Abstract Factitious thyrotoxicosis is characterized by the intentional or accidental intake of excess thyroid hormones or their derivatives. We describe 6 cases of patients who developed thyrotoxicosis and adverse effects by weight-reducing herbal medicines. Currently there is a lot of publicity about supplements that “help to lose weight”, which are over-the-counter and widely distributed in health food stores or online, which is why it is com mon to have patients who consume them, without many noticing their possible risks. If factitious hyperthyroidism is suspected, we should request thyroglobulin and anti-thyroglobulin tests, as well as a thyroid scan or uptake curve. To make the differential diagnosis between intake of thyroxine (T4) or triiodothyronine (T3) or its deriva tives, we must request the measurement of T4 and T3. In case of ingestion of T4, T4 and T3 will be elevated, but in case of ingestion of triodothyronine or its derivatives, T4 will be decreased with elevated T3.

Resumen La tirotoxicosis facticia se caracteriza por la ingesta de un exceso de hormonas tiroideas o derivados de las mismas de forma intencional o accidental. Describimos 6 casos clínicos de pacientes que desarrollaron tirotoxicosis y efectos adversos con la ingesta de suplementos de herbales de venta libre para descenso de peso. Actualmente existe mucha publicidad sobre suplementos que “ayudan al descenso de peso”, los cuales son de venta libre y distribuidos ampliamente en tiendas de dietéticas o por internet por lo cual es habitual tener pacientes que los consumen, sin que muchos reparen en sus posibles riesgos. En caso de sospechar un hipertiroidismo facticio debemos solicitar tiroglobulina y anticuerpos anti tiroglobulina así como centellograma tiroideo o curva de captación. Para realizar el diagnóstico diferencial entre ingesta de tiroxina (T4) o triiodotironina (T3) o sus derivados debemos solicitar medición de T4 y T3. En caso de ingesta de T4, la T4 y T3 se encontrarán elevadas, pero en caso de ingesta de triodotironina o sus derivados la T4 se encontrará descendida con una T3 elevada.

ABSTRACT Objectives The main purpose of this study was to estimate the incidence rate and prevalence of clinically relevant pituitary adenomas (PAs) within the Hospital Italiano Medical Care Program (HIMCP), a well-defined population of 150,000 members living in the urban and suburban area of the city of Buenos Aires. We defined clinically relevant PAs as those associated with endocrine dysfunction and/or mass effect. Subjects and methods A retrospective open cohort study was conducted, including all members of the HIMCP over 18 years old, with active memberships during the period of the study, from January 1st 2003, to January 1, 2014. The incidence rates (IRs) were standardized (SIR) to the World Health Organization (WHO) 2000 standard population and were expressed per 100,000 members/year. Prevalence was estimated at January 1, 2014, and was expressed per 100,000 persons. The clinical records have been electronically managed since 2001. All lab and imaging studies were done in-house. Results The overall SIR was 7.39/100,000/year (95% CI 4.47-10.31). Female patients had a specific IR significantly higher than male patients (5.85 vs.1.54) and represented 73% of the affected members. Regarding tumor size, 61.4% were microadenomas, and the mean age at diagnosis was 46.4 years. Prolactinomas had the highest SIR (5.41), followed by acromegaly (Acro) and non-functioning adenomas (NFAs) with overlapping 95% CIs (0.44-1.41 and 0.31-0.99, respectively). Microprolactinomas were more frequent in female (72.6%) (p < 0.01) and younger members (38 vs.60 years; p < 0.04). The overall prevalence rate was 97.76/100,000. Prolactinomas had the highest prevalence (56.29), followed by NFAs (21.48), Acro (14.07) and CD (5.93). Conclusion Our results demonstrate that clinically relevant PAs are more common than usually suspected, especially prolactinomas and growth-hormone secreting PAs. These data highlight the need to increase the awareness of PAs, thereby enabling early diagnosis and treatment.