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Background: Limited data exist regarding safety and efficacy of levothyroxine given intramuscularly. Methods: To report a patient with thyroid cancer invading the trachea, with subsequent tracheostomy, gastrostomy tube feeding, and subtotal thyroidectomy complicated by severe hypoparathyroidism. All previous cases in the literature who received intramuscular levothyroxine were also described. Results: In our patient, levothyroxine administration in gastrostomy tube failed to suppress thyrotropin stimulating factor (TSH) levels, most likely due to concomitant administration of calcium and food constituents. Patient’s thyroid function stabilized few days after switching from enteral to intramuscular levothyroxine in a maintenance dose of 200 mcg daily. Review of literature reveals 7 patients who were treated with intramuscular levothyroxine, mostly once a week. Main causes of treatment with intramuscular thyroxine were non-compliance and gastrointestinal (GI) malabsorption. Adverse effects reported were transient tachycardia in one patient and self-limited left side weakness in another patient. Conclusions: Available data suggest that intramuscular administration of levothyroxine is effective, generally safe, and could be a viable alternative to oral levothyroxine in non-compliant patients or those with GI malabsorption. *Correspondence to: Nasser Mikhail, Department of Medicine, OliveViewUCLA Medical Center, Sylmar, CA 91342, USA, E-mail: nmikhail@dhs. lacounty.gov

Levothyroxine intramuscular administration-Case report and Review of literature