Monday, April 07, 2008

Murder by Thyroid Poisoning, or Paranoia?

A 40+ Y/O male presented to the ER with a rapid pulse and insomnia for a week.
He told the ER physician that he felt he was being poisoned by a female friend.
He stated that for 6 weeks he has been eating at her condo, and became progressively sicker in the last 2 weeks. He developed insomnia, anxiety and rapid heart beat which was confirmed
at the ER at 160/minute.The thyroid was mildly enlarged. He described the poison plot to the physician, who had the patients stomach pumped. He described a grifter scam to get his money and his paid up house, by making him weak, and signing over all his assets. The scam was worked by the female age 35, and her boy friend. The thyroid hormone was ground up and put in his food. The delayed symptoms occurred 30 days after he began eating at her condo. When I first saw him, I asked how did he know he was being poisoned, with Synthroid, a brand name for thyroxine. He said it was a well known grifter scam listed on websites about scam artists. His heart rate was normal 4 days after the ER visit. No tremor, but still complained of insomnia. His thyroid was enlarged and nodular. However, the T4,T3, TSH, and antibodies were all normal.
The thyroglobulin TG was drawn at first to make sure it was exogenous induced hyperthyroidism, not Graves disease. When the TG came back normal, not suppressed, I knew he was not being poisoned by thyroid hormone placed in his food. His story was very strange. He has a goiter and small nodule which needs my follow up, but what about this poisoning story? When confronted with the news, he was shocked that his imagined poisoning was not real. I told him he had serious problem with reality, and needed to get help. He had planned to get the police to arrest the female, but I found no smoking gun. His paranoid thoughts were out of control. His small goiter was not enough to suspect poisoning. Also his I/123 thyroid uptake was normal. He said he would see a therapist, but did not go to the one I recommended.
Until next time,

Good thyroid health,