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Case Reports
. 2020 Aug 6:21:e923342.
doi: 10.12659/AJCR.923342.

Use of Adjunctive Therapy to Achieve Preoperative Euthyroidism in Graves' Disease: A Case Report

Noor Abdulghani Alghanim  1 , Shymaa M Alkahtani  1 , Fatimah S Assari  1 , Sarah W Alnosaier  1 , Reham M Bader  1 , Isra E Elmahi  1 , Mariam M Hendaz  1 , Amal Alhefdhi  2
Affiliations
Case Reports

Use of Adjunctive Therapy to Achieve Preoperative Euthyroidism in Graves' Disease: A Case Report

Noor Abdulghani Alghanim et al. Am J Case Rep. .

Abstract

BACKGROUND Graves' disease is an autoimmune disease of the thyroid gland and it is considered the most common cause of hyperthyroidism. It is characterized by particular eye manifestations, skin changes, and pretibial myxedema in addition to the signs and symptoms of hyperthyroidism. Graves' disease can be diagnosed based on clinical presentation and low thyroid stimulating hormone (TSH) and elevated free T4 (FT4) levels. Presence of TSH receptor antibody (TRAb) in the serum confirms the diagnosis of Graves' disease. Imaging studies like radioactive iodine scan will show a high and diffuse uptake. Graves' disease can be managed with three different treatment modalities: antithyroid medications, radioactive iodine, or surgical removal of the thyroid gland. Whenever surgery is indicated, careful preoperative management to achieve euthyroidism is needed to optimize the surgical outcome. CASE REPORT This is a case of a 37-year-old Saudi male known to have Graves' disease for 2 years who presented to the endocrine surgery clinic with neck swelling, difficulty breathing, and change in voice. After multiple attempts to control his fluctuating thyroid levels, the team eventually managed to achieve a euthyroid state in the patient with the addition of saturated solution of potassium iodide (SSKI), and thus rendering him eligible for urgent surgery. CONCLUSIONS We report this case to show that SSKI can be used as adjunctive therapy to achieve a preoperative euthyroid state in refractory Graves' disease.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1.
Figure 1.
Typical eye manifestations of Graves’ disease; proptosis and periorbital edema.
Figure 2.
Figure 2.
Ultrasound showing an enlarged and hypervascular left thyroid lobe with no suspicious nodules.
Figure 3.
Figure 3.
CT scan showing diffuse enlargement of the thyroid with no retrosternal extension or invasion of surrounding structures.
Figure 4.
Figure 4.
CT scan demonstrating that the distance from the anterior margin of the globe to the interzygomatic line exceeds 21 mm, indicating significant bilateral proptosis.
See this image and copyright information in PMC

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