Successful oral desensitization to levothyroxine. Report of one case

[helvella]

It seems quite extraordinary that although requiring great care, this fundamentally simple technique is claimed to have achieved desensitisation. If it is effective, I would have thought this could be replicated at any hospital with a decent pharmacology lab to prepare the levothyroxine at the required doses.

Perhaps the most amazing thing is that someone identified the problem and came up with an answer!

I'd very much like to see it replicated - many times - in order to fully convince both the medical establishment and me that it is as reported.

Revista médica de Chile

Print version ISSN 0034-9887

Rev. méd. Chile vol.146 no.3 Santiago Mar. 2018

dx.doi.org/10.4067/s0034-98...

Caso Clínico

Desensibilización a levotiroxina. Caso clínico

Successful oral desensitization to levothyroxine. Report of one case

María Antonieta Guzmán1

Cecilia Sepúlveda1 Claudio Liberman2 Rodrigo Cornejo3 Gigia Roizen4 Daniela Cereceda4 María Fernanda Lara4 Emilio Álvarez-Cuesta5

1Sección Inmunología, VIH y Alergias, Hospital Clínico Universidad de Chile. Santiago, Chile

2Sección Endocrinología, Hospital Clínico Universidad de Chile. Santiago, Chile

3Unidad de Pacientes Críticos, Hospital Clínico Universidad de Chile. Santiago, Chile

4Programa Formación Especialistas en Inmunología, Hospital Clínico Universidad de Chile. Santiago, Chile

5Servicio Alergología, Hospital Universitario Ramón y Cajal, Madrid, España

ABSTRACT

We report a 39-year-old female who underwent a total thyroidectomy as treatment for a thyroid papillary cancer. She suffered several episodes of mild angioedema in lips and tongue, after using different commercial Levothyroxine formulations, with and without excipients. Given the need to use this drug, the patient was admitted in our hospital and we proceeded to desensitize her with oral Levothyroxine. The patient fasted throughout the whole procedure, was properly monitored and had an adequate peripheral venous access. On the first day of the procedure, a 15-step protocol was performed, first administering placebo and then, compounded formulations of Levothyroxine starting from 0.01 ug, followed by doubling doses every 15 minutes until the cumulative dose of 111.95 ug was completed, corresponding to the daily dose of Levothyroxine her endocrinologist prescribed (112 ug). The patient was monitored at baseline, between each dose and up to 3 hours after the procedure was completed. There were no incidents such as urticaria, angioedema, or others. On the second day, the patient received a single-full dose of 112 ug on an empty stomach. The medication was successfully tolerated and she was discharged. Thereafter, she tolerates daily Levothyroxine.

Key words: Drug Hypersensitivity; Hypersensitivity; Thyroxine

Full paper - in Spanish not English - here:

scielo.conicyt.cl/scielo.ph...

[MaisieGray]

It seems far too simplistic to be true; or to put it another way, its' very simplicity seems to indicate other factors at play. I'd also like to see it replicated, if only to rule in or out, any psychological and/or psychiatric aspects of the angiodema. A 2007 meta analysis concluded that about one third of all cases of urticaria/angioedema can be triggered by psychological factors, alternately or associated with common etiologic agents; and that urticaria/angioedema with psychogenic triggers occur in patients with increased vulnerability to emotional distress (more frequently in females).

[helvella Administrator Thyroid UK in reply to MaisieGray]

That, of course, leaves two thirds not so triggered!

[MaisieGray in reply to helvella]

Yes, absolutely, but one swallow etc ...

Seriously, from my experience with my own clients during my years practising as a clinical therapist, including using desensitising techniques, I collated more than enough evidence to prove how powerful is the human brain to skew our experience of reality.