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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
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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
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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.


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




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