Clinical presentation: A 39-year-old man was referred for evaluation of a suspected hyperthyroidism. The patient's symptoms (fatigue, sweating, sleep disturbance, occasional high heart rate) developed after severe family conflict. Three weeks before the present examination, the TSH was 0.08 mIU/L and the FT4 level was 28.1 pM/L.

Palpation: no abnormality.

Laboratory tests: TSH 0.32 mIU/L, FT4 11.9 pM/L, FT3 4.76 pM/L, aTPO 0.3 U/mL, TSAb 0.1 U/L (normal values below 1.5).

Ultrasound. Both lobes were echonormal and intact. The vascularity was average.

Diagnosis. A healthy thyroid with great probability.

Summary. Hormonal abnormalities are probably caused by increased stress. For safety reasons, the TSH should be checked after one year.