L-carnitine treatment in a seriously ill cancer patient with severe hyperthyroidism.

Abstract

OBJECTIVE:

To report a case of vaccine-induced Graves' disease successfully managed with L-carnitine and propranolol and without antithyroid drugs (ATDs). ATDs sometimes need to be used at low doses or can be contraindicated/refused. One of the ancillary compounds available is L-carnitine. L-carnitine is a naturally occurring quaternary amine, which acts by impairing thyroid hormone access to the cell nucleus.

REPORT:

A 32-year-old Chinese woman with a synovial sarcoma received radiotherapy, chemotherapy and experimental immunotherapy. Two months after the start of immunotherapy, she developed autoimmune hyperthyroidism [thyroid-stimulating immunoglobulins (TSI)=152%, normal values <140]. Left untreated, hyperthyroidism worsened (TSI=248%), so that for 3 months she took L-carnitine (1-4 g/d) and propranolol (20-80 mg/d). Though the hyperthyroidism worsened biochemically (FT4>50 pg/ml, FT3>20 pg/ml, TSI=501%), it was tolerated very well clinically. Fearing a life-threatening thyroid storm, she agreed to have, while still hyperthyroid, total thyroidectomy. The operation was uneventful.

CONCLUSIONS:

This case expands previous observations involving two more patients who survived thyroid storms while being treated with L-carnitine (combined with low doses of ATD). Taking also into account that tissue concentrations of L-carnitine decrease in hyperthyroidism, there is room for wide therapeutic use of L-carnitine in several hyperthyroidism settings.

• Authors: Rene Chee, Ravin Agah, Roberto Vita, Salvatore Benvenga
• Journal: Hormones (Athens, Greece) (Hormones (Athens)) 2014 Jul-Sep Vol. 13 Issue 3 Pg. 407-12 ISSN: 2520-8721 [Electronic] Switzerland
• PMID: 25079466 (Publication Type: Case Reports, Journal Article)

Chemical References

• Cancer Vaccines
• Carnitine

Topics

• Adult
• Cancer Vaccines (adverse effects)
• Carnitine (therapeutic use)
• Female
• Graves Disease (blood, chemically induced, diagnosis, drug therapy, immunology)
• Humans
• Sarcoma, Synovial (diagnosis, immunology, therapy)
• Severity of Illness Index
• Skull Neoplasms (diagnosis, immunology, therapy)
• Thyroidectomy
• Time Factors
• Treatment Outcome