Refractory Thyrotoxicosis: Report of Two Cases and Literature Review

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.