{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:02:27Z","timestamp":1756425747996,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,6,15]]},"abstract":"<jats:p>A 62-year-old Caucasian woman presented with hypothyroid symptoms and biochemical thyrotoxic picture. Previously, she underwent right-sided subtotal thyroidectomy and left partial thyroid lobectomy for thyroid lumps, and treated with thyroxine replacement for hypothyroidism. Although there were no significant findings on clinical examination, investigations confirmed thyrotoxicosis with positive autoimmunity against thyroid gland\u00e2\u20ac\u201dall in line with a diagnosis of Graves\u00e2\u20ac\u2122 hyperthyroidism. We would like to highlight atypical presentations of thyroid dysfunction and conversion of underactive to overactive thyroid status with this case. Early recognition, diagnosis and intervention are essential to prevent and\/or reduce associated morbidity and mortality. When encountered with such clinical conundrums, we recommend seeking opinion from an experienced endocrinologist while interpreting such situation.<\/jats:p>","DOI":"10.1136\/bcr-2017-221061","type":"journal-article","created":{"date-parts":[[2017,7,14]],"date-time":"2017-07-14T07:52:20Z","timestamp":1500018740000},"page":"bcr-2017-221061","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Thyrotoxicosis in patients with hypothyroidism is not just overtreatment"],"prefix":"10.1136","volume":"2017","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0954-6512","authenticated-orcid":false,"given":"Punith","family":"Kempegowda","sequence":"first","affiliation":[{"name":"Department of Diabetes and Endocrinology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK"},{"name":"Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, West Midlands, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ananth U","family":"Nayak","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,7,14]]},"reference":[{"key":"2025082723233145000_2017.jul14_2.bcr-2017-221061.1","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1210\/jc.2016-3597","article-title":"Clinical Features of Early and Late Postoperative Hypothyroidism After Lobectomy","volume":"102","author":"Park","year":"2017","journal-title":"J Clin Endocrinol Metab"},{"key":"2025082723233145000_2017.jul14_2.bcr-2017-221061.2","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1097\/00007611-200007000-00013","article-title":"Hyperthyroidism after hypothyroidism","volume":"93","author":"Al-Sharafi","year":"2000","journal-title":"South Med J"},{"key":"2025082723233145000_2017.jul14_2.bcr-2017-221061.3","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1111\/cen.12979","article-title":"Symptoms of thyrotoxicosis, bone metabolism and occult atrial fibrillation in older women with mild endogenous subclinical hyperthyroidism","volume":"85","author":"Rosario","year":"2016","journal-title":"Clin Endocrinol"},{"key":"2025082723233145000_2017.jul14_2.bcr-2017-221061.4","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-193105000-00008"},{"key":"2025082723233145000_2017.jul14_2.bcr-2017-221061.5","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.7326\/0003-4819-50-6-1418","article-title":"Apathetic thyroidism: review of the literature and report of four cases","volume":"50","author":"McGEE","year":"1959","journal-title":"Ann Intern Med"},{"key":"2025082723233145000_2017.jul14_2.bcr-2017-221061.6","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1055\/s-2001-14942","article-title":"TSBAb (TSH-stimulation blocking antibody) and TSAb (thyroid stimulating antibody) in TSBAb-positive patients with hypothyroidism and Graves' patients with hyperthyroidism","volume":"33","author":"Takasu","year":"2001","journal-title":"Horm Metab Res"},{"key":"2025082723233145000_2017.jul14_2.bcr-2017-221061.7","first-page":"682","article-title":"Hyperthyroidism associated with histologic Hashimoto's thyroiditis","volume":"46","author":"Fatourechi","year":"1971","journal-title":"Mayo Clin Proc"},{"key":"2025082723233145000_2017.jul14_2.bcr-2017-221061.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0300-595X(79)80010-9"},{"key":"2025082723233145000_2017.jul14_2.bcr-2017-221061.9","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/S0021-9258(17)38254-6","article-title":"Production of a non-immunoglobulin thyroid stimulator by human lymphocytes during mixed culture with human thyroid cells","volume":"253","author":"Rapoport","year":"1978","journal-title":"J Biol Chem"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-221061","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:23:40Z","timestamp":1756362220000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-221061"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7,14]]},"references-count":9,"alternative-id":["10.1136\/bcr-2017-221061"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-221061","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2017,7,14]]}}}