CASE REPORT

Subclinical Hypothyroidism and Munchausen Syndrome: A Rare Entity
Subklinik Hipotiroidizm ve Munchausen Sendromu: Nadir Bir Birliktelik
Received Date : 26 Dec 2020
Accepted Date : 17 Feb 2021
Available Online : 17 Mar 2021
Doi: 10.25179/tjem.2020-80830 - Makale Dili: EN
Turk J Endocrinol Metab. 2021;25:238-242
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Non-compliance to the prescribed levothyroxine (LT4) treatment is one of the reasons for the failure in managing hypothyroidism. This problem can usually be overcome by following the prescribed medication regimen. However, continuing disadherence for the purpose of misleading is called pseudomalabsorption. This makes LT4 absorption tests essential for an exact diagnosis. While patients diagnosed with pseudomalabsorption may have psychiatric disorders, cases with the diagnosis of a component of Munchausen syndrome are rare. Munchausen syndrome, also called factitious disorder, is a psychiatric disorder that characterizes recurring illness and misleading healthcare professionals. The primary motive of the patient is emotional attention which can demonstrate a chronic state. We present here an interesting case in which we diagnosed LT4 pseudomalabsorption as the cause of the failure in hypothyroidism management and detected other clinical symptoms of Munchausen syndrome such as unexplained skin wounds, falsified symptoms, and an excessive number of hospital admissions.
ÖZET
Hipotiroidizm yönetimindeki başarısızlığın nedenlerinden biri levotiroksin (LT4) tedavisine uyumsuzluktur. Bu problem genellikle ilacın uygun kullanımı ile aşılabilir. Bununla birlikte, psuedomalabsorpsiyon olarak isimlendirilen hastanın yanıltma amaçlı olarak ilaç alma uyumsuzluğuna devam etmesi tedavi başarısızlığını devam ettirebilir. Kesin bir teşhis yapmak için LT4 absorpsiyon testlerinin yapılması gerekecektir. Pseudomalabsorpsiyon tanısı konan hastalarda, psikiyatrik bozukluklar olabileceği belirtilmektedir ancak munchausen sendromu içerisinde tanı konulmuş vakalar nadirdir. Munchausen sendromu ya da diğer isimiyle faktisyöz bozukluk, hastanın yanıltıcı bulgularla sağlık çalışanlarını kandırmasıyla karakterize psikiyatrik bir bozukluktur. Hastanın temel motivasyonu duygusal kazançtır ve bu kronik bir durum gösterebilir. Burada, hipotiroidizm tedavisindeki başarısızlığın nedeni olarak LT4 psödomalabsorpsiyonu tanısı koyduğumuz, ardından munchausen sendromunun diğer klinik özelliklerini (açıklanamayan cilt yaraları, tekrarlayan kandırma amaçlı semptom ve bulgular ve aşırı sayıda hastane başvurusu gibi) saptadığımız ilginç bir vaka sunuyoruz.
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