Levothyroxine toxicity in a patient with adjustment disorder: a rare case report

Introduction and Importance Levothyroxine (T4) toxicity, though uncommon, can be encountered in patient with deliberate self-harm and can result in serious toxicity. The clinical presentation of toxicity depends upon the ingested dose, rate of peripheral conversion, and chronicity of intake. This case report highlights the incident of levothyroxine intake in an adolescent female as mean of deliberate self-harm who was previously diagnosed with adjustment disorder. Case Presentation A 19-year-old female, diagnosed with hypothyroidism and adjustment disorder, presented to emergency department after ingesting 1.5 mg of levothyroxine (60 tablets of 25 µg) following verbal argument with her mother. No clinical features of hyperthyroidism were observed. A general examination revealed that her vital signs were stable. The laboratory result were within normal range. She was diagnosed with Impulsive Deliberate Self-Harm, started on Dialectical Behavioural Therapy, and discharged after 3 days of monitoring in hospital, with mandatory follow-up plans in psychiatric outpatient care. Clinical Discussion Although, cases of levothyroxine ingestion in toxic doses are reported, clinical manifestations and fatalities are uncommon. Monitoring of thyroid hormone and prompt treatment with propranolol or hemodialysis in symptomatic patients is crucial for better outcomes. Conclusion Patients may self-harm using both common drugs and unusual choices like levothyroxine. Clinicians should rely on detailed assessments and patient or caregiver history to recognize these risks and provide effective, holistic clinical, and psychological support.