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Thyrotoxicosis factitia (alimentary thyrotoxicosis, exogenous thyrotoxicosis) [1] [2] is a condition of thyrotoxicosis caused by the ingestion [3] of exogenous thyroid hormone. [4] [5] It can be the result of mistaken ingestion of excess drugs, such as levothyroxine [6] and triiodothyronine, [7] or as a symptom of Munchausen syndrome.
The deadline for the United States to begin using ICD-10-CM for diagnosis coding and Procedure Coding System ICD-10-PCS for inpatient hospital procedure coding was set at October 1, 2015, [51] [52] a year later than the previous 2014 deadline. [53] Before the 2014 deadline, the previous deadline had been a year before that on October 1, 2013.
A CT scan is the preferred method of diagnosis; however, free air from a perforation can often be seen on plain X-ray. [2] Perforation anywhere along the gastrointestinal tract typically requires emergency surgery in the form of an exploratory laparotomy. [2] This is usually carried out along with intravenous fluids and antibiotics. [2]
The syndrome can present with variable symptoms, even between members of the same family harboring the same mutation. [1] Typically most or all tissues are resistant to thyroid hormone, so despite raised measures of serum thyroid hormone the individual may appear euthyroid (have no symptoms of over- or underactivity of the thyroid gland).
Organ perforation is a complete penetration of the wall of a hollow organ in the body, such as the gastrointestinal tract in the case of gastrointestinal perforation.It mainly refers to accidental or pathologic perforation, rather than intentional penetration during surgery.
Binding of the antibody to the amino terminus of the TSH receptor shows stimulatory activity, whereas binding to residues 261-370 or 388-403 block the activity. TRAbs are present in 70–100% of Graves' disease (85–100% for activating antibodies and 75–96% for blocking antibodies) and 1–2% of normal individuals.
The TSH index is reduced in patients with secondary hypothyroidism resulting from thyrotropic insufficiency. [1] [9] [10] [11] For this indication, it has, however, up to now only been validated in adults. [12] JTI was also found reduced in cases of TACITUS syndrome (non-thyroidal illness syndrome) as an example of type 1 thyroid allostasis.
For a patient with appendicitis, this causes pain in the right iliac fossa. [2] The traction of spermatic cord is thought to cause right iliac fossa pain due to the apposition of the gonadal vessels against an inflamed appendix. [2] The sensitivity and specificity of the Ten Horn's sign is unknown.