The weight-reducing herbal medicines “Dream Shape” and “Ever Youth” became available in Japan in 2000. Herein, we describe 12 patients who developed thyrotoxicosis after taking them. The thyroid hormone content of 1 capsule or tablet of herbal medicine, measured following Pronase digestion and ethanol extraction, was approximately 1 μg of triiodothyronine and 3 to 4 μg of thyroxine. Two of us took 10 capsules or tablets of Dream Shape or Ever Youth, and changes in thyroid hormone levels were observed during the first 24 hours. Serum free triiodothyronine levels began to rise 2 hours after ingestion and reached peak levels at 4 to 8 hours; changes in free thyroxine and thyrotropin levels were small during the first 24 hours. Similar herbal medicines may have been distributed to other countries via the Internet. Resultant factitious thyrotoxicosis can create diagnostic and therapeutic confusion, particularly in patients with thyroid disease.
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Changes in thyroid function levels after oral ingestion of 10 capsules or tablets of Ever Youth (A) or Dream Shape (B). Free T4 indicates free thyroxine levels in nanograms per deciliter (normal range, 0.7-1.6 ng/dL); free T3, free triiodothyronine levels in picograms per deciliter (normal range, 170-370 pg/dL). Thyrotropin levels are given in milli-international units per liter (normal range, 0.3-5.0 mIU/L). To convert free T4 levels to picomoles per liter, multiply by 12.87; to convert free T3 levels to picomoles per liter, multiply by 0.0154.
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