A Pruritic Predicament: An Unusual Presentation of Graves' Disease Complicated by Pregnancy

Pruritus is a known but uncommon symptom of hyperthyroidism that can be misinterpreted or overlooked in a patient presentation. This is a case report of a 40-year-old female who presents with a 3-month history of severe, worsening pruritus. Further history demonstrated potential signs of hyperthyroidism, and laboratory values demonstrated low TSH levels, high T4 levels, and positive TSH receptor antibodies. A thyroid scan was performed, and increased uptake confirmed the diagnosis of Graves' disease in this patient. After discovering that the patient was pregnant, treatment with propylthiouracil was begun for the first 12 weeks of her pregnancy, with a switch to methimazole after the first 12 weeks. Graves' disease must be considered in the differential diagnosis of generalized pruritus, with thorough history and analysis of symptoms essential to determine if underlying hyperthyroidism may be present.