Renzu Mahvish, Mehta Vidhi, Qazi Adam, Satei Alexander M, Taha Wael
Internal Medicine, Trinity Health Oakland, Pontiac, USA.
Internal Medicine, Trinity Health Mid-Atlantic, Darby, USA.
Cureus. 2024 Apr 25;16(4):e58980. doi: 10.7759/cureus.58980. eCollection 2024 Apr.
Thyrotoxicosis, also known as hyperthyroidism, is a condition characterized by the excessive production of thyroid hormones by the thyroid gland. Besides Graves' disease, other common causes of thyrotoxicosis include toxic multinodular goiter, toxic adenoma, and subacute thyroiditis. The treatment of thyrotoxicosis depends on the underlying cause and may include medications (e.g., antithyroid drugs, beta-blockers), radioactive iodine therapy, or surgical removal of the thyroid gland (thyroidectomy). In this report, we present two instances of thyrotoxicosis where conventional high doses of antithyroid treatment failed to control the condition effectively. This failure prompted the exploration of alternative therapeutic interventions. These cases highlight the intricacies involved in managing thyrotoxic crises that do not respond to methimazole (MMI), emphasizing the necessity for innovative approaches such as plasmapheresis and thyroidectomy. Understanding such scenarios is vital for enhancing the care provided to patients encountering resistance to standard treatments. The distinct clinical pathways and treatment strategies adopted in these cases offer valuable insights into this disease management, particularly concerning resistance to MMI.
甲状腺毒症，也称为甲状腺功能亢进，是一种以甲状腺过度产生甲状腺激素为特征的病症。除了格雷夫斯病外，甲状腺毒症的其他常见病因包括毒性多结节性甲状腺肿、毒性腺瘤和亚急性甲状腺炎。甲状腺毒症的治疗取决于潜在病因，可能包括药物治疗（如抗甲状腺药物、β受体阻滞剂）、放射性碘治疗或手术切除甲状腺（甲状腺切除术）。在本报告中，我们呈现了两例甲状腺毒症病例，其中常规高剂量抗甲状腺治疗未能有效控制病情。这种失败促使人们探索替代治疗干预措施。这些病例突出了在管理对甲巯咪唑（MMI）无反应的甲状腺毒症危象时所涉及的复杂性，强调了诸如血浆置换和甲状腺切除术等创新方法的必要性。了解此类情况对于提高对抵抗标准治疗的患者的护理至关重要。这些病例中采用的独特临床途径和治疗策略为这种疾病的管理提供了宝贵的见解，特别是关于对MMI的抵抗。
