A case of masked toxic adenoma in a patient with non-thyroidal illness

BMC Endocrine Disorders

Ho-Cheol Kang¹  Hee Kyung Kim²  Jee Hee Yoon¹  Eun Ae Cho¹ 

[1] Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea;Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam 519-763, South Korea

关键词: Toxic adenoma;    Hyperthyroidism;    Non-thyroidal illness;    Thyroid;   

Others  :  1085398
DOI  :  10.1186/1472-6823-14-1

 received in 2013-04-23, accepted in 2013-12-30,  发布年份 2014

【 摘 要 】

Background

Non-thyroidal illness (NTI) refers to changes in thyroid hormone levels in critically ill patients in the absence of primary hypothalamic-pituitary-thyroid dysfunction, and these abnormalities usually resolve after clinical recovery. However, NTI can be accompanied by primary thyroid dysfunction. We report herein a case of a woman with NTI accompanied by primary hyperthyroidism.

Case presentation

A 52-year-old female was admitted to the intensive care unit with heart failure and atrial fibrillation. She had a longstanding thyroid nodule, and a thyroid function test revealed low levels of triiodothyronine and free thyroxine as well as undetectable thyroid stimulating hormone (TSH). She was diagnosed with NTI, and her TSH level began to recover but not completely at discharge. The thyroid function test was repeated after 42 months to reveal primary hyperthyroidism, and a thyroid scan confirmed a toxic nodule.

Conclusion

This case suggests that although NTI was diagnosed, primary hyperthyroidism should be considered as another possible diagnosis if TSH is undetectable. Thyroid function tests should be repeated after clinical recovery from acute illness.

【 授权许可】

   
2014 Cho et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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