title: Successful management of a patient with pseudomalabsorption of levothyroxine.
abstract: Pseudomalabsorption of levothyroxine is a factitious disorder. Despite the administration of large doses of levothyroxine, patients with this disorder show hypothyroidism due to noncompliance. These patients are different from the patients with simple noncompliance in that they have a psychiatric disorder. Because their psychological identities are rooted in their being a "patient," they go to great lengths to become and stay a patient. We report a case of pseudomalabsorption of levothyroxine. A 28-year-old woman was referred to us because she was believed to have unusual malabsorption of levothyroxine. We diagnosed the patient as having this factitious disorder, and as treatment, had her visit a hospital twice a week to take medicine under the observation of nurses so that she would not lose her status as a "patient." Her serum free T4 level normalized during three years with twice weekly dosing of thyroxine after hospital discharge. Our approach could be a therapeutic choice for this intractable disorder. To our knowledge, this is the first report of successful management of a patient with pseudomal-absorption of levothyroxine.
authors.affiliation: Kuma Hospital, Kobe, Japan. kubota@kuma-h.or.jp
authors.forename: Sumihisa
authors.initials: S
authors.lastname: Kubota
authors.forename: Shuji
authors.initials: S
authors.lastname: Fukata
authors.forename: Fumio
authors.initials: F
authors.lastname: Matsuzuka
authors.forename: Kanji
authors.initials: K
authors.lastname: Kuma
authors.forename: Akira
authors.initials: A
authors.lastname: Miyauchi
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005162:Factitious Disorders / Q000378:metabolism* / Q000523:psychology*; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000150:complications* / Q000188:drug therapy*; D008286:Malabsorption Syndromes / Q000150:complications* / Q000175:diagnosis*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000378:metabolism*; D016312:Treatment Refusal
chemical_list: D013972:Thyrotropin; D013974:Thyroxine