{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T20:44:42Z","timestamp":1780519482062,"version":"3.54.1"},"reference-count":13,"publisher":"Walter de Gruyter GmbH","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_dx-2019-0015_s_999_w2aab3b7b1b1b6b1aab1c16b1Aa\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although the most common cause of thyrotoxicosis is Graves\u2019 disease, the determination of the cause of thyrotoxicosis is important for establishing appropriate management. Diagnosis of surreptitious ingestion of thyroid hormones or factitious thyrotoxicosis often presents a difficult challenge especially in a patient with previously diagnosed Graves\u2019 disease. The objective of this report was to demonstrate various approaches to support the diagnosis of factitious thyrotoxicosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2019-0015_s_998_w2aab3b7b1b1b6b1aab1c16b2Aa\">\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We describe a patient with underlying Graves\u2019 disease who underwent definitive therapy and needed long-term levothyroxine (LT4) replacement therapy. Later she developed thyrotoxicosis. Although factitious thyrotoxicosis was suspected because of very low thyroid uptake and low thyroglobulin (Tg) levels with the absence of thyroglobulin antibodies (TgAbs), she still refused any medication or substance use. After the administration of bile acid sequestrant, the thyroid hormone levels rapidly returned to normal within 1 month.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2019-0015_s_997_w2aab3b7b1b1b6b1aab1c16b3Aa\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The diagnosis of factitious thyrotoxicosis is based upon the absence of goiter, suppressed serum Tg level, decreased radioactive iodine (RAI) uptake, and excellent response after cholestyramine treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/dx-2019-0015","type":"journal-article","created":{"date-parts":[[2019,3,30]],"date-time":"2019-03-30T16:24:25Z","timestamp":1553963065000},"page":"141-145","source":"Crossref","is-referenced-by-count":4,"title":["Factitious thyrotoxicosis: how to find it"],"prefix":"10.1515","volume":"7","author":[{"given":"Pakaworn","family":"Vorasart","sequence":"first","affiliation":[{"name":"Department of Medicine, Faculty of Medicine Ramathibodi Hospital , Mahidol University , Bangkok , Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chutintorn","family":"Sriphrapradang","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine Ramathibodi Hospital , Mahidol University , Bangkok , Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2019,3,30]]},"reference":[{"key":"2025121207032447384_j_dx-2019-0015_ref_001_w2aab3b7b1b1b6b1ab2b2b1Aa","doi-asserted-by":"crossref","unstructured":"Kang GY, Parks JR, Fileta B, Chang A, Abdel-Rahim MM, Burch HB, et al. Thyroxine and triiodothyronine content in commercially available thyroid health supplements. Thyroid 2013;23:1233\u20137.","DOI":"10.1089\/thy.2013.0101"},{"key":"2025121207032447384_j_dx-2019-0015_ref_002_w2aab3b7b1b1b6b1ab2b2b2Aa","doi-asserted-by":"crossref","unstructured":"Sriphrapradang C, Bhasipol A. Differentiating Graves\u2019 disease from subacute thyroiditis using ratio of serum free triiodothyronine to free thyroxine. Ann Med Surg (Lond) 2016;10:69\u201372.","DOI":"10.1016\/j.amsu.2016.07.024"},{"key":"2025121207032447384_j_dx-2019-0015_ref_003_w2aab3b7b1b1b6b1ab2b2b3Aa","doi-asserted-by":"crossref","unstructured":"Laurberg P, Wallin G, Tallstedt L, Abraham-Nordling M, Lundell G, Torring O. TSH-receptor autoimmunity in Graves\u2019 disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study. Eur J Endocrinol 2008;158:69\u201375.","DOI":"10.1530\/EJE-07-0450"},{"key":"2025121207032447384_j_dx-2019-0015_ref_004_w2aab3b7b1b1b6b1ab2b2b4Aa","doi-asserted-by":"crossref","unstructured":"Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016;26:1343\u2013421.","DOI":"10.1089\/thy.2016.0229"},{"key":"2025121207032447384_j_dx-2019-0015_ref_005_w2aab3b7b1b1b6b1ab2b2b5Aa","doi-asserted-by":"crossref","unstructured":"Kahaly GJ, Bartalena L, Hegedus L, Leenhardt L, Poppe K, Pearce SH. 2018 European Thyroid Association guideline for the management of graves\u2019 hyperthyroidism. Eur Thyroid J 2018;7:167\u201386.","DOI":"10.1159\/000490384"},{"key":"2025121207032447384_j_dx-2019-0015_ref_006_w2aab3b7b1b1b6b1ab2b2b6Aa","doi-asserted-by":"crossref","unstructured":"Mariotti S, Martino E, Cupini C, Lari R, Giani C, Baschieri L, et al. Low serum thyroglobulin as a clue to the diagnosis of thyrotoxicosis factitia. N Engl J Med 1982;307:410\u20132.","DOI":"10.1056\/NEJM198208123070705"},{"key":"2025121207032447384_j_dx-2019-0015_ref_007_w2aab3b7b1b1b6b1ab2b2b7Aa","doi-asserted-by":"crossref","unstructured":"Spencer C, Fatemi S. Thyroglobulin antibody (TgAb) methods \u2013 strengths, pitfalls and clinical utility for monitoring TgAb-positive patients with differentiated thyroid cancer. Best Pract Res Clin Endocrinol Metab 2013;27:701\u201312.","DOI":"10.1016\/j.beem.2013.07.003"},{"key":"2025121207032447384_j_dx-2019-0015_ref_008_w2aab3b7b1b1b6b1ab2b2b8Aa","doi-asserted-by":"crossref","unstructured":"Mortoglou A, Candiloros H. The serum triiodothyronine to thyroxine (T3\/T4) ratio in various thyroid disorders and after levothyroxine replacement therapy. 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Eur J Endocrinol 1999;140:452\u20136.","DOI":"10.1530\/eje.0.1400452"},{"key":"2025121207032447384_j_dx-2019-0015_ref_011_w2aab3b7b1b1b6b1ab2b2c11Aa","doi-asserted-by":"crossref","unstructured":"Dunzendorfer T, deLas Morenas A, Kalir T, Levin RM. Struma ovarii and hyperthyroidism. Thyroid 1999;9:499\u2013502.","DOI":"10.1089\/thy.1999.9.499"},{"key":"2025121207032447384_j_dx-2019-0015_ref_012_w2aab3b7b1b1b6b1ab2b2c12Aa","doi-asserted-by":"crossref","unstructured":"Bouillon R, Verresen L, Staels F, Bex M, De Vos P, De Roo M. The measurement of fecal thyroxine in the diagnosis of thyrotoxicosis factitia. Thyroid 1993;3:101\u20133.","DOI":"10.1089\/thy.1993.3.101"},{"key":"2025121207032447384_j_dx-2019-0015_ref_013_w2aab3b7b1b1b6b1ab2b2c13Aa","doi-asserted-by":"crossref","unstructured":"Shah KK, Mbughuni MM, Burgstaler EA, Block DR, Winters JL. Iatrogenic thyrotoxicosis and the role of therapeutic plasma exchange. 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