%0 Journal Article %T Resistance to Anti-Thyroid Drugs in Graves¡¯ Disease: Clinical-Biological Characteristics and Alternative Therapy in Tropical Area %A Ngon¨¦ Diaba Diack %A Nafy Ndiaye %A Mbaye Sene %A Mamadou Ba %A Ndeye Fatou Thiam %A Khadidja Samb %A Pape Momar Guisse %A Sokhna Awa Balla Sall %A Aida Diop Diene %A Marylin Zohoun %A Yakham Mohamed Leye %A Abdoulaye Leye %J Open Journal of Endocrine and Metabolic Diseases %P 147-153 %@ 2165-7432 %D 2020 %I Scientific Research Publishing %R 10.4236/ojemd.2020.1011014 %X
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) combined with 1% Lugol¡¯s solution. Conclusion: Resistance to ATDs complicates the management of Graves¡¯ disease. Total thyroidectomy following preoperative preparation with Lugol¡¯s solution and/or corticosteroids was shown to be successful.
%K Resistance %K Antithyroid Drugs %K Graves¡¯ Disease %K Lugol¡¯s Solution %K Africa %K Senegal %U http://www.scirp.org/journal/PaperInformation.aspx?PaperID=104618