Case PresentationAn 89-year-old woman with well-controlled type 2 diabetes mellitus was referred for routine evaluation of bone health. She had no history of prior falls or fractures, although she reported occasional low back pain for the past 6 months. She was receiving regular calcium and cholecalciferol supplements along with metformin for control of diabetes. Her general and systemic examination results were unremarkable. Breast examina-Fig. 1.
We present the case of a 45-year-old lady with long standing hypothyroidism who was euthyroid on replacement for many years, but stopped responding even to supraphysiological doses of LT4 since the last five years. She complained of abdominal discomfort, bloating, and nausea. She did not have diarrhea or weight loss. Levothyroxine absorption test was done which was suggestive of malabsorption and she was started on triple therapy for H. pylori eradication after confirmation of diagnosis. After 10 days of treatment initiation, she developed symptoms of thyrotoxicosis with her supraphysiological dose of LT4, which was then tapered to a lower dose. Euthyroid state was ultimately achieved with lower doses of LT4 replacement.
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