Factitious hyperthyroidism happens when someone purposely takes too much thyroid medication for reasons like losing weight or attracting medical attention.

Hyperthyroidism is a genuine medical condition resulting from an excess production of thyroid hormones by the thyroid gland. However, the misuse of thyroid medication can mimic the symptoms of hyperthyroidism, causing a false appearance of the condition called factitious hyperthyroidism.

It’s important for medical practitioners to be able to distinguish between true hyperthyroidism and cases induced by medication misuse. Accurate diagnosis is crucial for providing appropriate treatment.

Factitious hyperthyroidism, also known as factitious thyrotoxicosis, is a condition where an individual intentionally and secretly takes excessive amounts of thyroid hormone medication to induce the symptoms of hyperthyroidism.

The reasons for factitious hyperthyroidism can vary and may include a desire to lose weight, attract medical attention, or meet other personal goals.

It’s frequently seen in cases of Munchausen syndrome or among athletes and bodybuilders aiming to manage weight and fat loss. It’s often concealed and goes undiagnosed, leading to various health risks.

Symptoms of factitious hyperthyroidism mimic hyperthyroidism but without common signs like goiter or eye bulging found in Graves’ disease.

Too much thyroid hormone intake can result in serious complications, such as cardiac issues and even death.

Factitious hyperthyroidism vs. hyperthyroidism

Hyperthyroidism is a genuine medical condition where the thyroid gland produces an excessive amount of thyroid hormones (thyroxine and triiodothyronine).

It typically results from underlying thyroid disorders, the most common of which is Graves’ disease. But it can also be caused by thyroid nodules or inflammation of the thyroid gland (thyroiditis).

Factitious hyperthyroidism is a nonmedical, artificial condition where an individual intentionally manipulates thyroid function tests or takes too much thyroid hormone medication to mimic the symptoms of hyperthyroidism.

Factitious hyperthyroidism can lead to symptoms similar to those of genuine hyperthyroidism, including:

  • rapid heartbeat (tachycardia)
  • nervousness and anxiety
  • unexplained weight loss
  • tremors or shakiness
  • increased appetite
  • sweating excessively
  • heat intolerance
  • fatigue
  • diarrhea or frequent bowel movements
  • muscle weakness
  • difficulty sleeping (insomnia)
  • thinning of the skin
  • menstrual irregularities

The causes of factitious hyperthyroidism may include:

  • a desire to lose weight
  • seeking medical attention
  • pursuing personal objectives
  • association with conditions like Munchausen syndrome
  • athletes and bodybuilders managing weight and fat loss

Can levothyroxine cause factitious hyperthyroidism?

Misusing or overusing levothyroxine, a medication commonly used to treat hypothyroidism (underactive thyroid), can lead to hyperthyroid symptoms.

If a person takes an excessive dose intentionally, it’s referred to as factitious hyperthyroidism. On the other hand, if a doctor prescribes an excessively high dose, it’s known as iatrogenic hyperthyroidism.

Diagnosing factitious hyperthyroidism can be challenging, mainly because individuals with this condition often don’t readily admit their actions. However, several key factors and diagnostic clues can help identify it.

One important indicator is the presence of abnormal thyroid function tests, which may show thyroid hormone levels that aren’t consistent with typical clinical signs of hyperthyroidism. In addition, the absence of an enlarged thyroid gland (known as a goiter) and suppressed thyroglobulin levels can raise suspicion of factitious hyperthyroidism.

A 2020 case report illustrates this diagnostic challenge, where an individual with a prior diagnosis of Graves’ disease developed thyrotoxicosis.

The abnormal test results and the absence of medication or substance use led to suspicion of factitious thyrotoxicosis.

To confirm the diagnosis, the individual was treated with cholestyramine, which resulted in a rapid return of thyroid hormone levels to baseline. This provided strong support for the diagnosis of factitious thyrotoxicosis.

In general, doctors consider various factors in diagnosing factitious hyperthyroidism, such as:

  • the lack of a goiter (enlarged thyroid)
  • low levels of thyroglobulin
  • reduced radioactive iodine uptake
  • a positive response to cholestyramine treatment

The treatment of factitious hyperthyroidism can be complex and requires a multifaceted approach. Here are some treatment options and considerations:

  • Cessation of thyroid hormone misuse: The primary goal is to stop the individual from taking excessive thyroid hormone. In some cases, the excess thyroid hormone may need to be lowered gradually to prevent hypothyroid symptoms. Adjustments should be made under close medical supervision.
  • Endocrinologist consultation: Consultation with an endocrinologist is often needed to assess the individual’s thyroid function and determine the extent of the hormone imbalance.
  • Psychiatric evaluation and treatment: Factitious hyperthyroidism often occurs in the context of mental health conditions, such as Munchausen syndrome. Healthcare professionals may recommend individuals undergo a psychiatric evaluation and receive appropriate treatment for underlying mental health conditions.
  • Monitoring and follow-up: Long-term monitoring is necessary to ensure that the individual doesn’t resume excessive thyroid hormone use. Frequent thyroid function tests can help track progress.
  • Education and support: Providing education about the risks and consequences of thyroid hormone misuse is essential. Offering emotional support and mental health counseling can help individuals address underlying psychological concerns.
  • Addressing complications: Factitious hyperthyroidism can lead to severe complications, such as cardiac arrhythmias and rapid weight loss. These complications may require specific treatments and interventions.

Factitious hyperthyroidism occurs when a person takes too much thyroid medication on purpose, leading to high thyroid hormone levels and hyperthyroidism-like symptoms.

Factitious hyperthyroidism is a challenging condition to diagnose due to its concealed nature, but early recognition is essential to prevent severe health consequences.

With proper medical care and support, individuals with factitious hyperthyroidism can find effective treatment and regain their well-being.