Case report

A 39 year old male, with no past medical history arrived to A&E by ambulance with out of hospital VF cardiac arrest. CPR was started immediately by the patient’s partner, paramedics delivered DC shock on scene 10 minutes after the arrest. Sinus rhythm was established with the return of cardiac output. On examination:

• GCS 6 E1, V1, M4,

• Pupils 3 mm bilaterally and not reacting to light.

• HR 110 BPM, regular, good volume

• BP 120/78

• RR 10/minute

• Temp 35.8C

• BM 12.6

• ECG: Sinus rhythm, no other abnormality

After initial treatment collateral history from partner revealed that the patient had been taking slimming tablets (which had been purchased over the internet) over the last 12 days. Further questioning of the family revealed the tablets were Liothyronine 25micrograms and the patient was taking up to 4 tablets a day over a period of 1 week.

The patient was intubated and admitted to intensive care unit for supportive treatment, further investigations showed:

• ECHO: normal

• CT head: Normal

• CT angiogram: Normal

• Thyroid Function Test: Elevated levels of T3 and T4 with low TSH levels.

Patient’s ETT removed one week after admission to ITU. Patient continued to have sinus tachycardia which was treated with B-Blocker.

Unfortunately major neurological deficits and cognitive impairment resulted from the cardiac arrest due to hypoxic brain injury.

The patient was transferred to neurological rehabilitation unit after being stabilised on ITU. He has regained most of his neurological functions and able to walk and communicate however her cognitive rehabilitation is still ongoing.

Discussion

Taking slimming tablets without prescription or knowing their active ingredient is a rising challenge to Acute Care Physicians. In this case the patient took Liothyronine which is being advertised as T3 and the Clenbuterol stack (cycle) is probably the most effective weight loss program. (1)

T3 is 4 times more active than the more abundant T4. The half-life of T4 is 5-7 days; the half-life of T3 is only 1 day. (2)

Cardiac arrhythmias are a recognised complication of thyroid hormones treatment, but major adverse outcomes are very rarely reported. None is reported in the UK and overall 3 major adverse outcomes in the USA 2008. (3)

This case report is written to highlight the possibility of an increase in number of people purchasing online slimming tablets. One example is Liothyronine. This needs to be kept in mind when a normally fit and healthy patient presenting with cardiac arrest without obvious medical problems or predisposing factors arrives in A&E. This case report raises the awareness of this modern day phenomena among Acute Care Physicians.