triiodothyronine--reverse and Factitious-Disorders

The clinical and laboratory findings are described in three patients who ingested large amounts of L-thyroxine (two cases) and L-thyroxine together with L-triiodothyronine and who were treated with propranolol. Serum concentrations of thyroxine (maximum values 75 micrograms/dl, 64 micrograms/dl, and 20 micrograms/dl, respectively; normal range 4-12 micrograms/dl), triiodothyronine (maximum values 837 ng/dl, 453 ng/dl, and 566 ng/dl, resp.; normal range 80-180 ng/dl), reverse triiodothyronine (maximum values 235 ng/dl, 190 ng/dl, and 65 ng/dl, resp.; normal range 10-40 ng/dl) as well as free thyroxine equivalent and free triiodothyronine equivalent were monitored daily until they reached the normal range. Statistical analysis of the kinetics of these parameters indicated that the extreme thyroxine conversion was directed toward reverse triiodothyronine, partly due to the treatment with the beta-adrenergic blocker propranolol. The striking discrepancy between the high concentrations of the active hormones and the moderate clinical symptoms was most likely caused by peripheral effects of propranolol.

Topics: Adolescent; Adult; Dose-Response Relationship, Drug; Factitious Disorders; Female; Humans; Hyperthyroidism; Male; Propranolol; Suicide, Attempted; Thyroxine; Triiodothyronine; Triiodothyronine, Reverse