Steven Snyder, MD; Marc Jaffe, MD
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Snyder S, Jaffe M. Thyrotoxicosis Insistiates: Report of 17 Cases. Ann Intern Med. 1997;127:88. doi: 10.7326/0003-4819-127-1-199707010-00020
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Published: Ann Intern Med. 1997;127(1):88.
TO THE EDITOR:
Although thyrotoxicosis secondary to the ingestion of excess thyroid hormone (thyrotoxicosis medicamentosa or thyrotoxicosis factitia) has been well documented , no previous reports have described patients who insist that their physician prescribe thyroid hormone replacement therapy (THRT) that results in consistently undetectable serum thyroid-stimulating hormone (TSH) levels (sensitivity of assay, 0.002 µU/mL).
We have found 17 patients with thyrotoxicosis insistiates (Latin for “thyrotoxicosis having been demanded or insisted”) followed by endocrinologists in our large health maintenance organization. Most of the patients began receiving THRT by fee-for-service physicians in the early 1970s before joining our health maintenance organization. All of these patients insist that their symptoms of fatigue or depression or their weights (or both) should govern the dosage of THRT (L-thyroxine dosage ranged from 175 to 700 micro g/d for 13 patients, and thyroid extract dose ranged from 3 to 7 grains for 4 patients) and that consistently undetectable serum TSH levels should be ignored, even in the face of osteoporosis or atrial tachyarrhythmia. Any physician who attempts to modify the dosage of THRT is summarily dismissed by the patient.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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