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

1 Citation (Scopus)

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

Keywords

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

ASJC Scopus subject areas

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

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