Case history
Case history #1
A 31-year-old woman is 4 months postpartum, breastfeeding, and found to have a resting heart rate of 92 bpm. She has a slightly enlarged non-nodular, nontender thyroid and no proptosis. Serum thyroid-stimulating hormone (TSH) is undetectable, free T4 and T3 are modestly elevated, and thyroid peroxidase antibodies are positive. The ratio of total serum T3 to T4 is 12.
Case history #2
A 62-year-old man presents with atrial fibrillation. He has not noticed any tremulousness, heat intolerance, or weight loss. His thyroid gland is non-nodular, nontender, and slightly enlarged. Serum TSH is undetectable, free T4 and T3 are modestly elevated, and thyroid peroxidase antibodies are positive with a low titer. A 24-hour radioiodine uptake is 0.2%.
Other presentations
Painless thyroiditis with transient thyroid dysfunction may occur in association with immunomodulatory therapy such as interferon alfa, tyrosine kinase inhibitors (e.g., sunitinib), and monoclonal antibodies (e.g., alemtuzumab, ipilimumab, nivolumab). It may also occur following treatment with lithium or amiodarone.[5] Transient hyperthyroidism or hypothyroidism may be noted on screening tests, or patients may present with classic symptoms of hyperthyroidism or hypothyroidism.
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