A 22-year-old female is admitted with a history of loss
of weight, diarrhoea and secondary amenorrhoea. Her mother is known to have
hypothyroidism and is on thyroxin. On examination she is thin, there are no
thyroid eye signs, her palms are warm and sweaty, there is a fine tremor of
her hands and she has a resting tachycardia. Her thyroid gland is not
palpable; there is no tenderness over her thyroid. Pembertonís sign cannot
be elicited. There is evidence of proximal myopathy. Chest x-ray is
unremarkable. Investigations show raised levels of T4 and T3
and TSH levels are undetectable.
In this patient which of the following features favours
the diagnosis of thyrotoxicosis factitia?
No thyroid acropachy
No thyroid tissue palpable