Case report:
A 43-year-old female patient referred from gynecology department to control her hyperthyroidism as she was scheduled for hysterectomy due to large multiple uterine fibroids, she reported to have type 2 diabetes mellitus over the last six years and has been on metformin 1 gm twice daily and liraglutide 1.8 mg once daily, she was also diagnosed to have hyperthyroidism over the last five years and was on carbimazole 80 mg daily. Clinically she looks very thin and emaciated with BMI of 17, no exophthalmos and no goiter, with unremarkable systemic examination. After reviewing her file we found that she underwent multiple plastic surgeries of her breast and abdomen (mammoplasty, abdominoplasty and liposuction), and she has also undergone gastric balloon followed by sleeve gastrectomy to reduce her weight as she was obese six years back with a BMI of 31, we have found that her TSH was suppressed all the times over the last five years although she claimed taking her carbimazole regularly, Thyroid radioactive iodine uptake (RAIU) scan done twice showed low uptake favoring a diagnosis of thyroiditis, in addition to this her diabetes history was inconsistent with her investigations, serial glucose and HB A1c results all were normal even before starting the anti-diabetic medications. we have also noticed that some vital imaging and tests were missing like thyroid ultrasound, serum thyroglobulin and thyroid receptor antibody. After thorough investigations [Table1] and imaging, we excluded diabetes and hyperthyroidism and a diagnosis of thyrotoxicosis factitia was considered and the patient was confronted and eventually confessed that she is taking dietary supplement containing levothyroxine and liraglutide since long time to reduce weight and she is still not happy with her weight and was eager to lose more.
Ultrasound Thyroid: was normal and no significant pathology. Repeated blood investigation after two months showed significant improvement [Table 2].