|LETTERS TO THE EDITOR
|Year : 2019 | Volume
| Issue : 6 | Page : 652-653
Reversible hair loss due to levothyroxine overdose
Chaitanya Yerawar1, Prerana G Deokar2, Bhaskar Noone3
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 Publication||20-Jan-2020|
Dr Chaitanyafs DTH Superspeciality Clinic, Doctors Lane, Nanded - 431 601, Maharashtra
Source of Support: None, Conflict of Interest: None
|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
Thyroid hormones along with estrogen, glucocorticoid, retinoids, prolactin, and growth hormone modulate hair growth. Hyperthyroidism and hypothyroidism both are associated with hair shaft abnormalities. 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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