KMID : 1011720160090020190
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International Journal of Thyroidology 2016 Volume.9 No. 2 p.190 ~ p.194
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A Case of Methimazole-Resistant Severe Graves¡¯ Disease: Dramatic Response to Cholestyramine
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Chae Seung-Byung
Kim Eun-Sook Lee Yun-Im Min Bo-Ram
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Abstract
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A 22-year-old woman with severe Graves¡¯ disease was referred from a local clinic because of her refractory hyperthyroidism. She presented with exophthalmos, diffuse goiter, and tachycardia. She was treated with a maximal dose of methimazole and a beta-blocker for 2 months. However, her thyroid function test (TFT) did not improve. TFT showed a free T4 level of 74.7 ng/dL and a thyroid stimulating hormone (TSH) level of 0.007 ¥ìIU/mL. She was then administered cholestyramine (4 g thrice daily), hydrocortisone (300 mg/day) and methimazole (100 mg/day) which prepared the patient for surgery by reducing the free T4 level (4.7 ng/dL). The patient underwent a total thyroidectomy without experiencing thyrotoxic crisis. This case describes the use of cholestyramine for the first time in Korea in treating Graves¡¯ disease and provides limited evidence that cholestyramine can be an effective option.
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KEYWORD
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Cholestyramine, Graves¡¯ disease, Thyrotoxicosis, Methimazole
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