Hypersensitivity to levothyroxine in a substitutional therapy of Hashimoto syndrome
, 1, 1, 1, 1
Abstract
A 25-year-old woman was admitted to the Emergency Ward because of a severe allergic reaction. The
clinical picture contained facial swelling, a rash of the face and neck (fig. 1.), skin itching and rumour,
and dyspnoea with difficulties in swallowing. A detailed interview was collected, with particular emphasis
on plausible allergens. The only substance that was new in the patient’s surroundings was the intake of
levothyroxine according to Hashimoto syndrome, which was diagnosed a few days before.
Given the suspicion of hypersensitivity to levothyroxine, the patient was admitted to the Clinic of Endocrinology.
At first, the substitution of L-thyroxine was interrupted. Then, the preparation of L-thyroxine was
changed to the liquid form and the patient started to take this under the observation of the ward’s medical
personnel. After 5 days of novel preparation intake, no hypersensitivity reaction was observed – therefore
the patient was discharged home with additional advice to attend the Allergology Ambulatory.
Keywords: hypersensitivitylevothyroxineHashimoto thyroiditisendocrinologyallergology
References
- Sandooja R, Morocco M, Smith M. SAT-504 Delayed Hypersensitivity to Levothyroxine, and Oral Desensitization. Journal of the Endocrine Society. 2020; 4(Supplement_1).
- Gansert E, Garzon-Siatoya W, Morgenstern-Kaplan D, et al. A tale of two patients with hypersensitivity reactions to levothyroxine. QJM. 2022; 115(5): 327–328.
- Jiang CYi, Shen BS, Yun TZ, et al. Successful Oral Levothyroxine Desensitization in a Patient with Severe Hypothyroidism Post Radioactive Iodine Therapy: A Case Report. J ASEAN Fed Endocr Soc. 2021; 36(2): 213–215.
- Yu H, Zhang W, Shen C, et al. Liver dysfunction induced by Levothyroxine Sodium Tablets (Euthyrox®) in a hypothyroid patient with Hashimoto's thyroiditis: case report and literature review. Endocr J. 2019; 66(9): 769–775.
- Nugent JS, Nugent AL, Whisman BA, et al. Levothyroxine anaphylaxis? Vocal cord dysfunction mimicking an anaphylactic drug reaction. Ann Allergy Asthma Immunol. 2003; 91(4): 337–341.