In fact, he has also been investigated for weight loss of 10kg over the past 2 years with various imaging methods and blood tumour markers, but without any positive lead. He has seen many physicians over this past two years, but his underlying weakness is not improving. He was previously on L-thyroxine 75microgram which was adjusted based on a very low TSH level (<0.01 pmol/L). His current medication is amlodipine 10mg daily, metformin 500mg daily and L-thyroxine 50 microgram. His hypothyroid condition was diagnosed two years ago based on a low T4 and correspondingly high TSH at a primary care clinic. Both hypertension and diabetes were diagnosed about 10 years ago. The patient has a background history of hypertension, diabetes and hypothyroidism. It typically occurs in clusters of a few days. This has been a recurrent problem for the past two years. Case reportĪ 70-years old man presented with weakness for two days to the neurologist. This is a case that correctly depicts the pitfall in the diagnosis and management of this condition. A referral to an endocrinologist is also warranted in certain cases. 1-2 In these patients, a structured approach that includes clinical reassessment of thyroid status, along with various potentiating factors can help in identifying the possible solution to this discordant TFT. a low TSH in patient with hypothyroid or normal TFT in patients is suspected to be strongly thyrotoxic. 1 In a subgroup of patients, the interpretation of TFT is more challenging, either because the results appear to not correlate with the clinical picture i.e. T4, thyroxine T3, triiodothyronine) and thyrotropin (TSH) concentrations that are commonly measured in a test called thyroid function test (TFT). A key factor in the diagnosis of thyroid disease such as hypothyroidism or hyperthyroidism, is accurate interpretation of thyroid hormone (TH i.e. Diagnosis of thyroid diseases is often challenging with various manifestations that are non-specific such as lethargy, weight gain or loss, palpitations or weakness.
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