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].