Endocrine Abstracts

We report the case of a previously healthy, 40 years old obese male, who was admitted in emergency with complaints of chest pain, shortness of breath and loose stools. His physical examination was relatively unremarkable except for sinus tachycardia and restlessness. He had no history of ischemic heart disease. He was admitted under cardiologists and had various investigations (echocardiogram, stress test and coronary angiogram), all normal. Due to the presentation, thyroid function tests (TFTs) were also checked, and surprisingly, showed picture of secondary hypothyroidism with a very low TSH and very low FT4 & FT3. He had no personal and family history of thyroid disease or endocrine disorder and he was not on any antithyroid medications. Endocrine opinion was sought and pituitary investigations were requested, with planned follow-up in the endocrine outpatient clinic. On discharge day, he revealed to the pharmacist that he had been taking over the counter Thyro-T2 fat burner, weight losing medications. On further scrutiny it was found that fat burners contain 3, 5 Diiodo-L-Thyronine (T2), a thyroid hormone metabolite. There have been very few case reports in the literature of severe hyperthyroidism induced by Thyro-T2 abuse. T2 is not routinely measured by assays and the biochemical picture could be confusing. A literature review and discussion follows the case.