Subclinical Hypothyroidism and Munchausen Syndrome: A Rare Entity

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.