{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T21:59:47Z","timestamp":1764194387749,"version":"3.44.0"},"reference-count":7,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,7,3]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>A 53-year-old woman was admitted with thyroid storm and severe behavioural problems. She had longstanding bipolar affective disorder. She was psychotic and obstructed in-patient medical management for thyroid storm. She required one-to-one psychiatric nursing and was placed under section 3 of the Mental Health Act meaning she could be detained in hospital for psychiatric treatment for up to 6 months. She underwent a total thyroidectomy. Due to her paranoid mental state, she refused treatment and the administration of thyroid hormone replacement was difficult. Postoperatively, intramuscular levothyroxine was used effectively to stabilise her thyroid function. There are no consensus guidelines on the use of parenteral levothyroxine and intramuscular levothyroxine is rarely used. This case uniquely illustrates its utility with bi-weekly blood tests showing a fast and stable response to intramuscular hormone replacement.<\/jats:p>","DOI":"10.1136\/bcr-2018-228147","type":"journal-article","created":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T05:59:11Z","timestamp":1566367151000},"page":"e228147","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Intramuscular levothyroxine: a solution to a mental health related thyroid crisis"],"prefix":"10.1136","volume":"12","author":[{"given":"Kate","family":"Laycock","sequence":"first","affiliation":[{"name":"Diabetes and Endocrinology, Homerton University Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chloe","family":"Beale","sequence":"additional","affiliation":[{"name":"Psychiatry, Homerton University Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Peters","sequence":"additional","affiliation":[{"name":"Intensive Care, Homerton University Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Anderson","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrinology, Homerton University Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,8,20]]},"reference":[{"key":"2025082711022152000_12.8.e228147.1","first-page":"244","article-title":"Hypothyroidism: an update","volume":"86","author":"Gaitonde","year":"2012","journal-title":"Am Fam Physician"},{"key":"2025082711022152000_12.8.e228147.2","unstructured":"Levothyroxine Injection. 2019 https:\/\/www.drugs.com\/pro\/levothyroxine-injection.html."},{"key":"2025082711022152000_12.8.e228147.3","first-page":"23","article-title":"[Parenteral replacement of thyroid hormones]","volume":"60","author":"Miyauchi","year":"1984","journal-title":"Nihon Naibunpi Gakkai Zasshi"},{"key":"2025082711022152000_12.8.e228147.4","doi-asserted-by":"crossref","unstructured":"Taylor PN , Tabasum A , Sanki G , et al . Weekly intramuscular injection of levothyroxine following Myxoedema: a practical solution to an old crisis. Case Report 2015.","DOI":"10.1155\/2015\/169194"},{"key":"2025082711022152000_12.8.e228147.5","unstructured":"Kalathil D , Ranjeev S , Chattington P . Hypothyroidism treated with intramuscular thyroxine injections.\u00a0Society for Endocrinology Conference. 2012."},{"key":"2025082711022152000_12.8.e228147.6","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2006.0283"},{"key":"2025082711022152000_12.8.e228147.7","first-page":"245","article-title":"Is parenteral levothyroxine therapy safe in intractable hypothyroidism?","volume":"110","author":"Peynirci","year":"2018","journal-title":"J Natl Med Assoc"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-228147","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:02:29Z","timestamp":1756317749000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-228147"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8]]},"references-count":7,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019,8,20]]},"published-print":{"date-parts":[[2019,8]]}},"alternative-id":["10.1136\/bcr-2018-228147"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-228147","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,8]]}}}