TSHR and hyperthyroidism: The main risk factor of PTL is the presence of Hashimoto thyroiditis, and that explains the frequent association with hypothyroidism.8 Some cases of hyperthyroidism were also reported, mainly in patients with Graves disease or in anti-TSH receptor antibody (TSHrAb)-negative patients with no thyroid scintigraphy, making a final etiological diagnosis difficult.1,4