Successful Oral Levothyroxine Desensitization in a Patient with Severe Hypothyroidism Post Radioactive Iodine Therapy

A Case Report

  • Yi Jiang Chua Selayang Hospital, Selangor, Malaysia https://orcid.org/0000-0001-9388-747X
  • Bay Shing Shen Selayang Hospital, Selangor, Malaysia https://orcid.org/0000-0003-2315-6676
  • Taye Zhi Yun Selayang Hospital, Selangor, Malaysia
  • Carolina Singarayar Selayang Hospital, Selangor, Malaysia
  • Foo Siew Hui Selayang Hospital, Selangor, Malaysia
Keywords: levothyroxine, thypersensitivity, hypothyroidism, desensitization

Abstract

Levothyroxine remains the standard therapy for patients with hypothyroidism worldwide. Levothyroxine allergy is rarely seen and alternative therapies are less efficacious and scarcely available. The use of liothyronine (LT3) monotherapy is less favoured due to its short half-life and unpredictable pharmacological profile.  We report a 59-year-old male with a hypersensitivity reaction to levothyroxine who was successfully desensitized with oral levothyroxine within a day using a 14-step protocol (Table 1.1).

Downloads

Download data is not yet available.

Author Biographies

Yi Jiang Chua, Selayang Hospital, Selangor, Malaysia

Medical Physician, Endocrinology Fellow

Endocrinology Unit, Department of Medicine

Bay Shing Shen, Selayang Hospital, Selangor, Malaysia

Medical Officer, Endocrinology Unit, Department of Medicine

Taye Zhi Yun, Selayang Hospital, Selangor, Malaysia

Clinical Pharmacist, Pharmacy Department

Carolina Singarayar, Selayang Hospital, Selangor, Malaysia

Endocrinologist, Endocrinology Unit, Department of Medicine

Foo Siew Hui, Selayang Hospital, Selangor, Malaysia

Senior Consultant, Endocrinologist

Endocrinology Unit, Department of Medicine

References

Wan Mohamed WMI, Sayuti SC, Draman N. Hypothyroidism and its associated factors after radioactive iodine therapy among patients with hyperthyroidism in the Northeast Coast State of Malaysia. J Taibah Univ Med Sci. 2018;13(5): 432-7. https://pubmed.ncbi.nlm.nih.gov/31435358. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694960. https://doi.org/10.1016/j.jtumed.2018.06.004.

Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism by the American Thyroid Association Task Force on thyroid hormone replacement. Thyroid. 2014;24(12):1670-751. https://pubmed.ncbi.nlm.nih.gov/25266247. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267409. https://doi.org/10.1089/thy.2014.0028.

Fevzi D, Nustafa G, Ozgur K, et al. Successful oral desensitization to levothyroxine. Ann Allergy Asthma Immunol. 2013;111(2):146-7. https://pubmed.ncbi.nlm.nih.gov/23886239. https://doi.org/10.1016/j.anai.2013.06.003.

Uzzaman Am, Cho SH. Classification of hypersensitivity reactions. Allergy Asthma Proc. 2012;33(Suppl 1):96-9. https://pubmed.ncbi.nlm.nih.gov/22794701. https://doi.org/10.2500/aap.2012.33.3561.

Charmorro-Pareja N, Carrillo-Martin I, et al. Self-reported allergy to thyroid replacement therapy: A multicenter retrospective chart review. Endocr Pract. 2020;26(7):761-7. https://pubmed.ncbi.nlm.nih.gov/33471645. https://doi.org/10.4158/EP-2019-0488.

Muraro A, Lemanske Jr. RF, Castells M, et al. Precision medicine in allergic disease - food allergy, drug allergy, and anaphylaxis - PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology. Allergy 2017;72(7):1006–21. https://pubmed.ncbi.nlm.nih.gov/28122115. https://doi.org/10.1111/all.13132.

Dayan C, Panicker V. Management of hypothyroidism with combination thyroxine (T4) and triiodothyronine (T3) hormone replacement in clinical practice: A review of suggested guidance. Thyroid Res. 2018; 11:1. https://pubmed.ncbi.nlm.nih.gov/29375671. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772692. https://doi.org/10.1186/s13044-018-0045-x.

De Las Vecillas Sánchez L, Alenazy LA, Garcia-Neuer M, Castells MC. Drug hypersensitivity and desensitizations: Mechanisms and new approaches. Int J Mol Sci. 2017;18(6):1316. https://pubmed.ncbi.nlm.nih.gov/28632196. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486137. https://doi.org/10.3390/ijms18061316.

Sandooja R, Morocco MD, Smith M. SAT-504 Delayed hypersensitivity to levothyroxine, and oral desensitization. JES. 2020;4(Suppl 1): A221. https://doi.org/10.1210/jendso/bvaa046.436.

Guzmán MA, Sepúlveda C, Lieberman C, et al. Successful oral desensitization to levothyroxine. Report of one case. Rev Med Chil. 2018; 146(3):394-8. https://pubmed.ncbi.nlm.nih.gov/29999112. https;//doi.org/10.4067/s0034-98872018000300394.

Published
2021-08-19
How to Cite
Chua, Y. J., Shing Shen, B., Yun, T. Z., Singarayar, C., & Hui, F. S. (2021). Successful Oral Levothyroxine Desensitization in a Patient with Severe Hypothyroidism Post Radioactive Iodine Therapy: A Case Report. Journal of the ASEAN Federation of Endocrine Societies, 36(2). https://doi.org/10.15605/jafes.036.02.10
Section
Case Reports