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To the Editor: The published case reports of L-thyroxine poisoning in children are scarce and the published case series included small numbers of patients, making it difficult to draw clear conclusions about L-thyroxine’s exposure epidemiology and severity [1,2,3]. Therefore, in this historical cohort, based on French Poison Control Center records, we describe the epidemiology, the clinical symptoms and outcomes related to thyroid hormone exposure in patients until 12-y-old from 1st January 2018 to 31st December 2020.
Among the 1,248 cases of exposure, preschool children (2–5 y) accounted for 935 cases (75%). Of these cases, boys were more involved than girls (Supplementary Table S1). The exposures were unintentional, intentional, or unknown in 1,225 (98.2%), 14 (1%), and 9 (0.8%) cases, respectively. Among intentional cases, 5 (0.4%) were suicide attempts involving children aged 8–12 y. In 97.5% of the cases, the drug belonged to a relative of the child. Overall, 10 children (0.8%) were symptomatic, and the severity was classified as minor (poisoning severity score = 1 [4], Supplementary Table S1). The symptoms reported were agitation (four children), diarrhea (two children), tachycardia (two children), vomiting (one child), and tremor (one child). The assumed ingested dose was 20.6 ± 33.8 (0.36–500) µg/kg for asymptomatic patients and 33.3 ± 27.6 (6.67–71.4) µg/kg for symptomatic patients. All of the symptomatic children fully recovered. Plasma thyroid hormone levels were measured only in 14 asymptomatic children and 2 symptomatic children. Of the two symptomatic patients, an increase in thyroid hormones plasma levels was seen in one child 7 d after ingestion. Among the 14 asymptomatic patients, this increase was objective in 5 children between 24 h and 7 d after ingestion.
In a large population of children, we confirmed that acute L-thyroxine poisoning mainly occurs unintentionally, generally causes only a few benign symptoms and has excellent clinical outcomes.
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Paradis, C., Courtois, A., Vaucel, JA. et al. Acute Thyroid Hormone Exposure in Children: A National Retrospective Study Using Health Data Routinely Collected by the French Poison Control Centers. Indian J Pediatr (2024). https://doi.org/10.1007/s12098-024-05114-0
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DOI: https://doi.org/10.1007/s12098-024-05114-0