Transgender Health Alert
Please share this information widely, via email and at events
November 19, 2007
Contact: Minnesota Transgender Health Coalition
<http://www.mntransh
ealth.org/>www.mntranshealth. org
612-823-1152
<mailto:mntranshealth@
yahoo.com>mntranshealth@
yahoo.comA sudden, unexpected death of a trans woman has
recently come to our attention in the Twin Cities.
It seems that the death was the result of
thallium (heavy metal) poisoning, and we suspect
that she was taking some kind of herbal
supplement from overseas for hair loss that may have contained thallium.
Due to medical privacy rules, it is difficult to
obtain more information. We don't know the name
of the supplement, and we think it was in pill
form, but it may have been topical.
If you have any further information about this
supplement or other similar cases, please contact us.
If you think you may be having some of the
symptoms described below, contact a doctor
immediately and ask to be tested for thallium
poisoning and share this information with
them. Thallium poisoning is often misdiagnosed;
please read below for symptoms and other information.
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Table of Contents
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1. Overview
2. Details about Thallium
3. Symptoms in Detail
4. Causes
5. General Safety Tips for Online and Non-Prescription Medication Purchases
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1. Overview
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Thallium is colorless, odorless and
tasteless. It can be absorbed by oral ingestion
in pill form or directly though the skin as in a salve or lotion.
The lethal dose of this substance is extremely
small! Example: for a 175lb (79Kg) human the
dose would be 1.2 grams (.04 oz.). Remember this
can be swallowed, inhaled or absorbed though the skin.
Initial symptoms of acute (sudden) thallium
poisoning are gastrointestinal. These happen in
the first 3-4 hours and will be characterized by
increasingly severe abdominal pain, nausea,
vomiting and diarrhea or constipation.
Thallium poisoning also results in symptoms that
are neurologic and can occur 3-5 days after
exposure. They include: pain and changes in
sensation in the hands and feet (especially pain
and numbness in the soles of the feet). This can
also include loss of coordination and unnatural
movements on the hands and feet.
During the second to third week, confusion and
personality changes can begin and rapid loss of
hair (alopecia) on scalp and body will
occur. (For a more detailed listing of symptoms, see below.)
Thallium poisoning can be treated if caught
early, so if you believe you have some or all of
these symptoms, see a doctor immediately –
especially if you have recently taken a
non-prescribed medication for hair loss or any
internet obtained medications from overseas. Be
sure to tell the doctor what you've taken, and
ask to be tested for thallium poisoning.
Remember, the only known safe method for facial
and body hair removal is laser and
electrolysis. Overseas herbal medications are to
be particularly suspect, since some herbal
remedies in the past have been found contaminated with thallium!
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2. Details about Thallium
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Source of information listed in sections 2-4 is eMedicine from WebMD
Website:
<http://www.emedicin
e.com/emerg/ topic926. htm>
http://www.emedicine.com/emerg/ topic926. htm
Thallium Toxicity
Author: Wendy R Regal, MD, Clinical Instructor, Department of Emergency
Medicine, Synergy Medical Education Alliance, Michigan State University
Key points:
Thallium is colorless, odorless, and tasteless.
Thallium was once used as a therapeutic
agent to treat syphilis, gonorrhea, tuberculosis,
and ringworm, and it was also used as a
depilatory for excess hair. However, reports of
poisoning and death were noted, and these uses have been discontinued.
Thallium was successfully used in killing
rodents but was banned in the United States in
1965 after multiple unintentional poisonings.
Thallium poisoning may occur via oral
ingestion, inhalation of contaminated dust, or dermal absorption.
The lethal dose of thallium is
approximately 15-20 mg/kg; however, significant
toxicity and death may occur with smaller amounts.
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3. Symptoms in Detail
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The clinical presentation of thallium toxicity
can vary depending on the type, severity, and
timeframe of the exposure. Acute thallium
poisoning is primarily characterized by
gastrointestinal symptoms, while neurologic
findings predominate with chronic exposure. The
neurologic manifestations tend to progress, even
despite decreasing blood thallium levels.
Thallium toxicity is characterized by a painful
ascending peripheral neuropathy and alopecia;
this clinical manifestation presents2-3 weeks after an acute poisoning.
Gastrointestinal symptoms: These symptoms
predominate early, usually within the first 3-4
hours, and the most common symptom is severe,
paroxysmal abdominal pain. Nausea, vomiting,
constipation, and diarrhea are reported. The
vomitus and stools are often bloody.
Neurologic symptoms: These symptoms
usually appear 2-5 days postexposure and include
severely painful, rapidly progressive, ascending
peripheral neuropathies. Pain and paresthesias of
the hands and the lower extremities, especially
the soles of the feet, also predominate. Distal
motor weakness occurs, with the lower limbs more
affected than the upper limbs. Ataxia, tremor,
athetosis, cranial nerve palsies, headache,
seizures, insomnia, coma, and death may also occur.
Neuropsychological manifestations may
include anxiety, confusion, delirium,
hallucinations, and psychosis. Acute agitation
and aggression, personality changes, depression,
apathy, and confabulation have been observed in
both adults and children. Psychosis and
associated symptoms can occur with or without a psychiatric history.
Ocular symptoms: Diplopia, abnormal color
vision, and impairment of visual acuity may
develop. Other manifestations may include loss of
the lateral half of the eyebrows, skin lesions on
the lids, ptosis, seventh nerve palsy, internal
and external ophthalmoplegia, and
nystagmus. Noninflammatory keratitis, lens
opacities, and optic atrophy due to toxic optic neuropathy also may occur.
Dermatologic symptoms: The first
cutaneous signs are not specific and include
scaling of the palms and soles and acne like
lesions of the face. During week 2-3, a sudden
onset of hair loss quickly progresses to diffuse
alopecia. The hair loss primarily affects the
scalp, temporal parts of the eyebrows, the
eyelashes, and the limbs. Less often, the
axillary regions are affected. One month after
the poisoning, Mees lines (transverse white lines
on the nails) appear in the nail plate. Other
dermatologic findings include crusted eczematous
lesions, hypohidrosis, anhidrosis, palmar
erythema, painful glossitis with redness of the
tip of the tongue, stomatitis, and hair discoloration.
Pulmonary symptoms: Some patients can
experience pleuritic chest pain or tightness upon
exposure. The mechanism for this particular symptom is unclear.
Early skin findings include scaling
of the palms and soles and acnelike lesions of
the face. Scalp alopecia, which is one of the
most characteristic manifestations of thallium
toxicity and is related to atrophy of the hair
follicles, usually occurs 10-21 days
postexposure. In addition to the scalp, hair loss
also occurs in the lateral eyebrows, the
eyelashes, the limbs, and occasionally the axillary regions.
Approximately 1 month after thallium
exposure, Mees lines (transverse white lines on
the nails) appear in the nail plate.
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4. Causes
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Thallium is still commonly used as a
rodenticide and insecticide in other countries
resulting in severe unintentional poisoning.
Thallium has been used as a pesticide in
other countries, such as Africa, causing
poisoning through contaminated foods. It has been
discovered as a contaminant in some Chinese herbal medications.
According to the 2002 American
Association of Poison Control Centers Annual
Report for toxic exposures, unintentional
thallium poisoning accounts for the majority of
reported cases. However, homicide and suicide
represent a significant percentage of cases in the United States.
Because chronic thallium exposure mimics
other disease, many cases of industrial thallium
exposure most likely go unnoticed. On the other
hand, accidental poisoning caused by direct
contact with and careless handling of
thallium-containing materials occurs more frequently.
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5. General Safety Tips for Online and Non-Prescription Medication Purchases
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It is extremely important to be informed about
any substance you purchase for the purposes of
treating or preventing a medical condition. It
is also important to be vigilant in researching
any product(s) you intend to use for the purposes
of facilitating a gender transition. While US
pharmacies are subject to local and federal laws,
online pharmacies can bypass this regulatory step with greater ease.
What does this mean for you?
It means that products purchased online are not
always what they appear to be.
Online purchases can sometimes result in products
which are: counterfeit, too strong/weak, are
expired, aren't labeled, stored or shipped
correctly, may severely interact with your other
medications, and may not have been approved by the FDA.
In addition, while many are aware that oral and
injectable products can be dangerous topical
(placed on the skin) medications can be just as hazardous.
What can you do? According to the FDA (
http://www.fda. gov/buyonline/ ), the best way to
prevent unsafe purchases is to look for websites
with practices that protect you. A safe website should:
1. be located in the United States and licensed
by the state board of pharmacy where the website
is operating (check
<http://www.nabp. info>www.nabp.info for a list of state boards of pharmacy)
2. have a licensed pharmacist to answer your questions
3. require a prescription from your doctor or
other health care professional who is licensed in
the United States to write prescriptions for medicine
4. have a way for you to talk to a person if you have problems
In addition to the above:
1. Inform all of your health care providers about
any new products you may be taking. This
includes prescription and non-prescription
products, herbal and vitamin supplements, topical
and oral/intravenous products. The more
information your health care providers have, the
less chance you have of experiencing a dangerous medication side-effect.
2. Report any and all suspicious prescription
websites to the FDA at
<http://www.fda. gov/buyonline>www.fda.gov/ buyonline
under "Notify FDA about problem websites".
