Diagnostic Approach and Therapeutic Strategies for Ambiguous Thyrotoxicosis

Thyrotoxicosis is a clinical syndrome caused by elevated circulating thyroid hormones, most commonly due to Graves’ disease but also seen in thyroiditis or nodular disease. Differentiating the etiology is crucial because treatment strategies vary, yet in practice, clinical features may overlap, making diagnosis challenging. We describe two illustrative cases: a young woman with recurrent Graves’ disease presenting with palpitations, weight loss, and positive thyroid stimulating hormone receptor antibody, and a man with rapid weight loss but no typical symptoms or eye signs who was initially misdiagnosed and treated with antithyroid drugs, later confirmed as painless thyroiditis with spontaneous recovery. These cases underscore the importance of integrating clinical history, physical findings, thyroid function tests, autoantibody assays, ultrasonography, and thyroid scan in the diagnostic process, while emphasizing that short-term follow-up can be decisive in ambiguous cases. Indiscriminate use of antithyroid drugs should be avoided, as careful stepwise evaluation and observation are essential for accurate diagnosis and safe management of patients with thyrotoxicosis.