BMJ Case Reports 2017; doi:10.1136/bcr-2017-221061
  • Reminder of important clinical lesson

Thyrotoxicosis in patients with hypothyroidism is not just overtreatment

  1. Ananth U Nayak1
  1. 1Department of Diabetes and Endocrinology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
  2. 2Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, West Midlands, UK
  1. Correspondence to Dr Punith Kempegowda, p.kempegowda{at}
  • Accepted 15 June 2017
  • Published 14 July 2017


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—all in line with a diagnosis of Graves’ 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.


  • Contributors PK prepared the first draft of the case report and AUK did overall supervision. Both were involved in the management of the case.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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