Article Text

Download PDFPDF
Case report
Delayed diagnosis of T3 supplementation in a bodybuilder presenting with tachycardia and features of sepsis
  1. Bronwen E Warner1,2,
  2. Charles J Woodrow3 and
  3. Aparna Pal4
  1. 1Internal Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
  2. 2Acute General Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
  3. 3Nuffield Department of Clinical Medicine, Oxford, Oxfordshire, UK
  4. 4Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, Oxfordshire, UK
  1. Correspondence to Dr Aparna Pal; Aparna.Pal{at}


A 25-year-old man presented generally unwell to the emergency department. Initial assessment identified systemic inflammatory response syndrome markers with an insect bite as a potential source of infection and he was treated for presumed sepsis. Tachycardia persisted and baseline thyroid function testing showed undetectable free thyroxine and thyroid-stimulating hormone (TSH), prompting further endocrine investigation. Triiodothyronine (T3) was markedly raised with normal TSH receptor antibodies, and the patient later confessed to supplementary testosterone and T3 use as part of bodybuilding activities. Following counselling, thyroid function normalised and the patient returned to his usual health. This case describes the diagnostic work up in a case of persistent tachycardia caused by T3 supplementation, demonstrating the potential for endocrine supplementation by bodybuilders which may be poorly understood and recognised by clinicians. T3 supplementation should be considered and a thorough drug history obtained in bodybuilders presenting with symptoms of thyrotoxicosis and deranged thyroid function tests.

  • thyrotoxicosis
  • drug misuse (including addiction)
  • thyroid disease
  • endocrine system
  • drugs in sport/doping control

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors AP identified the case and conceived the design of the work; BEW drafted the article; AP and CJW were involved in clinical management of the case; BEW, CJW and AP undertook critical revision of the article and gave final approval for the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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