CASE 5 EDUCATIONAL OBJECTIVES

1. What is the level of thyroid function in this patient? Are additional diagnostic tests necessary to define the level of thyroid function and if so which one(s)?

Hyperthyroid, rule out euthyroid.
Yes, TSH.

2. What is the most likely cause of this patient's illness, giving reasons for your conclusion?

Self-induced thyrotoxicosis, struma ovarii (much less likely).
Thyroid uptake which should show low to no uptake in the neck and in struma ovarii, high uptake in one side of the pelvis.
No.

3. What tests are necessary to confirm its cause? Are antithyroid antibodies helpful?

4. What are the treatment options?

Find out underlying reason for hidden self-treatment with l-T4 (prevent weight gain, energy maintenance, attention seeking) and address this with patient.