Endocrine Abstracts

Introduction: Graves’ disease (GD) is the most common cause of primary hyperthyroidism. The standard approach to managing GD involves the use of antithyroid drugs (ATD), radioactive iodine (RAI), and surgery. Additional supportive treatments include beta-blockers (Bb), corticosteroids (CTC), Lugol’s solution. In exceptional cases, some patients may exhibit resistance to these conventional methods, necessitating additional forms of management. We report a case of Graves’ Disease where ATD, Lugol’s solution and RAI failed to produce the expected response.

Case presentation: A 38 years old female, with personal history of gestational diabetes and familial autoimmunity field, referred with symptoms of clinical and biochemical thyrotoxicosis, which were not improving on Carbimazole 80 mg daily and propranolol 1 mg daily, despite of good compliance for 10 months. TRAb was strongly positive confirming diagnosis of Graves’ Disease. There was no evidence of malabsorption and a negative serology for Coeliac disease. She was then given methylprednisolone with Lugol’s Iodine for 13 days to make her euthyroid before thyroidectomy. However, she remained symptomatic with no improvement in her thyroid functions’ tests. Two doses of RAI were then administered 6 months apart. Unfortunately, she did not achieve remission after the 2nd RAI therapy, neither ATD dose reduction.

Conclusion: This case underscores the various management options available for patients with resistant GD. In challenging cases, radioactive iodine and surgery emerge as definitive modes of treatment, with steroids and/or Lugol’s solution playing a crucial role in preparing patients for those definitive interventions. The presented case involves a rare scenario where GD exhibited resistance to high-dose of ATD, Lugol’s solution and RAI.