Could past Atenolol overdoses cause long-term issues?

Question

Hello doctor,

I am asking about possible long-term systemic effects, especially autoimmune, neurological, and hormonal disorders, including hypothyroidism, that may be related to my history of repeated and significant Atenolol overdoses five to six years ago.

Relevant history of toxicity - five years ago:

Agent: Atenolol.
Exposure: Repeated, acute, concealed self-ingestions, estimated at about 1500 mg, which was about 10 to 20 tablets per episode per day, taken over five to six days within one month. At that time, I hid this and did not receive or take any treatment.
Acute symptoms (untreated): Profound bradycardia, excessive pulmonary secretions and mucus production, dizziness, anxiety, and severe fatigue.
Management: I did not seek any acute medical intervention or treatment for these overdose events.

Subsequent diagnoses (five to six years post-exposure)

Endocrine: I was diagnosed with primary hypothyroidism and was started on Levothyroxine 25 mcg.
Surgical history: I had surgical repair of bilateral inguinal hernias and hydrocele two months back.

I have hypothyroidism, and I also do not feel the urge to urinate. When I go to urinate, it passes without difficulty, but it feels incomplete.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Thank you for sharing your reports (attachments removed to protect the patient’s identity) and symptoms. I have reviewed your thyroid test results and medical history in detail.

1. Thyroid results:

Your blood tests show low T3 (triiodothyronine) and T4 (thyroxine) with a high normal TSH (thyroid-stimulating hormone), which confirms primary hypothyroidism. This can explain many of the symptoms you are experiencing, including fatigue, low energy, palpitations, reduced bladder sensation, and difficulty sensing when you need to urinate.

Your current dose of Levothyroxine 25 mcg is likely too low for full thyroid hormone replacement. You will need a dose adjustment. Try to increase Levothyroxine to 50 mcg one time a day, which can be done gradually. Thyroid levels should be rechecked after six weeks of any dose change.

2. Urinary symptoms:

Your reduced urge to urinate and feeling of incomplete emptying are commonly seen in untreated or undertreated hypothyroidism. As your thyroid levels normalize, these symptoms usually improve. If symptoms persist, we can arrange a bladder scan to check post-void residual volume.

Ultrasound abdomen findings:

Liver hemangioma: A benign finding. No treatment is needed.
Non-obstructing kidney stones: These are small and do not block the kidneys. Please keep well-hydrated.
Inguinal hernia: Your scan reflects what you had before surgery and is not related to your current symptoms.

Palpitations and physical symptoms: Your normal ECG (electrocardiogram) is reassuring. The episode you experienced during exertion is likely related to dehydration, fatigue, and thyroid imbalance. Once your thyroid levels stabilize, this should improve.

Please continue your medication as advised and follow up for dose adjustment and repeat thyroid tests. If any symptoms worsen, do let me know.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I understand your worries about whether your past Atenolol overdoses could have caused long-term neurological or autoimmune problems.

No evidence of long-term autoimmune or neurological damage from Atenolol overdose

Atenolol, even in high doses, does not cause delayed autoimmune diseases, hypothyroidism, neurological disorders, or ongoing organ damage years later.

Any symptoms from the overdose would occur immediately at the time of ingestion and would not cause chronic disease years later. Your current issues, including hypothyroidism, bladder sensations, fatigue, and sensitivity to sunlight, are not related to Atenolol toxicity.

Possible causes of your current symptoms are as follows:

Your symptoms, including red eyes, discomfort in sunlight, fatigue, and unusual sensations outdoors, can occur with:

Hypothyroidism that is not yet well controlled (underactive thyroid).
Allergic or dry eyes (ocular allergy or dry eye syndrome).
Vitamin D deficiency (cholecalciferol deficiency).
Anxiety or physiological sensitivity after being unwell (generalized anxiety disorder).
Post-hernia surgery recovery (after surgical repair of the hernia).

What you can do to rule out neurological or autoimmune conditions:

Basic screening includes vitamin B12 (cobalamin), vitamin D (cholecalciferol), HbA1c (glycated hemoglobin), TSH (thyroid-stimulating hormone), and free T4 (free thyroxine).
Neurological screening involves a simple neurological examination by a clinician (clinical neurological assessment). Vitamin B12 and thyroid correction alone usually resolve neurological-type sensations.
Autoimmune screening, only if symptoms suggest, includes ANA (antinuclear antibody), anti-TPO antibodies (thyroid peroxidase antibodies), and the anti-ENA panel (extractable nuclear antigen panel).

Most patients with your symptoms do not need MRI (magnetic resonance imaging) or advanced neurology tests unless you have true limb weakness (muscle weakness), loss of bowel or bladder control (urinary or fecal incontinence), vision loss (loss of eyesight), or persistent numbness or tingling (paresthesia).

What you should do now:

Continue thyroid treatment and recheck levels in six weeks (monitor thyroid hormone therapy). For your red eyes and sunlight sensitivity, consider lubricating eye drops (artificial tears), sunglasses in bright light, and hydration (adequate fluid intake). If symptoms persist or worsen, an eye examination is helpful to rule out allergic or dry eye conditions (ophthalmologic assessment).

Please feel free to share any new symptoms or questions. I am here to help.

Kindly follow up if you have more doubts.

Thank you.