{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T03:42:54Z","timestamp":1791430974751,"version":"4.3.3"},"reference-count":7,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2010,8,1]]},"abstract":"<jats:p>A 2-year-old girl was found with an empty bottle of levothyroxine and blue coloring around her mouth. Forty tablets of 150-\u03bcg levothyroxine tablets were missing. Her 6-hour postingestion total thyroxine (T4) level was 68.1 \u03bcg\/dL (normal range: 5\u201312 \u03bcg\/dL), and her total triiodothyronine (T3) level was 472 ng\/dL (normal range: 40\u2013130 ng\/dL). Serum levels of thyrotropin, T3, and T4 were then checked on days 3, 5, 7, and 10. On postingestion day 5, the child presented for follow-up with hyperthermia, vomiting, irritability, and increased lethargy. She was referred to the emergency department, where a heart rate of 220 beats per minute, a blood pressure of 130\/80 mm Hg, and a temperature of 101\u00b0F were recorded. She also had multiple episodes of diarrhea. The patient was treated with oral propranolol (0.8 mg\/kg) every 6 hours, intravenous normal saline, and ibuprofen; all her vital signs improved. Serial T3, T4, and thyrotropin serum levels were measured. Her total T3 levels were &amp;gt;800, 798, 445, 446, and 98 ng\/dL on days 3, 5, 6, 9, and 13, respectively. Total T4 measurement was repeated on day 13, and the concentration was found to be 11.9 \u03bcg\/dL. Her thyrotropin levels remained undetectable throughout the course of treatment. The patient was discharged from the hospital after a 4-day PICU stay, in good condition, on oral propranolol 0.8 mg\/kg every 8 hours. Propranolol administration was discontinued 8 days after initiation with no further tachycardia, hypertension, or hyperthermia. The child tolerated the recommended regimen.<\/jats:p>","DOI":"10.1542\/peds.2009-2138","type":"journal-article","created":{"date-parts":[[2010,7,20]],"date-time":"2010-07-20T00:35:53Z","timestamp":1279586153000},"page":"e470-e473","source":"Crossref","is-referenced-by-count":26,"title":["Thyroid Storm After Pediatric Levothyroxine Ingestion"],"prefix":"10.1542","volume":"126","author":[{"given":"Nima","family":"Majlesi","sequence":"first","affiliation":[{"name":"Emergency Department, Staten Island University Hospital, Staten Island, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard A.","family":"Greller","sequence":"additional","affiliation":[{"name":"Emergency Department\/Division of Medical Toxicology, North Shore University Hospital, Manhasset, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"McGuigan","sequence":"additional","affiliation":[{"name":"Long Island Regional Poison and Drug Information Center, Mineola, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Caraccio","sequence":"additional","affiliation":[{"name":"Long Island Regional Poison and Drug Information Center, Mineola, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark K.","family":"Su","sequence":"additional","affiliation":[{"name":"Emergency Department\/Division of Medical Toxicology, North Shore University Hospital, Manhasset, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gar M.","family":"Chan","sequence":"additional","affiliation":[{"name":"Emergency Department\/Division of Medical Toxicology, North Shore University Hospital, Manhasset, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2010,8,1]]},"reference":[{"issue":"1","key":"2021120820090441500_B1","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1542\/peds.75.1.129","article-title":"Levothyroxine poisoning","volume":"75","author":"White","year":"1985","journal-title":"Pediatrics"},{"issue":"2","key":"2021120820090441500_B2","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1542\/peds.84.2.262","article-title":"Acute thyroxine ingestion in pediatric patients","volume":"84","author":"Lewander","year":"1989","journal-title":"Pediatrics"},{"issue":"4","key":"2021120820090441500_B3","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1542\/peds.82.4.666","article-title":"Massive levothyroxine overdose: high anxiety\u2014low toxicity","volume":"82","author":"Gorman","year":"1988","journal-title":"Pediatrics"},{"issue":"1","key":"2021120820090441500_B4","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/00006565-198603000-00004","article-title":"Benign course after massive levothyroxine ingestion","volume":"2","author":"Tenenbein","year":"1986","journal-title":"Pediatr Emerg Care"},{"issue":"4","key":"2021120820090441500_B5","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/0735-6757(85)90050-6","article-title":"Levothyroxine ingestions in children: an analysis of 78 cases","volume":"3","author":"Litovitz","year":"1985","journal-title":"Am J Emerg Med"},{"issue":"9","key":"2021120820090441500_B6","first-page":"1025","article-title":"Clinical effects of accidental levothyroxine ingestion in children","volume":"141","author":"Golightly","year":"1987","journal-title":"Am J Dis Child"},{"issue":"15","key":"2021120820090441500_B7","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1001\/jama.1985.03360150085029","article-title":"Levothyroxine overdose associated with seizures in a young child","volume":"254","author":"Kulig","year":"1985","journal-title":"JAMA"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/126\/2\/e470\/1177203\/zpe0081000e470.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/126\/2\/e470\/1177203\/zpe0081000e470.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T06:01:32Z","timestamp":1685685692000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/126\/2\/e470\/68526\/Thyroid-Storm-After-Pediatric-Levothyroxine"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,8,1]]},"references-count":7,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2010,8,1]]},"published-print":{"date-parts":[[2010,8,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2009-2138","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,8,1]]}}}