Endocrine Abstracts

Grave’s disease is one of the autoimmune diseases with autoantibodies stimulating the TSH receptors and causing thyroid hyperplasia and leading to hyperthyroidism. Hyperthyroidism can lead several complications that can be fatal like arrhythmias, heart failure and pulmonary hypertension. Grave’s disease can also be associated with orbitopathy. Management of Grave’s disease include medical treatment with antithyroid medications, radioactive iodine that can reduce the thyroid tissue or surgical resection. Antithyroid resistant Grave’s disease is a recognized condition that might need surgical approach with total thyroidectomy. There are few case reports about this condition. We, hereby, are reporting a case of carbimazole resistant Grave’s disease that required total thyroidectomy.

Case report: This 26 year old lady with background of Systemic Lupus Erythematosus, Rheumatoid arthritis, Asthma and Personality disorder was diagnosed with Grave’s disease in October 2020 after having symptoms of extreme tiredness, unintentional weight, heat intolerance and loose stools. Her TSH was 0.01 mU/L and FT4 was 50.7 pmol/l and FT3 was 21.60 pmol/l. Thyrotropin receptor antibody was 18.34 U/L and Thyroid peroxidase antibody was >600 IU/ml. She has family history of thyrotoxicosis. CT neck showed diffusely enlarged thyroid gland with no retro-sternal extension. She was started on Carbimazole which was up titrated to 40 mg twice daily and Propranolol MR 80 mg BD but with no effect clinically or biochemically. Propylthiouracil was tried but patient didn’t tolerate it. So, she was referred to ENT and underwent a total thyroidectomy in June 2023 and histology showed diffuse benign hyperplasia and was started on Levothyroxine 150 mg per day.

Conclusion: It can be challenging to recognize and treat carbimazole resistant Grave’s disease. Non compliance and malabsorption should be excluded. Once recognized, patient should be referred for definitive treatment to avoid life threatening complications.