Hyperthyroidism is generally characterized by symptoms of anxiety, fatigue, palpitations, tremor, heat intolerance, increased perspiration, and weight loss. The most common cause of endogenous hyperthyroidism is Graves’ disease. However, the presence of exogenous hyperthyroidism should also be considered in the presence of hyperthyroidism symptoms in patients who are receiving levothyroxine replacement therapy. The term “exogenous hyperthyroidism” is used to describe hyperthyroidism caused by ingestion of excessive amounts of thyroid hormone. This is generally due to high dose of levothyroxine replacement which is aimed for TSH suppression during the treatment of thyroid carcinoma. However, it may also occur in patients with psychiatric disorders when they take excessive doses of thyroid hormone intentionally, especially when they aim to draw attention. This condition is termed “thyrotoxicosis factitia.” We hereby present a case with thyrotoxicosis factitia and the challenges during the process of diagnosis.
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