Presumed levothyroxine-induced pseudotumor cerebri in a pediatric patient being treated for congenital hypothyroidism

Abstract

Papilledema is considered a neuro-ophthalmic emergency because of its capacity to induce irreversible end-organ damage and the often grave nature of its precipitating factor. Even more concern is warranted when papilledema presents in a pediatric setting. After excluded the contributions of intracranial masses, congenital malformations, ischemic insults and acute infections, the investigation must focus on determining the contributions of other uncharacteristic causes of pediatric pseudotumor cerebri. Pediatric pseudotumor cerebri is a rare clinical entity which shares few commonalities to the adult condition in regards to its predicating factors or symptoms. Without adequate medical history questioning, funduscopic evaluation and ancillary testing, the possibility of an erroneous diagnosis is plausible. This case report aims to disclose the toxic role levothyroxine sodium tablets (Synthroid((R)), Abbott Laboratories, Abbott Park, IL, USA) played in inducing pseudotumor cerebri in a pediatric patient being treated for congenital hypothyroidism.

Keywords: Synthroid®; hypothyroidism; levothyroxine; papilledema; pseudotumor cerebri.

Figure 1

Funduscopic images of non-hemorrhagic, elevated, and edematous optic nerves noted in the right (1-A) and left (1-B) eyes of our patient. No spontaneous venous pulsations were detected at initial examination.