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LETTERS TO THE EDITOR
Year : 2019  |  Volume : 23  |  Issue : 6  |  Page : 652-653

Reversible hair loss due to levothyroxine overdose


1 Department of Endocrinology, Dr Chaitanya's DTH Superspeciality Clinic, Nanded, Maharashtra, India
2 Department of Biochemistry, KK Diagnostics, Bhaskar Hospital, Nanded, Maharashtra, India
3 Department of Paediatrics, Bhaskar Hospital, Nanded, Maharashtra, India

Date of Web Publication20-Jan-2020

Correspondence Address:
Chaitanya Yerawar
Dr Chaitanyafs DTH Superspeciality Clinic, Doctors Lane, Nanded - 431 601, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijem.IJEM_550_19

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How to cite this article:
Yerawar C, Deokar PG, Noone B. Reversible hair loss due to levothyroxine overdose. Indian J Endocr Metab 2019;23:652-3

How to cite this URL:
Yerawar C, Deokar PG, Noone B. Reversible hair loss due to levothyroxine overdose. Indian J Endocr Metab [serial online] 2019 [cited 2020 Feb 17];23:652-3. Available from: http://www.ijem.in/text.asp?2019/23/6/652/276216



Sir,

Thyroid hormones along with estrogen, glucocorticoid, retinoids, prolactin, and growth hormone modulate hair growth.[1] Hyperthyroidism and hypothyroidism both are associated with hair shaft abnormalities.[2] Here, we report a case of an infant with congenital hypothyroidism who suffered diffuse hair loss due to levothyroxine overdose.

A 9-month-old female infant, born of non consanguineous marriage, presented to our hospital with partial neck holding and developmental delay. The infant weighed 6900 g (3rd-15th percentile) and was 67 cm long (3rd-15th percentile). Physical examination revealed lethargy, hoarseness, dry skin, depressed nasal bridge, and macroglossia [Figure 1]a and [Figure 1]b. The results of the laboratory tests were suggestive of congenital hypothyroidism (Total T3-25 ng/dL, total T4-0.01 μg/dL, TSH >150 μIU/dL). Ultrasonography of neck revealed agenesis of thyroid gland. Infant was started on levothyroxine 50 μg/day (7.24 μg/kg/day). Fifteen to twenty days after starting levothyroxine, infant's mother noticed diffuse loss of scalp hairs. On examination, infant had non-scarring alopecia involving around 50-60% of the scalp area [Figure 1]c [Figure 1]d [Figure 1]e. At this stage, serum T3 and T4 levels were quite high and TSH was suppressed (Serum free T3 = 6.13 pg/ml, free T4 = 2.74, TSH = 0.039 μIU/dL). Levothyroxine overdose was suspected as the cause of effluvium hence dose was reduced to 37.5 μg/day. Follow up after 45 days showed marked regrowth of hair [Figure 1]f and g] which was normal in texture and distribution while on levothyoxine maintenance dose. To conclude, levothyroxine overdose may lead to hair loss and should be watched for.
Figure 1: Clinical picture showing reversible scalp hair loss. (a and b) At the time of diagnosis, before starting thyroxine supplements. (c-e) 30 days after starting levothyroxine (50 μg/day). (f and h) 45 days after reducing levothyroxine dose

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There are no conflicts of interest.



 
   References Top

1.
Paus R, Cotsarelis G. The biology of hair follicles. N Engl J Med 1999;341:491-7.  Back to cited text no. 1
    
2.
Van Beek N, Bodó E, Kromminga A, Gáspár E, Meyer K, Zmijewski MA, et al. Thyroid hormones directly alter human hair follicle functions: Anagen prolongation and stimulation of both hair matrix keratinocyte proliferation and hair pigmentation. J Clin Endocrinol Metab 2008;93:4381-8.  Back to cited text no. 2
    


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