Factitious Hyperthyroidism - A Diagnostic Challenge: Case Report

Abstract

Thyrotoxicosis factitia is not very uncommon but most often underestimated in the developing world. There are considerable chance of it being underdiagnosed or missed in our routine clinical practice which can have deleterious effects on patients and leads to significant patient morbidity apart from putting burden on health-care resources. It’s a condition which arises from the long term ingestion of thyroid hormones most often in those individuals who have psychological issues, for cosmetic reasons or accidental ingestion of high quantity of thyroid hormones, which has been especially seen in medical personnel who have easy access to thyroid hormones. Most of the times the patients deny the fact that they are taking thyroid hormones despite being aware of it. Hereby our team report a case of thyrotoxicosis factitia masquerading as refractory thyrotoxicosis in a young female patient diagnosed to have uncontrolled hyperthyroidism for more than five years on high dose methimazole despite the fact that her thyroid radioactive iodine uptake repeated twice showed very low uptake and was in favor of thyroiditis. A high index of clinical suspicion led to a detailed history and review of her file which eventually led us to the diagnosis of factitial hyperthyroidism.