Use of liothyronine without levothyroxine in the treatment of mild consumptive hypothyroidism caused by hepatic hemangiomas

[helvella]

One form of hypothyroidism that has rarely, if ever, been discussed here is consumptive hypothyroidism. This is where something in the body is taking in and using up T4 at a disproportionately high rate. This leaves the rest of the body short - hence the hypothyroidism.

Haemangiomas are, I think, the most frequently discussed cause of consumptive hypothyroidism.

Use of liothyronine without levothyroxine in the treatment of mild consumptive hypothyroidism caused by hepatic hemangiomas

Shinji Higuchi, Masaki Takagi, Yukihiro Hasegawa

Author information

Shinji Higuchi

Department of Endocrinology and Metabolism, Tokyo Metropolitan Children’s Medical Center, Tokyo 183-8561, Japan

Masaki Takagi

Department of Endocrinology and Metabolism, Tokyo Metropolitan Children’s Medical Center, Tokyo 183-8561, Japan

Department of Pediatrics, Keio University School of Medicine, Tokyo 160-8582, Japan

Yukihiro Hasegawa

Department of Endocrinology and Metabolism, Tokyo Metropolitan Children’s Medical Center, Tokyo 183-8561, Japan

Department of Pediatrics, Keio University School of Medicine, Tokyo 160-8582, Japan

Keywords: Consumptive hypothyroidism, Hemangioma, Liothyronine, Type 3 deiodinase

Volume 64 (2017) Issue 6 Pages 639-643

DOI doi.org/10.1507/endocrj.EJ1...

Abstract

There have been reports of the use of levothyroxine or levothyroxine plus liothyronine for consumptive hypothyroidism caused by hepatic hemangiomas. Administration of levothyroxine without liothyronine can be inadequate to maintain normal levels of both free T3 and free T4 in some patients. However, there is no report of treatment with liothyronine plus propranolol. We herein present a case in which we used liothyronine therapy for multifocal hepatic hemangiomas in a Japanese patient with low free T3 and normal free T4 levels. A 2-month-old Japanese male was referred to our hospital because of jaundice. Abdominal computed tomography showed multifocal hemangiomas in both lobes of the liver. TSH level was elevated, free T3 level was low, free T4 level was normal, and hypothyroidism due to hepatic hemangiomas was diagnosed. In addition to propranolol, liothyronine was started. We used liothyronine without levothyroxine for hypothyroidism because only free T3 level had decreased, whereas free T4 level remained in the normal range. The TSH and free T3 levels normalized in this patient in less than 1 month. The liothyronine dose was gradually reduced with regression of the hemangiomas, and liothyronine administration was discontinued at the age of 5 months. At the age of 11 months, growth and neurological development of the patient met age-specific norms, and he was euthyroid at that time. This is the first report demonstrating the use of liothyronine with propranolol for treatment of this type of consumptive hypothyroidism.

Full paper freely available here:

jstage.jst.go.jp/article/en...

Overview of Liver hemangioma

mayoclinic.org/diseases-con...

This link will take you to a search page in PubMed for Consumptive hypothyroidism:

ncbi.nlm.nih.gov/pubmed/?te...

[jimh111]

I haven't read the paper. I assume propranolol is the best treatment for the liver condition. Unfortunatly, propranolol reduces T4 to T3 conversion which creates an additional need for L-T3.

[helvella Administrator Thyroid UK in reply to jimh111]

Given the excessive conversion of T4 to rT3 in the case reported, that might very well not be an issue, or even an advantage.

[jimh111 in reply to helvella]

Just discovered hemangiomas produces excess D3 which would explain the high rT3 and I believe propanalol also inhibits D3. I'm getting out of my depth, just wanted to point out the effects of propanalol on deiodinase.

[Hidden]

Interesting!