The three major forms of treatment for Graves thyrotoxicosis are antithyroid drugs, radioactive iodine therapy and thyroidectomy. Surgery is the definitive treatment for Graves thyrotoxicosis that is generally recommended when other treatments have failed or are contraindicated. Generally, thyrotoxic patients should be euthyroid before surgery to minimize potential complications which usually requires preoperative management with thionamides or inorganic iodine. But several cases of refractory Graves' disease have shown resistance to conventional treatment. Here we report a 40-year-old female patient with Graves' disease who complained of thyrotoxic symptoms for 7 months. Her thyroid function test and thyroid autoantibody profiles were consistent with Graves' disease. One kind of thionamides and β-blocker were started to control her disease. However, she was resistant to nearly all conventional medical therapies, including β-blockers, inorganic iodine, and two thionamides. She experienced hepatotoxicity from the thionamides. What was worse is her past history of serious allergic reaction to corticosteroids, which are often used to help control symptoms. A 2-week regimen of high-dose cholestyramine improved her uncontrolled thyrotoxicosis and subsequent thyroidectomy was successfully performed. In conclusion, cholestyramine could be administered as an effective and safe adjunctive agent for preoperative preparation in patients with severe hyperthyroid Graves's disease that is resistant to conventional therapies.

Citations

Citations to this article as recorded by  

• Enhanced predictive validity of integrative models for refractory hyperthyroidism considering baseline and early therapy characteristics: a prospective cohort study
  Xinpan Wang, Tiantian Li, Yue Li, Qiuyi Wang, Yun Cai, Zhixiao Wang, Yun Shi, Tao Yang, Xuqin Zheng
  Journal of Translational Medicine.2024;[Epub]     CrossRef
• Refractory Graves’ Disease in an Adolescent Successfully Treated With Cholestyramine and Subsequent Thyroidectomy
  Raghad Alsaidalani, Hesham Eltomy, Alaa B Aljuhani, Moutaz Osman
  Cureus.2024;[Epub]     CrossRef
• Non-thionamide antithyroid drug options in Graves’ hyperthyroidism
  Aliya Ruslan, Onyebuchi E Okosieme
  Expert Review of Endocrinology & Metabolism.2023; 18(1): 67.     CrossRef
• Gestione clinica dell’ipertiroidismo refrattario
  Daniela Gallo, Federica Martina Bianchi, Francesca Manzella La Barbera, Ilaria Clementi, Adriana Lai, Eliana Piantanida, Maria Laura Tanda
  L'Endocrinologo.2023; 24(2): 167.     CrossRef
• Carbimazole-Resistant Grave’s Thyrotoxicosis is a Diagnostic and Therapeutic Dilemma, Case Report with Literature Review
  Fateen Ata, Adeel Ahmad Khan, Shuja Tahir, Zaina Al Amer
  International Medical Case Reports Journal.2023; Volume 16: 783.     CrossRef
• Medical treatment of thyrotoxicosis
  Lorenzo SCAPPATICCIO, Giuseppe BELLASTELLA, Maria I. MAIORINO, Luca GIOVANELLA, Katherine ESPOSITO
  The Quarterly Journal of Nuclear Medicine and Molecular Imaging.2021;[Epub]     CrossRef
• THERAPEUTIC EFFECTS OF COMBINATION REGIMENS INCLUDING METHIMAZOLE ON GRAVES HYPERTHYROIDISM: A NETWORK META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
  Maorong Wang, Yerong Yu
  Endocrine Practice.2020; 26(6): 675.     CrossRef
• Cholestyramine alters bile acid amounts and the expression of cholesterol‐related genes in rabbit intestinal and hepatic tissues
  Dong Ni Qiu, Quan Shang, Da Yu Sun, Wei Qun Ding, Zhong Guang Luo, Jian Chen, Wei Ru Jiang, Jian Ping Huang, Xiao Yun Jiang
  Journal of Digestive Diseases.2017; 18(2): 107.     CrossRef
• ENDOCRINOLOGY IN PREGNANCY: Pregnancy and the incidence, diagnosing and therapy of Graves’ disease
  Peter Laurberg, Stine Linding Andersen
  European Journal of Endocrinology.2016; 175(5): R219.     CrossRef
• 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis
  Douglas S. Ross, Henry B. Burch, David S. Cooper, M. Carol Greenlee, Peter Laurberg, Ana Luiza Maia, Scott A. Rivkees, Mary Samuels, Julie Ann Sosa, Marius N. Stan, Martin A. Walter
  Thyroid.2016; 26(10): 1343.     CrossRef
• Cholestyramine Use for Rapid Reversion to Euthyroid States in Patients with Thyrotoxicosis
  Jeonghoon Ha, Kwanhoon Jo, Borami Kang, Min-Hee Kim, Dong-Jun Lim
  Endocrinology and Metabolism.2016; 31(3): 476.     CrossRef
• The role of bile acids in metabolic regulation
  Libor Vítek, Martin Haluzík
  Journal of Endocrinology.2016; 228(3): R85.     CrossRef
• Recent Advances in Autoimmune Thyroid Diseases
  Won Sang Yoo, Hyun Kyung Chung
  Endocrinology and Metabolism.2016; 31(3): 379.     CrossRef
• A Case of Methimazole-Resistant Severe Graves' Disease: Dramatic Response to Cholestyramine
  Seung Byung Chae, Eun Sook Kim, Yun Im Lee, Bo Ram Min
  International Journal of Thyroidology.2016; 9(2): 190.     CrossRef