http://www.ncbi.nlm.nih.gov/pubmed/17961449
Case Reports
Patient 1
A 63-year-old man, who and been progressively graying
over the years and who had a 1-year history of fungoid
mycosis (stage IA) treated with psoralen-UV-A (PUVA)
(3 sessions/wk), went into a myxedema coma of unknown
cause. When he attended the clinic for a PUVA session
accompanied by a family member, he showed a low level
of consciousness, irregular breathing, inflammation,
reddening of the face and both hands, and periorbital edema.
His vital signs were as follows: systolic blood pressure, 110
mmHg; diastolic blood pressure, 60 mm Hg; pulse rate,
56 beats/min; and body temperature, 35ºC. Of note in the
laboratory tests were free T3 levels of 0.4 pg/mL (normal
range, 1.5-4.3 pg/mL), free thyroxine (T4) levels of 1.8
pmol/mL (normal range, 10.5-25.0 pmol/mL), and thyroid
stimulating hormone (TSH) levels of 102 mU/L (normal
range, 0.45-7.0 mU/L). The patient was admitted to the
intensive care unit (ICU) for 10 days, where he received
support measures and intravenous therapy with 0.5 mg of
L-thyroxine. He responded satisfactorily and continued
oral therapy with 0.1 mg of L-thyroxine. He was able to
return home after a month. On discharge from the ICU,
complete repigmentation of all gray hairs of his scalp was
observed and these have retained their coloration during 2
years of follow-up. His underlying disease did not show
significant changes and he still needed specific treatment.
The patient did not receive any other medication while he
was in hospital.
Patient 2
The second patient was a 51-year-old man with Cowden
syndrome and a history of thyroid carcinoma treated by
surgery and thyroid hormone replacement therapy. His hair
had gone progressively gray over time. Two years later, he
developed non-Hodgkin lymphoma of the tonsils and cervical
lymph nodes, which was treated with chemotherapy and
radiotherapy (total dose, 36 Gy). At the time, 60% of his
hair was white. After completing 4 cycles of chemotherapy
(cyclophosphamide, doxorubicin, vincristine, prednisone,
and bleomycin) he presented in the clinic suffering from
nervousness, anxiety, and insomnia. He had lost 15 kg. He
was diagnosed with iatrogenic hyperthyroidism caused by
hormone replacement therapy (0.2 mg/d of L-thyroxine).
The laboratory tests performed revealed free T3 levels of
1.62 pg/mL, free T4 levels of 34.4 pmol/L, and undetectable
TSH (<0.1 mU/L). During this time, complete
repigmentation of his hair occurred. The levels of free T4
were normal 3 months after daily treatment with 0.15 mg
of L-thyroxine. The pigmentation of his hair has persisted
during the 3 years of follow-up.
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is there any protocol for topical use of liothyronine?
Case Reports
Patient 1
A 63-year-old man, who and been progressively graying
over the years and who had a 1-year history of fungoid
mycosis (stage IA) treated with psoralen-UV-A (PUVA)
(3 sessions/wk), went into a myxedema coma of unknown
cause. When he attended the clinic for a PUVA session
accompanied by a family member, he showed a low level
of consciousness, irregular breathing, inflammation,
reddening of the face and both hands, and periorbital edema.
His vital signs were as follows: systolic blood pressure, 110
mmHg; diastolic blood pressure, 60 mm Hg; pulse rate,
56 beats/min; and body temperature, 35ºC. Of note in the
laboratory tests were free T3 levels of 0.4 pg/mL (normal
range, 1.5-4.3 pg/mL), free thyroxine (T4) levels of 1.8
pmol/mL (normal range, 10.5-25.0 pmol/mL), and thyroid
stimulating hormone (TSH) levels of 102 mU/L (normal
range, 0.45-7.0 mU/L). The patient was admitted to the
intensive care unit (ICU) for 10 days, where he received
support measures and intravenous therapy with 0.5 mg of
L-thyroxine. He responded satisfactorily and continued
oral therapy with 0.1 mg of L-thyroxine. He was able to
return home after a month. On discharge from the ICU,
complete repigmentation of all gray hairs of his scalp was
observed and these have retained their coloration during 2
years of follow-up. His underlying disease did not show
significant changes and he still needed specific treatment.
The patient did not receive any other medication while he
was in hospital.
Patient 2
The second patient was a 51-year-old man with Cowden
syndrome and a history of thyroid carcinoma treated by
surgery and thyroid hormone replacement therapy. His hair
had gone progressively gray over time. Two years later, he
developed non-Hodgkin lymphoma of the tonsils and cervical
lymph nodes, which was treated with chemotherapy and
radiotherapy (total dose, 36 Gy). At the time, 60% of his
hair was white. After completing 4 cycles of chemotherapy
(cyclophosphamide, doxorubicin, vincristine, prednisone,
and bleomycin) he presented in the clinic suffering from
nervousness, anxiety, and insomnia. He had lost 15 kg. He
was diagnosed with iatrogenic hyperthyroidism caused by
hormone replacement therapy (0.2 mg/d of L-thyroxine).
The laboratory tests performed revealed free T3 levels of
1.62 pg/mL, free T4 levels of 34.4 pmol/L, and undetectable
TSH (<0.1 mU/L). During this time, complete
repigmentation of his hair occurred. The levels of free T4
were normal 3 months after daily treatment with 0.15 mg
of L-thyroxine. The pigmentation of his hair has persisted
during the 3 years of follow-up.
-------------------------------------------------------------------------------------------
is there any protocol for topical use of liothyronine?
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