From Oral Levothyroxine Resistance To Intravenous Levothyroxine Hypersensitivity: A Challenging Primary Hypothyroidism Case

    January 2026 in “ JCEM Case Reports ”
    Ahmet Kürşat Soyer, Didem Ozdemir, Aslı Altınbezer, Koray Demirel, İclal Hocanlı, Oya Topaloğlu, Reyhan Ersoy, Bekir Çakır
    TLDR A woman with hypothyroidism developed an allergy to IV levothyroxine after being resistant to oral forms.
    A 51-year-old woman with primary hypothyroidism, unresponsive to oral levothyroxine (LT4) and experiencing hair loss among other symptoms, developed an allergic reaction to intravenous (IV) LT4. Despite being euthyroid for 12 years on oral LT4, she became resistant to treatment, and alternative formulations and adjunctive therapies failed. An allergic reaction to liquid LT4 and anaphylaxis during the first IV infusion were managed with emergency treatment and a desensitization protocol. The patient eventually tolerated the IV treatment with a simplified protocol and reduced premedication. This case highlights the potential for allergic reactions to IV LT4 in patients with previous allergies to other forms of the drug.
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