A RESISTANT CASE OF THYROTOXICOSIS IN A PATIENT WITH GRAVES' DISEASE

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 449-497-Thyroid Neoplasia & Case Reports
Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-455
Harshani Chandrasekera*1, Emma Grennell1 and Anita Banerjee2
1South London Healthcare, London, United Kingdom, 2South London Healthcare Trust, Greater London, United Kingdom
A resistant case of thyrotoxicosis in a patient with Graves’ disease

Dr H M Chandrasekera, Dr E Grennell, Dr A Banerjee

Background: Thyrotoxicosis is commonly managed with anti-thyroid drugs, radioactive iodine and surgery. In some cases, patients may be resistant to these treatments and remain a challenge for long-term management.

Clinical Case: A 44-year old woman had a typical presentation, twenty years ago, of thyrotoxicosis secondary to Graves’ disease. Her asymmetrical thyroid eye disease required right upper lid tarsorrhaphy.  She remained symptomatic and required subtotal thyroidectomy five years after diagnosis. She opted for surgery over radioactive iodine to minimise the amount of time spent away from her children.   She relapsed nine years later and was commenced on low-dose carbimazole.  She then underwent a total thyroidectomy.  Post-operatively she received thyroid replacement therapy. She became pregnant and her thyroid function remained stable, but post-partum she developed frank thyrotoxicosis.  Bloods revealed a free T4 of 26.4pmol/L (9.4-22.7), free T3 of 8.0pmol/L (3.5-6.5) and TSH of <0.01mu/mL (0.35-5.50).  Ultrasound revealed three areas of overactive thyroid tissue, likely re-growth post-surgery.  She was commenced on a weaning dose of corticosteroids. She received a dose of 800MBq (maximal dose) of radioactive iodine  and was re-commenced on thyroxine.   After close monitoring of her thyroid function she has settled on a dose of 175mcg thyroxine weekdays and 200mcg at weekends.

Follow-up: She is now clinically and biochemically euthyroid and is due for follow-up in 3 months.

Conclusion: Surgery in conjunction with both radioactive iodine and tightly controlled medical therapy may be necessary in complex cases of resistant thyrotoxicosis.

Nothing to Disclose: HC, EG, AB

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm