Low Serum Thyroglobulin as a Clue to the Diagnosis of Thyrotoxicosis Factitia
Abstract
SURREPTITIOUS ingestion of thyroid hormones may be responsible for thyrotoxicosis (thyrotoxicosis factitia). Identification of this condition often presents a difficult diagnostic challenge, since thyrotoxicosis factitia may be confused with other types of thyrotoxicosis associated with low radioiodine uptake.1 , 2 Serum thyroglobulin levels are elevated in many varieties of hyperthyroidism.3 4 5 6 7 8 Recently, some authors1 , 2 , 9 have suggested that low rather than elevated concentrations of circulating thyroglobulin in hyperthyroid patients may indicate the presence of thyrotoxicosis factitia.We have evaluated serum thyroglobulin levels in six patients with thyrotoxicosis factitia. In all cases serum thyroglobulin was undetectable by a sensitive immunoradiometric assay. Serial measurements in two . . .
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If not elucidated by the history, factitious ingestion of thyroid hormone can be distinguished from other causes of thyrotoxicosis by a low serum thyroglobulin level, a near-zero RAIU, and a T3 to T4 ratio (ng/lg) <20 if due to exogenous levothyroxine.
“If not elucidated by the history, factitious ingestion of thyroid hormone can be distinguished from other causes of thyrotoxicosis by a low serum thyroglobulin level, a near-zero RAIU, and a T 3 to T 4 ratio (ng/lg) <20 if due to exogenous levothyroxine (53).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [53]
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References 15 · Cited by 155
- Authors
- Mariotti, S., Martino, E., Cupini, C., Lari, R., Giani, C., Baschieri, L., & Pinchera, A.
- Affiliations
- University of Pisa (IT)
- ORCID
- Mariotti, Stefano
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1982-08-12
- Volume
- 307
- Issue
- 7
- Pages
- 410-412
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2026712661
- Cited by
- 155
- References
- 15
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 4 · 2020: 1 · 2019: 2 · 2018: 3 · 2017: 5 · 2016: 5 · 2015: 5 · 2014: 1 · 2013: 3 · 2012: 6
- FWCI
- 7.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- UNICA IRIS Institutional Research Information System (University of Cagliari) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Keywords
- thyrotoxicosis factitia, serum thyroglobulin, hyperthyroidism, radioiodine uptake
- MeSH terms
- Adult, Diagnosis, Differential, Factitious Disorders, Female, Humans, Hyperthyroidism, Middle Aged, Self Medication, Thyroglobulin, Thyroid Function Tests, Thyroid Hormones
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