Levothyroxine sodium 152microgram / Liothyronine 36microgram tablets

BackgroundLevothyroxine (LTX) is one of the most commonly used medications due to the high prevalence of hypothyroidism in various age groups. Overdose (OD) with LTX, intentional or unintentional, is rare but can have clinically significant and even life-threatening consequences. Data on clinical outcomes of patients with LTX OD are limited, and guidelines on its management are suboptimal.AimTo compile all available data on the clinical characteristics, management, and outcomes of patients with LTX OD.MethodsA systematic literature search was conducted to identify English-language articles through PubMed, Scopus, and EMBASE that reported primary patient data on LTX OD in all age groups. All analyses were performed using STATA-18.ResultsForty-nine studies, comprising 95 individual cases and six larger retrospective studies (n = 11513), were analyzed. The median age of patients in case reports was 20 years (3.5-42), with a female preponderance (66.1%). The median ingested dose of LTX was 4250 μg (1250-10000), with a median time to presentation of 4.5 hours (1.5-24). Tachycardia (38.9%), confusion (23.2%), and fever (18.9%) were the most frequent symptoms. Severe complications included atrial fibrillation (5.3%), and one death was reported. Patients with intentional LTX OD were significantly older (median 35.5 vs 3.5 years, P P = 0.003), while non-intentional OD cases had higher heart rates (P = 0.02). Among the 11513 patients from larger studies, more than 90% experienced minimal or no symptoms, particularly in pediatric cohorts. Rarely severe outcomes, such as coma and cardiac failure, were observed in adults with high-dose ingestions, requiring interventions such as beta-blockers, corticosteroids, and plasmapheresis.ConclusionThis study provides the first comprehensive dataset on LTX OD. Patients with non-suicidal/accidental LTX OD mainly belong to the pediatric age group, while those with suicidal intent belong to the older age group. Despite the risk of toxicity with ingestion of high doses of LTX, mortality is extremely rare.

Abstract licence: CC BY-NC

BackgroundHypothyroidism often impairs quality of life (QoL). This network meta-analysis (NMA) evaluated the efficacy and safety of additional interventions alongside levothyroxine (LT4).MethodsThis study adhered to the PRISMA guidelines and is registered on PROSPERO (CRD420251085765). PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched for randomized controlled trials (RCTs) on the treatment of hypothyroidism. A Bayesian NMA was performed, reporting standardized mean differences (SMDs) or risk ratios (RRs) with 95% credible intervals (CrIs). Evidence certainty was assessed using the CINeMA framework.ResultsThirty-five RCTs involving 3,508 patients were included. Compared with placebo, levothyroxine (LT4) + aerobic training (AT) + resistance training (RT) significantly reduced thyroid-stimulating hormone (TSH) levels (SMD = -3.97, 95% CrI: -5.76, -2.18, CINeMA: high certainty); LT4 + zinc (Zn) + magnesium (Mg) + vitamin A (VA) raised free thyroxine (FT4) (SMD = 1.95, 95% CrI: 1.37, 2.53, CINeMA: high certainty); and LT4 + Zn increased free triiodothyronine (FT3) (SMD = 1.46, 95% CrI: 0.40, 2.51, CINeMA: low certainty). In addition, LT4 + AT + RT significantly improved QoL score (SMD = 1.62, 95% CrI: 0.78, 2.46) and mental health score (MHS) (SMD = 2.1, 95% CrI: 1.19, 3.01, CINeMA: low certainty) compared with LT4 alone. LT4 + RT significantly improved physical function score (SMD = 1.59, 95% CrI: 0.76, 2.43). Liothyronine (LT3) increased adverse events versus placebo (RR = 15.54, 95% CrI: 2.68, 501.14, CINeMA: very low certainty).ConclusionThe combination of LT4, AT, and RT may be the preferred strategy for reducing TSH, enhancing QoL, and improving MHS. Clinical interventions should be tailored based on individual patient profiles.

Abstract licence: CC BY-NC-ND