Comprehensive management of refractory Graves ‘disease with multiple radioiodine ablations: A case report

Graves' Disease (GD) is a prominent autoimmune thyroid disorder predominantly characterized by the overproduction of thyroid hormones, known as hyperthyroidism, triggered by autoantibodies that target the thyroidal TSH receptor, leading to increased synthesis and secretion of thyroid hormones. The management of Graves’ disease presents a notable challenge, primarily due to the contentious nature of selecting an appropriate primary therapy. The UK National Institute for Health and Care Excellence (NICE) has shifted its guidelines to recommend radioiodine as the first-line treatment in the UK, citing its cost-effectiveness and efficacy relative to thioamides. This case report presents the management of Graves’ disease with radioiodine ablation. The case illustration was a 52-year-old female patient who presented primarily with palpitations. The patient had been diagnosed with Graves’ disease and had undergone three radioiodine ablations on July 11, 2022, July 12, 2023, and November 7, 2023, each using a 10 mCi dose of NaI-131. The result shows that multiple radioiodine ablations illustrate the necessity of a tailored approach in achieving effective disease control. The progressive reduction in thyroid gland activity through repeated radioiodine treatments leads to stable hypothyroidism managed with levothyroxine. This case demonstrates that radioiodine therapy remains a pivotal option for patients with severe or resistant Graves' disease, emphasizing the need for continuous monitoring and adjustment of treatment strategies to optimize patient outcomes and improve quality of life.