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Challenges in the Diagnosis and Management of Graves' Disease in an Elderly Female With Antithyroid Drug Intolerance

Year: 2025

Type: article

Abstract: Graves' Disease (GD) is uncommon in the elderly. This report explores the case of an 87-year-old female diagnosed with Graves' Disease following a non-specific decline and new-onset atrial fibrillation (AF). Incidental blood tests on admission revealed severe thyrotoxicosis with a thyroid-stimulating hormone (TSH) level of <0.0005mu/L and free thyroxine (fT4) level of 72 pmol/L, with positive TSH-receptor antibodies confirming Graves' Disease. Initial management with carbimazole achieved some biochemical control but led to hepatotoxicity. Reduced dosing caused similar hepatic derangement. Propylthiouracil also did not adequately control thyroid function and caused mild liver function derangement. The patient re-presented with decompensated thyrotoxicosis, including hypotension, fast AF, and confusion. The endocrinology multidisciplinary team (MDT) decided the patient was unsuitable for definitive treatments; hence, Lugol's iodine was commenced. Thyroid function gradually stabilised on a combination of Lugol's iodine, propranolol, steroid and low-dose propylthiouracil. This case was challenging due to anti-thyroid drug intolerance in conjunction with limited definitive management options, with our endocrinology team resorting to non-standard therapies to stabilise the patient. This case ultimately demonstrates the diagnostic and therapeutic challenges of managing Graves' hyperthyroidism in the elderly. .

Source: Cureus

DOI: 10.7759/cureus.94221

Authors: Charlotte Soan, Charlotte Fernando, Kimberley Lambert, Meenakshi Parsad

Institutions: Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust

Language: English

Topic: Thyroid Disorders and Treatments

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4415010640