Endocrine Abstracts

Introduction: Graves’ disease is the commonest cause of thyrotoxicosis; and is usually responsive to radio-iodine therapy. In Nigeria, radio-iodine therapy is becoming a common and cost effective option for treatment of thyrotoxicosis; with the less likelihood of most of the complications associated with thyroidectomy.

Case presentation: A 49-year-old Nigerian lady, presented to the endocrinology clinic, at LAUTECH Teaching Hospital, Ogbomoso, 8 years ago with a 10 year history of an anterior neck swelling, which only increased in size during pregnancies. She noticed hand tremors and palpitations. Physical examination, revealed tachycardia, mild hypertension and a WHO grade 1 goitre. There were no features suggestive of an accompanying thyroid eye disease. Past medical history was significant for hypertension and was on antihypertensives, on and off. A thyroid function tests ordered showed a fully suppressed TSH- 0.02 mUI/l (reference limits, 0.37-3.5 mIU/l) and a raised free T4- 20.4 pmo/l (reference limits, 7.2-16.4 pmo/l). An ECG revealed a sinus tachycardia. Her features were suggestive of thyrotoxicosis secondary to Graves’ disease. She was commenced on tablets carbimazole 30 mg daily and propanolol 40 mg twice daily. Carbimazole, was continued at a reduced dose of 5 mg daily, after she achieved resolution of symptoms and biochemical euthyroidism. Definitive treatment options including: radio-iodine therapy and thyroidectomy, were discussed with the patient. She opted for radio-iodine therapy and she was referred to the nuclear medicine department, University College Hospital, Ibadan, Nigeria, 2 years, after the initial diagnosis. She was treated with a single dose, 30 mCi of Iodine 131. She developed transient hypothyroidism and was treated with 25 mg daily of levothyroxine; which was discontinued after few months.

Conclusions: Our patient did not need to recommence levothyroxine; and the thyroid function tests have remained within reference limits in last 6 years.