Palpation-Induced Thyrotoxicosis—An Underrecognized Complication of Parathyroidectomy

Document Type

Abstract

Publication Date

9-1-2025

Abstract

Description: Case Report: We present a case of a 70-year-old woman who presented to the hospital 5 days after partial parathyroidectomy (PTX), with removal of 3 glands. The initial presentation was for altered mental status, diagnosed with urinary tract infection. Initial lab workup revealed free T4 elevated at 1.84 and thyroid-stimulating hormone suppressed at 0.05. In discussion with family, the patient had no prior history of thyroid abnormalities. She had normal thyroid function 1 year earlier, and normal thyroid ultrasound prior to PTX. Additionally, she had not been on any thyrotoxic medications. Given the acute timing post-PTX and lack of other precipitants, thyrotoxicosis was thought to be most likely palpation-induced. The patient’s thyroid function was monitored during the hospital course and returned to baseline without medical intervention. Discussion: Common causes of thyroiditis include autoimmune, subacute, postpartum, fibrous, and infectious thyroiditis. Palpation thyroiditis is a much rarer cause, in which the thyroiditis is thought to occur through vigorous manual stimulation of the thyroid follicles causing release of thyroid hormone. Many patients with thyroiditis can be asymptomatic. Symptoms, when present, indicate thyrotoxicosis and include fatigue, palpitations, diaphoresis, tremors, and hyperreflexia. Most of these symptoms are caused by sympathetic activation due to the excess thyroid hormone in the circulation. Management depends on the cause, but can include beta blockade for symptomatic relief. Conclusion: While PTX is not a common cause of symptomatic thyroiditis, it is important to recognize the signs and symptoms in the correct clinical context as this will help determine an appropriate treatment plan. Both patients and providers should be made aware of the potential for thyrotoxicosis post-PTX.

Publication Title

Endocrine Practice

Volume

31

Issue

9 Supplement

First Page

S138

Last Page

S139

Comments

AACE Annual Meeting 2025 held 2025-05-15 to 2025-05-17 in Orlando, FL, US.

Link to Full Text

Open Access

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