Clinical Case Database / Category: Patient Management

Hyperthyroidism: failure of medical treatment

Publication details

Mr Daniel L J Morris, Mr Ahmed M El-Sharkawy, Dr David M Green, Dr Naresh Nandwani, Mr Krishna Lingam
Foundation Years Journal, volume 8, issue 5, p.38 (123Doc Education, London, May 2014)


A 42 year old male presented with weight loss, fine resting tremor, proximal muscle weakness, abdominal pain and vomiting. He was found to have primary hyperthyroidism and primary hypercalcaemia. Treatment with carbimazole, propylthiouracil, Lugol’s iodine and prednisolone were unsuccessful in achieving euthyroidism. Thionamide treatment precipitated deranged liver function tests. The patient refused radioiodine ablation and underwent a successful total thyroidectomy whilst hyperthyroid. This case highlights the challenge posed by failure of medical treatment in hyperthyroidism, as further management options require patient euthyroidism. We demonstrate that a total thyroidectomy can be performed in a hyperthyroid patient if necessary.

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Mr Daniel L J Morris

Nottingham City Hospital
Hucknall Road
Nottingham, NG5 1PB

Mr Ahmed M El-Sharkawy

Queens Medical Centre
Derby Road
Nottingham, NG7 2UH

Dr David M Green

Royal Derby Hospital
Uttoxeter Road
Derby, DE22 3NE

Dr Naresh Nandwani

Royal Derby Hospital
Uttoxeter Road
Derby, DE22 3NE

Mr Krishna Lingam

Royal Derby Hospital
Uttoxeter Road
Derby, DE22 3NE


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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