FROM FAMINE TO A FEAST: LITTLE ENDOGENOUS THYROXINE TO OVERPRODUCTION

Objective: Spontaneous conversion of autoimmune hypothyroidism to Graves' disease is a rare occurrence. We present a case of antibody confirmed autoimmune hypothyroidism, where the patient was on replacement therapy with levothyroxine for 8 years, had spontaneous conversion to Graves' disease with positive thyrotropin receptor antibodies (TRAb). Methods/case presentation: A 79-year-old woman was evaluated for persistent fatigue following acute dermatomal herpes zoster. She had developed progressive tremor of the extremities and heat intolerance. Her other problems included Hashimoto's thyroiditis and vitiligo, diabetes mellitus, cerebrovascular disease, coronary artery disease, osteoporosis and hypercholesterolemia. Her medications included metformin, aspirin, lisinopril, atorvastatin, zoledronic acid and levothyroxine. Clinical examination was notable for healed lesions of herpes zoster and hand tremors. Results: Laboratory evaluation revealed T3 levels of 1.83 (0.80–2.00 ng/ml), free T4 of 1.53 levels 1...