Endocrine Abstracts

A 60 year old nurse presented to the emergency department with palpitations, itchy skin, shortness of breath, diarrhoea, insomnia, weight loss and feeling hot /clammy. She felt her symptoms were in keeping with the menopause although she had been amenorrhoeic for six years. Thyroid function tests revealed fT4 73 pmol/land TSH <0.01 mIU/lhaving been normal six months previously. She was started on carbimazole 40 mg/day and was seen urgently in clinic. She reported to feeling unwell for the past few years and had taken Spirulina, krill oil, Ashwaganda,’Iodine’, Probiotics, Vitamin D, Vitamin K and magnesium. At clinic she was clinically thyrotoxic with fT4 >100 pmol/l. TRAB and TPO Abs were negative. Carbimazole was titrated to 80 mg/day with ongoing urgent review. Ultrasound showed a normal appearance. An iodine uptake scan demonstrated very low uptake at 0.1% (n= 6-18%). On further questioning she reported taking Lugol’s iodine, ‘a few drops every so often’ from a bottle that her daughter had purchased from Amazon. The duration of ingestion was about six months. She was initially sceptical of stopping her supplements but agreed to do so and carbimazole was reduced to stop. Repeat function tests off all treatment and supplements normalised with fT4 12.1 pmol/land TSH 3.18 mIU/l. While Ashwaganda is an evergreen shrub thought not to contain iodine, the supplements Spirulina (blue-green algae) and Krill oil (derived from crustaceans) are thought to do so. The most problematic supplement however is Lugol’s iodine which is a mixture of iodine and potassium iodide. Amazon sells 2-5% solution preparations. For example the 5% solution contains 6.3 mg per concentrated drop whilst daily requirements are ~ 150mg/day. The case illustrates the challenges of the self-help movement and the Amazon world in the peri -Covid era.