PSAT322 A "Natural Thyroid Booster" Induced Hyperthyroidism

BACKGROUND: In the recent years market got filled with a variety of freely available and not FDA regulated supplements that claim to ensure thyroid gland "support", "activation", "boost", "restoration", "drive", "edge", "strength" and a midst of other positive effects. These supplements are often not considered as medications and often are not reported during medication reconciliation. We present a case of hyperthyroidism in a patient using a supplement containing potassium iodide CLINICAL CASE: 54-year-old male with newly diagnosed atrial fibrillation in Feb 2021 presented in September 2021 with non-ST elevation myocardial infarction. He continued to have persistent atrial fibrillation. At presentation TSH was nearly suppressed at 0.02 MIU/ml, FT4 was normal at 1.6 ng/dl, TT3 increased at 241 ng/dL. During endocrinology evaluation in October 2021 thyroid function values remained the same, TSI and TRAB were negative and TGAB were increased at 8 IU/ml. Imaging studies were not consistent with thyroiditis (heterogenous and hypervascular gland on ultrasound, normal RAI), a possibility of antibody negative Graves’ disease was entertained, however thyroid function tests in November 2021 were quite different and showed elevated TSH of 71 MIU/L, FT4 low at 0.3 ng/dl, low TT3 at 48 ng/dl. At this time patient recalled being on thyroid supplement in the recent past, per patient he did not realize that it was relevant information to disclose to the physician. He was on "Thyroid PX" from September 2020 to February 2021 per recommendation from naturopathic doctor for symptomatic subclinical hypothyroidism when in September 2020 TSH was noticed to be mildly elevated at 6.73 MIU/ml, FT4 normal at 1. 0 ng/dl and TT3 normal at 99 ng/dl. CONCLUSION: This case represents an example of thyroid supplement use related thyrotoxicosis. He was taking "megadoses" (80 times the recommended daily dose) of iodine that likely have caused Jod-Basedow phenomenon, which is a hyperthyroidism following exposure to the excess of iodine. Among documented ingredients of "Thyroid PX" are potassium iodide, cholecalciferol, methylcobalamim, Ashwagandha root, Ginger root, Nettle leaf and others. Each capsule contains 6000mcg of Potassium Iodide (daily dose – 2 capsules) with recommended daily iodine dose for adults of 150mcg. Hyperthyroid stage was followed by the stage of profound hypothyroidism. The patient could have been predisposed to Jod-Basedow phenomenon due to Hashimoto thyroiditis. This illustrates an importance of obtaining detailed history of use of any/thyroid supplements in all patients with unexplained hyperthyroidism. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.