A rare case of Graves? disease during regular hemodialysis

Abstract

We report a case of Graves' disease in a patient on regular hemodialysis. The patient also suffered from Wolff-Parkinson-White (WPW) syndrome and paroxysmal atrial fibrillation, which may both have been manifestations of the Graves' disease because of the increased oxygen demand. To our knowledge, this is the first case to illustrate the usefulness of the antithyroid agent propylthiouracil for Graves' disease complicated by endstage renal disease (ESRD) and WPW syndrome.

Masked hyperthyroidism in a haemodialysis patient successfully treated by potassium iodide

“…Methimazole (Mercazole Ò ) or propylthiouracil (Thiuragyl Ò ) was administered for the treatment of hyperthyroidism, but both the drugs were withdrawn because of skin eruptions (this patient). She was successfully treated with 50 mg KI ( Table 2) [1][2][3][4][5][10][11][12][13][14].…”

Masked hyperthyroidism in a haemodialysis patient successfully treated by potassium iodide

“…Methimazole (Mercazole ® ) or propylthiouracil (Thiuragyl ® ) was administered for the treatment of hyperthyroidism, but both the drugs were withdrawn because of skin eruptions (this patient). She was successfully treated with 50 mg KI ( Table 2 ) [ 1 – 5 , 10 – 14 ].…”

Characteristics of Graves’ Disease in Haemodialysis Patients

“…Although, the abnormal thyroid hormone production and metabolism are relatively common [9], hyperthyroidism is a very unusual condition in patients undergoing regular haemodialysis. Its incidence is 1.14%, similar to the incidence in healthy individuals [2].…”

“…Cardiac manifestions reported are Wolff-Parkinson-White syndrome, paroxysatrial fibrillation [9] and angina pectoris, which may both have been manifestations of Graves' disease due to the increased oxygen demands [14].…”

“…Treatment of Graves' disease is efficient and resolves cardiac symptoms of the disease [9,14]. Treatment of Graves' disease in these patients is initially antithyroid agent propylthiouracil [9,15] and then iodine-131 therapy [15,37]. The risk of the antithyroid agent propylthiouracil treatment is neutropenia.…”