A Case of Methimazole-Resistant Severe Graves' Disease: Dramatic Response to Cholestyramine

Chae, Seung Byung; Kim, Eun Sook; Lee, Yun Im; Min, Bo Ram

doi:10.11106/ijt.2016.9.2.190

Cited by 7 publications

(9 citation statements)

References 12 publications

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“…Cholestyramine was first used to treat Graves’ disease in 2016 in Korea [ 18 ]. The patient in that study was a 22-year-old female with severe refractory Graves’ disease who was initially managed with a maximal dose of methimazole and propranolol, with no improvement.…”

Section: Discussionmentioning

confidence: 99%

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Use of Adjunctive Therapy to Achieve Preoperative Euthyroidism in Graves’ Disease: A Case Report

et al. 2020

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Section: Discussionmentioning

confidence: 99%

“…The next day cholestyramine was added, which resulted in a rapid decline of FT4. Ten days after admission, the patient underwent total thyroidectomy [ 18 ]. Several cases of refractory Graves’ disease were reported in the literature between 2008 to 2018.…”

Section: Discussionmentioning

confidence: 99%

Use of Adjunctive Therapy to Achieve Preoperative Euthyroidism in Graves’ Disease: A Case Report

et al. 2020

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“…Therefore, ATDs are the first choice of treatment in Graves' disease [1] [3]. However, exceptional cases of resistance to ATDs have been described during the management of Graves' disease and are mainly resistant to methimazole [4] [5] [6].…”

Section: Commentsmentioning

confidence: 99%

“…Other alternatives have been proposed in such cases, such as cholestyramine and plasma exchange for the rapid development of euthyroidism before surgery [6] [12] [13]. Furthermore, a herbal decoction of Anemarrhena Bounge is potentially effective in patients with resistance to ATDs and is a therapeutic avenue warranting future exploration [5].…”

Section: Commentsmentioning

confidence: 99%

“…These molecules have been shown to be effective in restoring euthyroidism [3]. However, exceptional cases of resistance to ATS have been described during the management of Graves' disease [4] [5] [6]. Such cases are characterized by the persistence of thyrotoxicosis and hyperthyroidism in patients on an optimal dose of ATDs for at least 6 months with good patient compliance and at least one substitution of the ATD type.…”

Section: Introductionmentioning

confidence: 99%

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Resistance to Anti-Thyroid Drugs in Graves’ Disease: Clinical-Biological Characteristics and Alternative Therapy in Tropical Area

Diack¹,

Ndiaye²,

Sène³

et al. 2020

OJEMD

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Background: Resistance to anti-thyroid drugs (ATDs) is a rare entity recently described. We report two African observations in the treatment of Graves' disease. Case 1: A 19-year-old Senegalese woman presented on admission with thyrotoxicosis syndrome associated with diffuse goitre and Grave's orbitopathy. TSH levels were low (0.005 mIU/ml; N = 0.27-4.20) and fT4 elevated (60 pmol/L; N = 12-22]. Combination therapy with propranolol (40 mg/day) and carbimazole (starting dose of 45 mg/day and increased to 60 mg/day) was initiated. In view of the persistence of symptoms despite good therapeutic compliance, carbimazole was replaced by methimazole with an initial starting dose of 40 mg/day, followed by 60 mg/day. Despite the change in therapy, clinical symptoms of thyrotoxicosis persisted, and fT4 levels remained elevated. The patient was diagnosed with resistance to ATDs in Graves' disease. Total thyroidectomy following 10 days of preoperative preparation with 1% Lugol's solution was performed successfully. Case 2: A 22-year-old woman was referred for continued management of Graves' disease with elevated thyroid-stimulating hormone receptor antibody (TRAb) levels (34 UI/mL; N < 1.75). Treatment included propranolol (80 mg/day) and carbimazole at an unusual dose of 80 mg/day. Combined therapy was clinically and biologically ineffective, with an fT4 level of 100 pmol/L [N: 12-22]. Upon admission, methimazole (40 mg/day) followed by propylthiouracil (800 mg/day) replaced carbimazole. Despite good patient compliance, the patient's symptoms remained unaltered and fT4 levels elevated. A total robot thyroidectomy using the right axillary approach was performed successfully after 10 days of preoperative preparation, including prednisone (40 mg/day

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A methimazole resistant patient with Graves’ disease (GD): A case report of mid-term management with herbal decoctions mainly composed of Anemarrhena Bunge

Kim

2018

Complementary Therapies in Medicine

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A Case of Methimazole-Resistant Severe Graves' Disease: Dramatic Response to Cholestyramine

Cited by 7 publications

References 12 publications

Use of Adjunctive Therapy to Achieve Preoperative Euthyroidism in Graves’ Disease: A Case Report

Use of Adjunctive Therapy to Achieve Preoperative Euthyroidism in Graves’ Disease: A Case Report

Resistance to Anti-Thyroid Drugs in Graves’ Disease: Clinical-Biological Characteristics and Alternative Therapy in Tropical Area

A methimazole resistant patient with Graves’ disease (GD): A case report of mid-term management with herbal decoctions mainly composed of Anemarrhena Bunge

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