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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
Levothyroxine substitution and anaphylactic shock symptoms
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.
Levothyroxine substitution and anaphylactic shock symptoms
by Renraw, Oct 25, 2005 12:00AM
After my hypothroid was finally diagnosed, I was put on Synthroid and dose was regulated at 88cmg (c.1995). Recently, my insurance company switched medication to levothyroxine at 88 cmg and cholestrol increased 150 points, ALT to 57, AST to 35,and GGT increased 150 above recommended max. So doctors increased levothryoxine to 1.5 tablets every other day. After some time, I had an anaphylactic shock type reaction that sent me for emergency care. Was given the standard treatment for anaphylactic shock and an Rx for prednisone on a decreasing dose for 7 days. On day 8, woke up with breathing difficulty and went to ER. Treated again for anaphlactic shock. Went to UVA Allegery and Immunology Clinic and was given 11 blood tests. they found THY MICROSOMAL A was 7.1 and sid I was producing an Anti Microsomal Antibody and used the terms urticaria and angioedema. Returned to Synthroid and no further problems. What is history of Levothyroxine causing this type of situation?
Doctor's Answer
by Mark Lupo, M.D., Oct 25, 2005 12:00AM
, Oct 25, 2005 12:00AM
The microsomal antibody is consistent with autoimmune response against the thyroid. In some cases this can cause urticaria (hives) and in rare cases angioedema. Usually this is seen in patients with history of environmental allergies (sometimes with asthma and recurrent sinus problems as well).
The treatment is to keep the TSH low (around 0.5). My guess is that when switched to generic, you did not absorb it as well and you became relatively hypothyroid compared to the good control you had achieved with synthroid -- that is consistent with the elevated cholesterol and the effort to increase the levothyroxine dose. More unlikely would be a true allergic reaction to the levothyroxine -- not the hormone in the pill -- but one of the fillers or the dye.
Stick with the synthroid. If the angioedema recurs then the likely diagnosis is idiopathic (we don't know why) angiodema -- I imagine UVA did a thorough evaluation for the other causes of urticaria/angioedema.
The treatment is to keep the TSH low (around 0.5). My guess is that when switched to generic, you did not absorb it as well and you became relatively hypothyroid compared to the good control you had achieved with synthroid -- that is consistent with the elevated cholesterol and the effort to increase the levothyroxine dose. More unlikely would be a true allergic reaction to the levothyroxine -- not the hormone in the pill -- but one of the fillers or the dye.
Stick with the synthroid. If the angioedema recurs then the likely diagnosis is idiopathic (we don't know why) angiodema -- I imagine UVA did a thorough evaluation for the other causes of urticaria/angioedema.
Member Comments
by CyberBOS, Apr 01, 2009 09:29PM
A related discussion, Thyroid Disorders was started.
