Asian Journal of Case Reports in Surgery

Refractory Thyrotoxicosis: Report of Two Cases and Literature Review

M. S. Baharudin *

Department of Surgery, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia and Department of Surgery, University Malaya Medical Centre, Malaysia.

M. S. Nurshahirah

Department of Surgery, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.

A. R. Syazwani

Department of Surgery, University Malaya Medical Centre, Malaysia.

W. Suriza War

Department of Surgery, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.

R. A. Raflis

Department of Surgery, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.

*Author to whom correspondence should be addressed.

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Abstract

Thyrotoxicosis occurs in approximately 2% of women and 0.2% of men (1) Patients with thyrotoxicosis usually present with heat intolerance, palpitations, anxiety, fatigue, weight loss, muscle weakness, diarrhea, and in women – irregular menses. Clinical findings may include tremor, tachycardia, lid lag, and goiter. Causes of thyrotoxicosis are Grave’s disease, toxic multinodular goiter, thyroiditis and exogenous ingestion of thyroid hormone. In overt thyrotoxicosis, the serum value of TSH is decreased and free thyroxine (T4) or free tri-iodothyronine (T3), or both, are raised. Conventional management of thyrotoxicosis includes antithyroid drugs. (2) Very rarely, patients may be resistant to these modalities and require additional management. Refractory thyrotoxicosis is when patients do not respond to conventional treatments.

Keywords: Thyrotoxicosis, refractory thyrotoxicosis, thyroidectomy

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