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Thyrotoxicosis of a rare aetiology
  1. M Ismail,
  2. R V Bhat
  1. Department of Medicine, Kasturba Medical College, Mangalore 575 001, India
  1. Dr Ismail Ismail{at}bgl.vsnl.net.in

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A 28 year old woman was admitted with an eight month history of menstrual irregularities and a four month history of weight loss, haemoptysis, and dyspnoea. She had had menorrhagia for six months, for which a dilatation and curettage was done. Following this, she developed amenorrhoea. Her obstetric history was unremarkable. She was a mother of two (the last childbirth was two years previously). Physical examination revealed bilateral exophthalmos, lid lag, fine tremors in the outstretched fingers, warm and moist skin, and pallor. She had resting tachycardia and tachypnoea. Temperature and blood pressure were normal. There was no goitre. Fine crepitations were heard throughout inspiration and expiration all over the thorax. Haematological studies showed a haemoglobin concentration of 89 g/l, a leucocyte count of 10.9 × 109/l, and erythrocyte sedimentation rate of 70 mm/h. Thyroid function tests confirmed the diagnosis of thyrotoxicosis: thyroid stimulating hormone 0.01 mIU/l (reference range 0.35–5.5 mIU/l), T4 22.4 μg/dl (3.2–12.6), and T32.54 ng/ml (0.6–1.81). The serum biochemical profile was in the normal range. Chest x ray showed multiple cannon ball opacities. An ultrasound study of the abdomen was normal. Further studies were performed to establish the aetiology.

Questions

(1)
What is the diagnosis?
(2)
What diagnostic procedure supports it?
(3)
What is the cause of the thyrotoxicosis?

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