Graves’ disease is the most common cause of autoimmune hyperthyroidism and is typically managed with antithyroid medications, radioactive iodine, or surgery. However, a subset of patients develops persistent thyrotoxicosis or severe complications requiring definitive treatment. We report the case of a 23-year-old woman with Graves’ disease and type 1 diabetes mellitus who presented with persistent thyrotoxicosis despite prolonged treatment with methimazole and beta-blockers, with a prior history of diabetic ketoacidosis complicated by thyroid storm. Physical examination revealed a diffuse grade III goiter with clinical features of hyperthyroidism, while laboratory tests showed suppressed thyroid-stimulating hormone and markedly elevated free thyroid hormone levels. Imaging demonstrated diffuse thyroid enlargement with increased vascularity and mild tracheal compression. Following multidisciplinary evaluation, the patient underwent total thyroidectomy with an uneventful postoperative course, and histopathology confirmed diffuse hyperplastic goiter with chronic thyroiditis. This case highlights total thyroidectomy as a safe and effective definitive treatment for refractory thyrotoxicosis, and suggests that early surgical intervention may prevent life-threatening complications, such as thyroid storm, particularly in patients with complex metabolic comorbidities.
Moreno et al. (Wed,) studied this question.
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