Endocrine Abstracts

An eighty four year old lady was admitted to medical ward with an acute on chronic confusion. She was diagnosed to have thyrotoxicosis 5 weeks prior to this [TSH less than 0.02 (ref range 0.35 -5.00 miu per litre) & fT4 of 41.7 (ref range 11.0 - 23.0 pmol per litre)] and was treated by her general practitioner with carbimazole 30 mg daily. Despite this her thyroid function did not improve. The dose of carbimazole was further increased to 60mg daily with minimal response. There were no clinical signs and symptoms of thyroiditis such as goitre, neck pain etc and there was no history of exposure to drugs like amiodarone or other iodine containing substances, lithium, alpha interferon or interleukin-2. In addition, her antibodies (peroxidase and TSH receptor) were also negative. Further investigations were not performed due to her frail condition and she was treated with prednisolone 40mg daily. This controlled her thyroid function (TSH less than 0.02 & fT4 of 21.5) and improved her confusion. Carbimzole was stopped and prednisolone was gradually tapered and stopped with which she continues to remain euthyroid. Her clinical picture was similar to type II amiodarone induced thyrotoxicosis without exposure to amiodarone. We have not come across any such case reported in literature. We believe that refractory thyrotoxicosis should have a trial of steroid as our case illustrates.