51 to 142 nmol/L; free T , 10 to 36 pmol/L; total T , 1.2 to 3.4 nmol/L; and TSH, 0.4 to 3.5 mU/L. The shaded areas show the upper normal range values for T and T and the lower normal range values for TSH.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Journal Club
Related Point of Care
Topic Collections

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)