Levothyroxine sodium/octreotide
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Lack of efficacy and autoimmune thyroiditis: case report A 46-year-old woman experienced lack of effectiveness during treatment with levothyroxine sodium for hypothyroidism. Additionally, she also developed autoimmune thyroiditis during treatment with octreotide for TSH secreting tumour [not all frequency stated; routes and time to reaction onset not stated]. The woman, who was initially treated for hypothyroidism since 2014, presented with high levels of TSH and goitre one year later. She was clinically euthyroid at her initial visit. She was on levothyroxine sodium [thyroxine] 125µg. She had various concurrent conditions. Her TSH continued to remain high and the dose of levothyroxine sodium was increased to 225µg daily. She started experiencing occasional palpitations and was started on atenolol. However, she had non suppressed levels of TSH suggestive of persistent hypothyroidism. The woman’s levothyroxine sodium therapy was withdrawn on admission considering inappropriate TSH (ITSH). Thyroid function tests, contrast enhanced MRI and T3 suppression test were suggestive of concurrent TSH secreting pituitary tumour with cavernous sinus invasion (grade I). She started receiving octreotide (short acting) injection at a dose of 50µg thrice daily. Four days following the initiation of octreotide, normalisation of TSH and T3 levels were noted. On day 8 of the initiation of short acting octreotide, short acting octreotide was replaced with octreotide long acting release [octreotide LAR] 20mg. It was followed by a second administration of octreotide LAR 28 days later. Two months following the initiation of octreotide, she continued to be euthyroid with normal T4 and T3 levels and imaging studies revealed reduction in nodular goitre and pituitary tumour size. However, eighteen days after initiation of octreotide, a repeat FNAC revealed thyroiditis with evidence of lymphocytes infiltrating sheets of the thyroid follicular cells. Anti thyroid peroxidase (TPO) levels became positive, which were initially found to be negative prior to the octreotide therapy. A diagnosis of autoimmune thyroiditis attributed to octreotide was made [outcome not stated]. Kulshreshtha B, et al. Thyroiditis developing post initiation of octreotide in a case of tsh secreting tumor. Acta endocrinologica (Bucharest, Romania) 16: 90-94, No. 1, Jan803499258 Mar 2020. Available from: URL: http://doi.org/10.4183/aeb.2020.90
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Reactions 5 Sep 2020 No. 1820
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