# Rare Presentation of Thyrotoxicosis Defying Methimazole Treatment: A Case Series

## TL;DR

This case series describes two thyrotoxicosis patients who did not respond to methimazole, requiring alternative treatments like plasmapheresis and thyroidectomy.

## Contribution

The study highlights treatment resistance to methimazole and presents alternative interventions for refractory thyrotoxicosis cases.

## Key findings

- High-dose methimazole failed to control thyrotoxicosis in two patients.
- Alternative treatments like plasmapheresis and thyroidectomy were necessary for managing resistant cases.
- These cases emphasize the need for innovative approaches in thyrotoxicosis management.

## Abstract

Thyrotoxicosis, also known as hyperthyroidism, is a condition characterized by the excessive production of thyroid hormones by the thyroid gland. Besides Graves' disease, other common causes of thyrotoxicosis include toxic multinodular goiter, toxic adenoma, and subacute thyroiditis. The treatment of thyrotoxicosis depends on the underlying cause and may include medications (e.g., antithyroid drugs, beta-blockers), radioactive iodine therapy, or surgical removal of the thyroid gland (thyroidectomy). In this report, we present two instances of thyrotoxicosis where conventional high doses of antithyroid treatment failed to control the condition effectively. This failure prompted the exploration of alternative therapeutic interventions. These cases highlight the intricacies involved in managing thyrotoxic crises that do not respond to methimazole (MMI), emphasizing the necessity for innovative approaches such as plasmapheresis and thyroidectomy. Understanding such scenarios is vital for enhancing the care provided to patients encountering resistance to standard treatments. The distinct clinical pathways and treatment strategies adopted in these cases offer valuable insights into this disease management, particularly concerning resistance to MMI.