title: Thyroxine, shape, and weight: interaction of Graves' disease and bulimia nervosa.
abstract: OBJECTIVE
  A case of a 25-year-old woman with bulimia nervosa and Graves' disease is presented. Graves' disease is the cause of 50-80 % of hyperthyroidism. The disease is characterized by increases of thyroid hormone production, activation of the metabolism, and successive weight loss. Bulimia nervosa is characterized by purging behavior after binge eating episodes.
  
  
  RESULTS
  We report a patient suffering from both entities. A pronounced non-compliance to the intake of antithyroid drugs (Carbimazole) correlated with eating disorder symptoms like negative evaluation of the body and fear of weight gain. Thus, elevated hyperthyroidism due to Graves' disease served as a purging method. During 8 weeks of inpatient psychotherapy, the patient adapted to a structured eating behavior. Self-esteem was less influenced by body shape and body weight, and compliance to endocrinological recommendations improved.
  
  
  CONCLUSIONS
  Non-compliance to antithyroid drugs may be a symptom of an eating disorder. A careful and primarily non-confronting interdisciplinary diagnostic and treatment approach is required.
authors.affiliation: Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstrasse 5, 72076, Tübingen, Germany, martin.teufel@med.uni-tuebingen.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Teufel
authors.forename: Katrin Elisabeth
authors.initials: KE
authors.lastname: Giel
authors.forename: Jule
authors.initials: J
authors.lastname: Lehr
authors.forename: Sandra
authors.initials: S
authors.lastname: Becker
authors.forename: Michaela
authors.initials: M
authors.lastname: Muthig
authors.forename: Stephan
authors.initials: S
authors.lastname: Zipfel
authors.forename: Jürgen
authors.initials: J
authors.lastname: Kuprion
mesh_terms: D000328:Adult; D013956:Antithyroid Agents / Q000627:therapeutic use; D001828:Body Image / Q000523:psychology*; D052018:Bulimia Nervosa / Q000150:complications* / Q000523:psychology / Q000628:therapy; D002231:Carbimazole / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D005260:Female; D006111:Graves Disease / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D012649:Self Concept; D016896:Treatment Outcome
chemical_list: D013956:Antithyroid Agents; D002231:Carbimazole