Intractable pruritus as the presenting complaint in a patient with Graves disease

A 44-year-3old woman was referred for persistent pruritus unrelieved by antihistamines. Additionally, she noted heat intolerance, increased perspiration, tiredness, hyperdefecation, and weight loss for 8 months. Physical examination showed enlargement of the right thyroid lobe, hyperreflexia, and skin excoriations. She did not have exophthalmos, lidlag, or tremor. Laboratory studies showed normal blood count, liver and renal function. She was diagnosed with hyperthyroidism (thyroid-stimulating hormone <0.01 mIU/ mL, total T4: 20.9 μg/dL, T3: 410 ng/dL, I 123 sodium iodide uptake was 61% at 5 hours and 75%, at 24 hours) (see Fig. 1) and received 8.5 mCi of I 131. She had resolution of pruritus within 3 weeks after treatment. Pruritus can be the initial symptom of hyperthyroidism and disappears after successful treatment. Hyperthyroidism should be included in the differential diagnosis of chronic recalcitrant pruritus.