Study on Resistant Hyperthyroidism, Responses Dramatically to Adjunctive Oral Cholestyramine

Abstract

A few patients with hyperthyroidism are resistant to the conventional antithyroid medications. In several trials, cholestyramine has been used to sequester thyroid hormones in the intestine and when added as an adjuvant treatment to the conventional antithyroid drugs, leading to a more rapid decline in thyroid hormone levels. The objective of this study is to present a case of resistant graves’ disease that respond well to the adjunctive oral cholestyramine and to discusses the safety and efficacy of this adjunctive medication.

Here we report a 27-year-old female patient with Graves’ disease who complained of thyrotoxicosis symptoms for 18 months that not responded even to a high dose of a combination therapy of Neomercazol, Propranolol and Prednisolone. On presentation, her T4 was 19.3 (4.9 – 11.0 \(\mu\)g/mL). We administer an oral cholestyramine (5g twice daily) as adjunctive therapy. After 1 week, the patient shows dramatic response, her T4 level became 10.6 (4.9 – 11.0 \(\mu\)g/mL). Total thyroidectomy has been done after another one week of same treatment combination. The postoperative course was passed smoothly without complications.