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Factitious hyperthyroidism

Factitious thyrotoxicosis; Thyrotoxicosis factitia; Thyrotoxicosis medicamentosa

 

Factitious hyperthyroidism is higher-than-normal thyroid hormone levels in the blood that occur from taking too much thyroid hormone medicine.

Causes

 

The thyroid gland produces the hormones thyroxine (T4) and triiodothyronine (T3). In most cases of hyperthyroidism, the thyroid gland itself produces too much of these hormones.

Hyperthyroidism can also be caused by taking too much thyroid hormone medicine for hypothyroidism. This is called factitious hyperthyroidism. When this occurs because the prescribed dosage of hormone medicine is too high, it is called iatrogenic, or doctor-induced, hyperthyroidism.

Factitious hyperthyroidism can also occur when someone takes too much thyroid hormone on purpose. These may be people:

  • Who have mental disorders such as Munchausen syndrome
  • Who are trying to lose weight
  • Who want to get money from the insurance company

Children may take thyroid hormone pills accidentally.

In rare cases, factitious hyperthyroidism is caused by eating meat that has thyroid gland tissue in it.

 

Symptoms

 

The symptoms of factitious hyperthyroidism are the same as those of hyperthyroidism caused by a thyroid gland disorder, except that:

  • There is no goiter. The thyroid gland is often small.
  • The eyes do not bulge, as they do in Graves disease (the most common type of hyperthyroidism).
  • The skin over the shins does not thicken, as it sometimes does in people who have Graves disease.

 

Exams and Tests

 

Blood tests used to diagnose factitious hyperthyroidism include:

  • Free T4
  • Radioactive iodine uptake
  • Thyroglobulin
  • Total T3
  • Total T4
  • TSH

 

Treatment

 

Your health care provider will tell you to stop taking thyroid hormone. If you need to take it, your provider will reduce the dosage.

You should be re-checked in 2 to 4 weeks to be sure that the signs and symptoms are gone. This also helps to confirm the diagnosis.

People with Munchausen syndrome will need mental health treatment and follow-up.

 

Outlook (Prognosis)

 

Factitious hyperthyroidism will clear up on its own when you stop taking or lower the dosage of thyroid hormone.

 

Possible Complications

 

When factitious hyperthyroidism lasts a long time, the same complications as untreated or improperly treated hyperthyroidism may develop:

  • Abnormal heartbeat (atrial fibrillation)
  • Chest pain (angina)
  • Heart attack
  • Loss of bone mass (if severe, osteoporosis)
  • Weight loss

 

When to Contact a Medical Professional

 

Contact your provider if you have symptoms of hyperthyroidism.

 

Prevention

 

Thyroid hormone should be taken only by prescription and under the supervision of a provider.

 

 

References

Davies TF, Laurberg P, Bahn RS. Hyperthyroid disorders. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 12.

Kopp P. Autonomously functioning thyroid nodules and other causes of thyrotoxicosis. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 85.

 
  • Thyroid gland

    Thyroid gland - illustration

    The thyroid gland, a part of the endocrine (hormone) system, plays a major role in regulating the body's metabolism.

    Thyroid gland

    illustration

    • Thyroid gland

      Thyroid gland - illustration

      The thyroid gland, a part of the endocrine (hormone) system, plays a major role in regulating the body's metabolism.

      Thyroid gland

      illustration

    Tests for Factitious hyperthyroidism

     

       

      Review Date: 5/20/2016

      Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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