Endocrine Abstracts

Background: Autoimmune thyroid conditions such as Hashimoto’s thyroiditis and Graves’ disease are more common in women than men. Both conditions are characterized by symptoms and signs on the opposite spectrum of the scale. Although cases of conversion from hyperthyroidism to hypothyroidism are often encountered in clinical practice, the exact incidence of this conversion is not known -it is possible that such conversion may be due to development of blocking and stimulating antibodies. Treatment is straightforward with anti-thyroid medications once the diagnosis is suspected and confirmed. It is important to get the correct diagnosis to be able to treat such patients appropriately

Case Presentation: A 57-year-old man was referred with complaining of feeling hot and sweaty with palpitation and found to be thyrotoxicosis. He was then treated for thyrotoxicosis with ATD but found to have positive antibodies so diagnosis of graves’ disease was made. He was then developed the symptoms of hypothyroidism while on the lowest maintenance dose of ATD. He was then found to be overt hypothyroidism which needs a period of replacement treatment. He then redeveloped the over active symptoms causing thyrotoxicosis pictures again. He completed the 18 months of ATD treatment with biochemical resolution of euthyroid status but then he developed severe thyroid eye disease. He eventually planned for total thyroidectomy for his Graves’ disease and ongoing ophthalmology input

Conclusions: Although Graves’ thyrotoxicosis is common thyroid manifestation in day-to-day thyroid clinic, it is important to be aware of the nature of TRABs can be switching from stimulating to blocking activities and it makes the case to be challenging to manage in order to avoid the over hyper or hypothyroidism.