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The Use of Bile Acid Sequestrants to Lower Serum Thyroid Hormones in Iatrogenic Hyperthyroidism
Abstract
Hyperthyroidism occasionally must be rapidly restored to euthyroidism, especially if it is associated with an emergent condition such as myocardial infarction. Several modalities are available to render endogenous hyperthyroid patients to a euthyroid state rapidly. Few therapeutic options, however, are available to rapidly treat hyperthyroidism caused by ingestion of excess thyroid hormones, except perhaps the use of β-blockers. We observed hypothyroidism develop in two patients taking stable doses of levothyroxine after cholestyramine was added to their drug regimen. This finding led us to treat two patients with iatrogenic hyperthyroidism with cholestyramine. A euthyroid state was achieved in 72 to 96 hours whereas in three similar patients without cholestyramine treatment it had taken almost 8 days for serum thyroid hormone levels to fall into normal range. Our preliminary results suggest that bile acid sequestrants may be useful in treating exogenous thyroid-hormone-induced hyperthyroidism in emergent situations.
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“Treatment with cholestyramine (671) and charcoal hemoperfusion (672) have been used in this circumstance.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [671]
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Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., et al. (2016) · Thyroid® · doi:10.1089/thy.2016.0229 · Cited by 2,938
“Treatment with cholestyramine (671) and charcoal hemoperfusion (672) have been used in this circumstance.”
MethodThyrotoxicosis and Thyroid Storm
Nayak, B. M., & Burman, K. D. (2006) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2006.09.008 · Cited by 392
“Cholestyramine was also found to be useful in rapidly decreasing thyroid hormone levels in a case of iatrogenic hyperthyroidism.”
BackgroundSurks, M. I., & Sievert, R. (1995) · New England Journal of Medicine · doi:10.1056/nejm199512213332507 · Cited by 349
Treatment with thyroid hormone
Biondi, B., & Wartofsky, L. (2014) · Endocrine Reviews · doi:10.1210/er.2013-1083 · Cited by 259
Gastrointestinal malabsorption of thyroxine
Virili, C., Antonelli, A., Santaguida, M. G., Benvenga, S., & Centanni, M. (2019) · Endocrine Reviews · doi:10.1210/er.2018-00168 · Cited by 164
Metadata
- Authors
- Shakir, K. M. M., Michaels, R. D., Hays, J. H., & Potter, B. B.
- Affiliations
- Uniformed Services University of the Health Sciences (US)
- Corresponding author
- Shakir, K. M. Mohamed
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 1993-01-15
- Volume
- 118
- Issue
- 2
- Pages
- 112-113
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2022517313
- Cited by
- 45
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2021: 2 · 2020: 1 · 2019: 2 · 2018: 2 · 2017: 1 · 2016: 2 · 2014: 2 · 2013: 1
- FWCI
- 1.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
- Keywords
- iatrogenic hyperthyroidism, bile acid sequestrants, cholestyramine, levothyroxine, thyroid hormone excess, hypothyroidism, euthyroidism, myocardial infarction, beta-blockers, serum thyroid hormones
- MeSH terms
- Cholestyramine Resin, Female, Humans, Hyperthyroidism, Male, Middle Aged, Preoperative Care, Thyroid Hormones, Thyroxine
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