Combination therapy of propranolol, levothyroxine, and liothyronine was effective in a case of severe consumptive hypothyroidism associated with infantile hepatic hemangioma

Asami Osada, Eriko Araki, Yukio Yamashita, Tomohiro Ishii

Research output: Contribution to journalArticle

Abstract

Infantile hepatic hemangioma (IHH) can be accompanied by consumptive hypothyroidism. We report the case of a 4-mo-old boy who showed massive hepatomegaly, peripheral coldness, lethargy, and failure to thrive. An enhanced computed tomography scans demonstrated multiple hemangiomas in both lobes of the liver, and a thyroid function tests showed severe hypothyroidism: TSH 561.5 µIU/mL, free triiodothyronine (fT 3 ) 1.0 pg/mL, and free thyroxine (fT 4 ) < 0.7 ng/dL. IHH gradually regressed following propranolol treatment and fT 4 increased to a low normal level (1.0 ng/dL) by high dose replacement of levothyroxine, while fT 3 remained very low (< 1.0 pg/mL), even following high doses of levothyroxine; fT 3 eventually normalized following the administration of liothyronine. We suggest that treatment strategies should be individualized based on thyroid function, and that the combination therapy of propranolol for anti-tumor treatment and levothyroxine and liothyronine for respective thyroid hormone replacement is effective, particularly in cases of severe consumptive hypothyroidism due to multiple IHHs.

Original languageEnglish
Pages (from-to)9-14
Number of pages6
JournalClinical Pediatric Endocrinology
Volume28
Issue number1
DOIs
Publication statusPublished - 2019 Jan 1

Fingerprint

Triiodothyronine
Hemangioma
Hypothyroidism
Thyroxine
Propranolol
Liver
Thyroid Function Tests
Failure to Thrive
Lethargy
Hepatomegaly
Therapeutics
Thyroid Hormones
Thyroid Gland
Tomography
Neoplasms

Keywords

  • Consumptive hypothyroidism
  • Infantile hepatic hemangioma
  • Levothyroxine
  • Liothyronine
  • Propranolol

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

@article{416b4b28c27a4c20a7bba47186264232,
title = "Combination therapy of propranolol, levothyroxine, and liothyronine was effective in a case of severe consumptive hypothyroidism associated with infantile hepatic hemangioma",
abstract = "Infantile hepatic hemangioma (IHH) can be accompanied by consumptive hypothyroidism. We report the case of a 4-mo-old boy who showed massive hepatomegaly, peripheral coldness, lethargy, and failure to thrive. An enhanced computed tomography scans demonstrated multiple hemangiomas in both lobes of the liver, and a thyroid function tests showed severe hypothyroidism: TSH 561.5 µIU/mL, free triiodothyronine (fT 3 ) 1.0 pg/mL, and free thyroxine (fT 4 ) < 0.7 ng/dL. IHH gradually regressed following propranolol treatment and fT 4 increased to a low normal level (1.0 ng/dL) by high dose replacement of levothyroxine, while fT 3 remained very low (< 1.0 pg/mL), even following high doses of levothyroxine; fT 3 eventually normalized following the administration of liothyronine. We suggest that treatment strategies should be individualized based on thyroid function, and that the combination therapy of propranolol for anti-tumor treatment and levothyroxine and liothyronine for respective thyroid hormone replacement is effective, particularly in cases of severe consumptive hypothyroidism due to multiple IHHs.",
keywords = "Consumptive hypothyroidism, Infantile hepatic hemangioma, Levothyroxine, Liothyronine, Propranolol",
author = "Asami Osada and Eriko Araki and Yukio Yamashita and Tomohiro Ishii",
year = "2019",
month = "1",
day = "1",
doi = "10.1297/cpe.28.9",
language = "English",
volume = "28",
pages = "9--14",
journal = "Clinical Pediatric Endocrinology",
issn = "0918-5739",
publisher = "Jeff Corporation Co. Ltd",
number = "1",

}

TY - JOUR

T1 - Combination therapy of propranolol, levothyroxine, and liothyronine was effective in a case of severe consumptive hypothyroidism associated with infantile hepatic hemangioma

AU - Osada, Asami

AU - Araki, Eriko

AU - Yamashita, Yukio

AU - Ishii, Tomohiro

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Infantile hepatic hemangioma (IHH) can be accompanied by consumptive hypothyroidism. We report the case of a 4-mo-old boy who showed massive hepatomegaly, peripheral coldness, lethargy, and failure to thrive. An enhanced computed tomography scans demonstrated multiple hemangiomas in both lobes of the liver, and a thyroid function tests showed severe hypothyroidism: TSH 561.5 µIU/mL, free triiodothyronine (fT 3 ) 1.0 pg/mL, and free thyroxine (fT 4 ) < 0.7 ng/dL. IHH gradually regressed following propranolol treatment and fT 4 increased to a low normal level (1.0 ng/dL) by high dose replacement of levothyroxine, while fT 3 remained very low (< 1.0 pg/mL), even following high doses of levothyroxine; fT 3 eventually normalized following the administration of liothyronine. We suggest that treatment strategies should be individualized based on thyroid function, and that the combination therapy of propranolol for anti-tumor treatment and levothyroxine and liothyronine for respective thyroid hormone replacement is effective, particularly in cases of severe consumptive hypothyroidism due to multiple IHHs.

AB - Infantile hepatic hemangioma (IHH) can be accompanied by consumptive hypothyroidism. We report the case of a 4-mo-old boy who showed massive hepatomegaly, peripheral coldness, lethargy, and failure to thrive. An enhanced computed tomography scans demonstrated multiple hemangiomas in both lobes of the liver, and a thyroid function tests showed severe hypothyroidism: TSH 561.5 µIU/mL, free triiodothyronine (fT 3 ) 1.0 pg/mL, and free thyroxine (fT 4 ) < 0.7 ng/dL. IHH gradually regressed following propranolol treatment and fT 4 increased to a low normal level (1.0 ng/dL) by high dose replacement of levothyroxine, while fT 3 remained very low (< 1.0 pg/mL), even following high doses of levothyroxine; fT 3 eventually normalized following the administration of liothyronine. We suggest that treatment strategies should be individualized based on thyroid function, and that the combination therapy of propranolol for anti-tumor treatment and levothyroxine and liothyronine for respective thyroid hormone replacement is effective, particularly in cases of severe consumptive hypothyroidism due to multiple IHHs.

KW - Consumptive hypothyroidism

KW - Infantile hepatic hemangioma

KW - Levothyroxine

KW - Liothyronine

KW - Propranolol

UR - http://www.scopus.com/inward/record.url?scp=85061511036&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061511036&partnerID=8YFLogxK

U2 - 10.1297/cpe.28.9

DO - 10.1297/cpe.28.9

M3 - Article

VL - 28

SP - 9

EP - 14

JO - Clinical Pediatric Endocrinology

JF - Clinical Pediatric Endocrinology

SN - 0918-5739

IS - 1

ER -