Secondary hypothyroidism following the Resolution of Graves’ Disease: A Case Report

Abstract

This is the case report of a 39-year-old lady who presented with clinical and laboratory features of secondary hypothyroidism two years after achieving clinical and biochemical resolution of Graves' disease and cessation of anti-thyroid medications. The thyroid function tests at presentation revealed: Serum T₃ 1.33ng/ml (normal range 0.8-1.7ng/ml), Serum T₄ 2.92 (normal range 4.5-12.0µg/dl), and TSH 0.2mIU/l (normal range 0.5-5.0mIU/l). Thyroid-related autoantibodies could not be assayed in the patient due to financial constraints. However, pointers to the possible autoimmune nature of secondary hypothyroidism include the recurrence of exophthalmos, dating of symptoms back to puerperium, relative lymphocytosis, and moderately elevated erythrocyte sedimentation rate (ESR). The patient was subsequently placed on levothyroxine and low-dose steroids, and the patient achieved clinical and biochemical euthyroidism in the sixth, ninth, and twelfth months of follow-up. This report is to demonstrate the development of secondary hypothyroidism following Graves' disease, and it also serves to highlight the judicious use of clinical acumen in the face of limited laboratory support to diagnose and treat endocrine disorders in resource-poor settings.