Evidence mapPaperPMID 41732503Full record

ArticleJournal of diabetes and metabolic disorders2026

Intentional co-ingestion of levothyroxine and insulin in a teenager.

Sarah El Yaman, Kathryn Swaby, Jeffrey N Bernstein, Janine E Sanchez

Abstract readCase Reports
In one paragraph

Article in Journal of diabetes and metabolic disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Sarah El YamanDepartment of Pediatric Endocrinology, University of Miami/Jackson Health System, Miami, FL USA.ORCID 0000-0003-4656-1287
Kathryn SwabyDepartment of Pediatric Critical Care Medicine, University of Miami/Jackson Health System, FL Miami, USA.ORCID 0009-0004-4722-704X
Jeffrey N BernsteinDepartment of Emergency Medicine, Medical Toxicology, University of Miami/Jackson Health System, Miami, FL USA.ORCID 0000-0002-9562-980X
Janine E SanchezDepartment of Pediatric Endocrinology, University of Miami/Jackson Health System, Miami, FL USA.ORCID 0000-0003-3790-6140

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Purpose: To report a case of polydrug ingestion involving levothyroxine and insulin in an adolescent, demonstrating potential protective effects of insulin co-ingestion against symptomatic thyrotoxicosis. Methods: A 14-year-old female with type 1 diabetes and Hashimoto thyroiditis presented following intentional ingestion of 6.75 milligrams levothyroxine, 60 units insulin aspart, and 80 units insulin degludec. Laboratory studies revealed severe biochemical thyrotoxicosis with free thyroxine greater than 7.77 nanograms per deciliter and total triiodothyronine 220.5 nanograms per deciliter. She required glucose infusion at 2.3 to 3.7 milligrams per kilogram per minute to maintain normoglycemia, with hypoglycemic episodes lasting up to 17 h post-ingestion. Throughout her 12-day admission, she maintained normal vital signs with no clinical evidence of sympathetic overactivity despite prolonged biochemical thyrotoxicosis. Conclusions: Co-ingestion of insulin and levothyroxine appears to minimize symptomatic thyrotoxicosis risk, potentially through inhibition of thyroxine to triiodothyronine conversion and glucose homeostasis maintenance. This case highlights complex interactions in polydrug ingestions and suggests insulin may provide protection against thyroid storm in mixed overdoses.

Indexed as

AdolescentInsulinLevothyroxineOverdoseThyrotoxicosis

Identifiers

PMID41732503
PMCPMC12924816

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.