Symptomatic Hyperthyroidism in a Patient Taking the Dietary Supplement Tiratricol

An 87-year-old woman was referred for evaluation of nervousness, tremor, insomnia, and fatigue of 2 months' duration. Initial laboratory evaluation revealed a suppressed thyrotropin level and an elevated triiodothyronine level. A review of her medications revealed that she had started taking se...

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Bibliographic Details
Published in:Mayo Clinic proceedings 2002-06, Vol.77 (6), p.587-590
Main Authors: Bauer, Brent A., Elkin, Peter L., Erickson, Dana, Klee, George G., Brennan, Michael D.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anxiety - chemically induced
Biological and medical sciences
Dietary Supplements - adverse effects
Endocrinopathies
Fatigue - chemically induced
Female
Humans
Hyperthyroidism - chemically induced
Hyperthyroidism - diagnosis
Medical History Taking
Medical sciences
Non tumoral diseases. Target tissue resistance. Benign neoplasms
Sleep Initiation and Maintenance Disorders - chemically induced
Thyroid. Thyroid axis (diseases)
Thyrotropin - drug effects
Tremor - chemically induced
Triiodothyronine - administration & dosage
Triiodothyronine - adverse effects
Triiodothyronine - analogs & derivatives
Triiodothyronine - drug effects
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Summary:An 87-year-old woman was referred for evaluation of nervousness, tremor, insomnia, and fatigue of 2 months' duration. Initial laboratory evaluation revealed a suppressed thyrotropin level and an elevated triiodothyronine level. A review of her medications revealed that she had started taking several dietary supplements at the recommendation of her chiropractor before the onset of symptoms. One of these was tiratricol (3,5,3′-triiodothyroacetic acid or Triac), a substance sold as a dietary supplement despite classification as a drug by the Food and Drug Administration. Tiratricol has weak thyromimetic effects, can inhibit pituitary thyrotropin secretion, and in higher doses can significantly stimulate metabolism. Such was the case with this patient who presented with signs, symptoms, and biochemical evidence of hyperthyroidism that promptly resolved after discontinuation of tiratricol therapy. To our knowledge, this is the first reported case of documented thyrotoxicosis secondary to tiratricol use. Because tiratricol is still available for sale on several Internet sites, this case emphasizes the importance of inquiring about the use of dietary supplements in all patients. The availability of such products on the Internet increases the already complex task of monitoring patients' use of dietary supplements.
ISSN:0025-6196
1942-5546
DOI:10.4065/77.6.587