Endocrine Abstracts

54-year old woman with Graves’ disease was admitted to Endocrinology Department because of severe thyrotoxicosis and antithyroid drugs inolerance. The apathetic form of thyrotoxicosis was diagnosed; she lost 12 kg during 3 months and she had heavy muscle weakness. Previously she demonstrated allergic skin reactions (macular rushes) after both: Methimazole and Propylthiouracil. At admission her TSH was 0.001 mU/l, fT3 24 pg/ml, fT4 37 pmol/l. Lithium, propranolol and glucocorticoids were instituted but within few days she deteriorated and threatening thyroid storm was noted. She was given low doses of Methimazole, iopanoic acid, propranolol and glucocorticoids iv. Both clinical and biochemical performance improved during the next days but hepatitis probably due to Methimazole developed. Methimazole and iopanoic acid were stopped and after etablishing T24 RAIU 50%, 20 mCi 131-I was administered. Subsequently glucocorticoids, lithium and propranolol were continued. She became stable for several days and then deteriorated again. Her fT3 and fT4 were 9,4 pg/ml and 44 pmol/l respectively. She was transferred to Surgical Department and successful bilateral subtotal thyroidectomy was performed. Three days after surgery her fT3 and fT4 were within normal range. Substitution with L-thyroxine was started on the third week and no relapse of thyrotoxicosis has occured so far.

Conclusion: Thyroidectomy should be concidered as a method of treatment for severe life threatening cases of thyrotoxicosis.