Endocrine Abstracts

Introduction: Graves’ disease is the most common cause of hyperthyroidism. There are three main therapeutic weapons: synthetic antithyroid drugs, surgery and radioactive iodine. The latter represents an effective treatment without noticeable side effects. We report a case of Graves’ disease refractory to iratherapy.

Observation: This is a 38-year-old patient, with no notable history, who consulted for Graves’ disease diagnosed with clinical signs of thyrotoxicosis and a biological profile of primary hyperthyroidism (TSH = 0.00 mUi/ml; T3 = 4.23 pg/ml; T4 = 22.13 pg/ml) with positive TRAKs. The morphological assessment objectified a goiter hyper fixing to the thyroid scintigraphy. Iodine-131 treatment is given at an initial dose of 25 mci. The course is marked by a persistence of a suppressed TSH (0.05 mIU/ml) after 6 months leading to the administration of an additional dose of 25 mci. Laboratory evaluation after 6 months objected to hyperthyroidism with TSH low at 0.08 mIU/ml. The patient received an additional 25 mci dose with the onset of hypothyroidism for which the patient was put on hormone replacement therapy with LT4 with good clinical and biological progress.

Discussion and conclusion: Graves’ disease is a frequent endocrinopathy with potentially serious complications which can sometimes pose a difficulty in choosing a treatment. Iodine-131 iratherapy is a low-cost, simple treatment that is currently considered the treatment of choice for Graves’ disease. However, the course can sometimes be marred by an absence of response to the radioactive treatment requiring a repeat of the doses in order to obtain a clinical and biological resolution as is the case for our patient.