Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Methodol. Jun 20, 2026; 16(2): 111025
Published online Jun 20, 2026. doi: 10.5662/wjm.v16.i2.111025
Published online Jun 20, 2026. doi: 10.5662/wjm.v16.i2.111025
Clinical insights into levothyroxine overdose: A systematic review
Fateen Ata, Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44118, United States
Haseeb Ahmad Khan, Internal Medicine, The Rotherham NHS Foundation Trust, Yorkshire S60 2UD, United Kingdom
Aamna Kashif, Medicine, Faisalabad Medical University, Faisalabad 38000, Punjab, Pakistan
Adeel Ahmad Khan, Internal Medicine, Cleveland Clinic Akron General Hospital, Akron, OH 44301, United States
Rabia Fawad, Medicine, Niazi Medical and Dental college, Sargodha 40100, Punjab, Pakistan
Hafiz Waqas Younas, Emergency Medicine, NHS Stockport Foundation Trust, Manchester SK2 7JE, United Kingdom
Bilal Ahmed, Endocrinology, University Hospital of Coventry and Warwickshire, West Midlands CV2 2DX, United Kingdom
Huzaifa Javed, Internal Medicine, Griffin Health, Derby, CT 06418, United States
Co-first authors: Fateen Ata and Haseeb Ahmad Khan.
Author contributions: Ata F designed the research, supervised the project; Ata F, Khan HA, Kashif A, Khan AA, Fawad R, Younas HW, Ahmed B, Javed H did the literature review; Ata F, Khan HA, Younas HW screened articles; Khan HA, Younas HW, Javed H, Fawad R, and Ahmed B collected data; Ata F and Khan AA analyzed the data; Ata F, Khan HA, and Kashif A wrote the paper.
Conflict-of-interest statement: There is no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Fateen Ata, MD, Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44118, United States. docfateenata@gmail.com
Received: June 23, 2025
Revised: August 9, 2025
Accepted: November 11, 2025
Published online: June 20, 2026
Processing time: 306 Days and 20.6 Hours
Revised: August 9, 2025
Accepted: November 11, 2025
Published online: June 20, 2026
Processing time: 306 Days and 20.6 Hours
Core Tip
Core Tip: This systematic review presents the most comprehensive data synthesis on levothyroxine (LTX) overdose (OD) across all age groups. It highlights key clinical patterns that distinguish unintentional pediatric OD from intentional adult OD, with the latter exhibiting more prominent symptom severity. Despite wide dose variability, mortality was rare. Most cases were managed conservatively. Extracorporeal modalities were employed in cases that were severe and refractory. This systematic review highlights the need for treatment protocols and prevention strategies for LTX toxicity, providing valuable insights for clinicians managing thyroid hormone toxicity.