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Puzzling thyroid function test
  1. Nandhini Lakshmana Perumal1,
  2. Jaya Prakash Sahoo2,
  3. Sadishkumar Kamalanathan2,
  4. Carla Moran3
  1. 1Department of Endocrinology, Jawaharlal Institute of Post Graduate Medical Education, Puducherry, India
  2. 2Department of Endocrinology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
  3. 3Institute of Metabolic Science, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Sadishkumar Kamalanathan, sadishkk{at}


A 13-½-year-old boy was referred to the Department of Endocrinology as a case of thyrotoxicosis for initiation of antithyroid medication. His chief complaint was a swelling in front of the neck, which was incidentally noted by his mother 2 weeks prior to presentation. He denied any history of symptoms suggestive of hyperthyroidism or ophthalmological involvement. His physical examination was unremarkable except for a grade 2 goitre. Thyroid function test revealed elevated free triiodothyronine and tetraiodothyronine in the face of an unsuppressed thyroid-stimulating hormone level. Technetium-99 uptake scan showed increased uptake indicating enhanced thyroid activity. However, he was clinically euthyroid. This raised the possibility of resistance to thyroid hormones, which was confirmed by documenting similar thyroid function test abnormalities in other members of his family and genetic testing. The family was reassured of the benign nature of the condition.

  • thyroid disease
  • paediatrics

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  • Contributors NLP managed the patient, collected data, drafted the initial manuscript and reviewed and revised the manuscript. JPS and SK supervised the management of the patient and data collection and also critically reviewed the manuscript. CM helped with genetic testing and also critically reviewed the manuscript.

  • Competing interests None declared.

  • Patient consent Guardian consent obtained.

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